Physiology 1.4 Flashcards
whats typical for inflammation phase? what forms?
hematoma
symptoms of inflammation during tendon healing
pain in/around the tendon
what forms during proliferation pahse
collagen type 3, new blood vessels, granulation tissue (new capillaries growing)
whats typical to proliferation phase regarding leg circumference/muscle belly
decrease in muscle size
most important signs of proliferation phase?
decreased ROM; Changed inter-intramuscular coordination-> leads to preventative stiffness around joints ; Stiff joints (prevention strategy of the body)
most important symptoms of proliferation phase?
decreased motor control; changed inter-intramuscular coordination
most important sign of remodeling phase?
decrease in joint mobility/stiffness
most important symptoms of remodelling phase
fatigue in gastrocnemius; muscle atrophy; decrease in motor control
exercise: band on sole, press foot into plantarflexion. which menchanisms is this training
contraction of gastroc (stimulates protein synthesis of actin-myosin); resistance of tendino-myogenic and bone-tenodn junctions (stimulate fibroblast activity (collagen formation)
what should treatment of meniscal tear focus on
strength, mobility
how do you objectify exertion?
borg scale 6-20
whats the Karvonen equation (%of HRR)
Hfmax - Hfrest
whats overload?
gradually increase intensity/weight/frequency/nr of reps
explain pros of supercompensation
allows athlete with the right training load with proper recovery to develop capacity for even better level of performance
whats reversibility
the loss of training adaptations as a result of stopping to training (u lose it if you don’t use it)
explain specificity in training
adaptations to training are specific to training (eg if youre training endurance, that’s whats gonna improve)
how long is recovery after endurance capacity traiining
24hrs
where is glucose stored and as what?
glycogen in liver and skeletal muscle
name micronutrients
vitamins and minerals
which of macronutrients is essential as a vitamin carrier?
lipids/fats
which macronutrient protects vital organs?
lipids/fats
what are the amino acids called that our body cannot create itself so they must be consumed?
essential acids (eg isoleucine, leucine, valine)
name water soluble vitamins
Vit B and C
name fat soluble vitamins
vit A, D, E, K
which vitamins are important for bone health
vit D and K
which vitamin is important in bloot clotting
vit K
which is the vision vitamin?
vit A
which vitamin is important in skin, bone health, infections?
vit C
which vitamin is involved in energy metabolism?
vit B
which vitamin enhances immune system? and affects arteries?
vit C
what does Vit D do?
regulates blood calcium and phosphorus levels,
what does vit D deficiency lead to?
rickets in children, osteomalacia in adults
what does vit K deficiency lead to?
bleeding, bruising
whats function of minerals?
bones, nerve impulses, enyzmes function
what is calcium? name its function and where its found
a mineral; bone structure; blood clotting, nerve impulse transmission, muscle contraction; found in dairy products
which mineral is involved in muscle contraction, blood clotting, bone matrix, nerve function, cellular metabolism?
calcium
name 2 minerals
calcium and magnesium
function of magenesium?
maintains muscle and nerve function; keeps bones strong; relaxes muscle
name an example of a change in muscle property
muscle atrophy
describe changes in muscle fibers
reduced capillary density, increased CO2, decreased O2
what happens to type 1 fibers in the neck when there are changes in muscle fibers, fatty infiltration and muscle atrophy? and why is this a problem?
type 1 change into type 2b which are not suited for maintaining posture. they tire quickly
describe properties of type 2b fibers
Fast twitch
Little mitochondria
Tired quickly
Limited aerobic metabolism
High anaerobic capacity
Largest, fastest muscle fibers
Lots of power but not efficient
name the deep neck flexors
longus colli, capitas longum
is it more difficult to maintain posture of global muscles or local muscles?
global
whats the function of local muscles?
coordination and muscle endurance
which type of fibers are local muscles made up of?
slow twitch type 1
describe type 1 fibers
Slow fibers, lots of mitochondria, many capillaries, high resistance to fatigue, aerobic metabolism, efficient but less powerful
the muscles that provide segmental stability in the neck as well as neutral vertebral position (upright posture): what are they called?
local stabilisers
what does dysfunction of local stabilisers lead to?
local stabiliser atrophy, changes in muscle fibers, infiltration of fat
name global stabilisers in the neck
sternocleidomastoid, scalenii, trapz descendens, levator scapula, longissimus, splenius, hyoids
which muscles control the ROM?
global stabilisers
whats the result of dysfunction of global stabilisers?
Muscle strength in different contraction forms (Disability of concentric contraction; Decrease of isometric endurance and strength; Poor eccentric control;
Increased muscle tension)
motor control impairments in the neck: what are we talking about exactly? underlying cause?
- Reduced ability for contraction caused by decreased strength of deep neck flexors;
- Changed contraction patterns
- Reduced neuromuscular efficiency
- Loss of segmental motor control
describe neck pain grade 1
neck pain, no symptoms suggesting major pathology, no/minor interference with ADLs
describe neck pain grade 2
neck pain, no symptoms of pathology, interference with ADLs
describe neck pain grade 3
neck pain, no symptoms of pathology, presence of neurological signs eg weakness
describe neck pain grade 4
signs or symptoms of pathology eg fracture
name 3 tests to test neck pain grade 3 (neurological symptoms)
ULTT (upper limb tension test); spurling; cervical traction/distraction test
describe the spurlings test for neck pain
testing radicular pain in neck. PT turns patient’s head to the affected side while extending and applying downward pressure to the top of the patients head. one hand on shoulder to stabilize torso.
explain the ULTT test for neck pain
tests for radicular symptoms; tension on nerves. shoulder pressed down, arm ABD to 110degrees, 90deg ext rot of arm, extend wrist and fingers and extend elbow
explain spurling test
tests for cervical radicular syndrome. first, extend the head, flex laterally to the affected side, then apply axial compression. pain elicited?
signs and symptoms of non-specific neck pain?
- Intolerance to long term static postures
- Tiredness, inability to keep head up
- Better with external support
- Continuous need for self manipulation
- Sensation of instability, shaking or loss of head control (places arms under chin for support)
- Pain worse at the end of the day
- Episodes of acute neck pain complaints
clinimetrics/questionnaires for neck pain?
NPRS: numeric pain rating scale
NDI
Neck bournemouth questionnaire
PSFS patient specific functional scale
upper crossed syndrome
shortened pectoralis and SCM + weak deep cervical flexors + weak lower trapezius and serratus ant. + shortened upper traps and levator scapula
name some aspects you could find in someone with nonspecific neck pain during physical examination
Poor coordination: Changes in contraction patterns
Motion not smooth through ROM
Abberant movement
Hypomobility of upper thoracic spine
Increased muscle tone, spasms, muscle guarding:
Difference between AROM and PROM
Decreased endurance of deep neck flexors
Pain provocation by compression or traction
how to test deep neck flexors
cranio cervical flexion test (CCFT)
when you see a huge increase in EMG activity while doing harris endurance test or CCFT, what does it mean?
global muscles are engaged (but you want to be testing for local deep neck flexors so should avoid these peaks/engagement or global)
how do you test cervical extensor muscles?
cervical extensor endurance test
describe treatment profile A for neck pain
used when normal recovery course; inform and advise mostly and advise on work related risk factors, max 3 sessions
describe treatment profile B
abnormal recovery course; inform and advise, recommend additional therapy (exercise therapy + cervical and/or thoracic mobilisations),
whats the focus of treatment profile C neck pain
behaviour, psychological aspect. (encourage gradual increase in PA)
what type of exercise therapy is most important for treatment profile B and C
stability training (strength + stability of cervicothoracic region, endurance training + neuromuscular reeducation exercises and stretches
whats the goal with stabilizing exercises for neck pain?
activate deep cranial cervical flexors, endurance training deep neck flexors and extensors, muscle strengthening
how can we train the contraction of local deep neck flexors?
pressure pillow: do increments, increase by 2mm, hold for 10 seconds. feedback from the pressure unit. they can see how much pressure they put on the pillow.
what can you use to perform isometric stabilizing exercises?
a band (long, different strengths)
whats a good protocol (sets x reps) to train neck muscles/stability/endurance?
3x20reps
how can you train
risk factors for achilles tendon rupture
sports (with change direction); older age, corticosteroid injections, Males, smoking
which structure is regenerating for up to or even longer than a year after a lesion in a tendon?
nerves
why is pain a good thing?
it senses harmful stimuli, heightens sensitivity after tissue damage to reduce further damage
how long can acute pain last?
1-6months max
whats neuropathic pain
pain arising from neurological structure damage
what is nociceptive pain
pain that arises from actual or threatened damage to non-neuronal tissue and is due to activation of nociceptors
cutting yourself is what type of nociceptive brain?
somatic
whats transduction?
transduction of noxious mechanical and chemical stimuli into electrical signals in nociceptors
whats transmission
nervous signals - travels through spinal cord to higher centers where it may be perceived as pain
whats modulation
nervous system can alter pain sensitivity via inhibition or facilitation
name fibers in the ascending nociceptive tract
A delta fibers and C nerve fibers
name which hormones are part of descending inhibitory /facilitatory tract
dopamine, seratonin, norepinephrine
what are the A delta fibers
respond to strong stimuli, respond fast, mechanical/mechanotheramal stimuli; myelinated fibers
function of C nerve fibers
respond to thermal, mechanical and chemical stimuli
which fibers sense sharp pain
A delta
which fibers sense dull aching longer lasting pain
C fibers
whats the trigeminal pathway related to
pathway related to all nerves in the face
explain gate control theory
a nonpainful stimulus blocking transmission of a noxious stimuli eg rub area to reduce pain sensation
endogenous opioids
molecules that are produced in the brain, circulate through all organ systems, try to limit transmission of nociceptive signals
whats IGF 1
growth hormone
which white blood cells are released during inflammation
neutrophils, macrophages
- signs of inflammation phase
2. symptom of it
- colouring, warm sensation, thickening/swelling
2. pain reported by patient in/around the affected area
whats functio leasia
decreased changed activity level, eg different walking pattern, loss of capacity to function properly. eg when tendon ruptures, no PFL possible
whats happening to the tissue during proliferation
growth of new tissue, new blood vessels forming; skin healing
signs: muscle atrophy, metabolic stress, decreased mechanotransduction, decreased protein synthesis. signs of which phase: inflammation, prolif or remodeling?
remodeling
1 sign of proliferation phase
1 symptom of proliferation phase
explain why this happens
sign: less ROM
symptom: less motor control
happens due to decreased/changed inter-intramuscular coordination
remodeling phase
name signs and symptoms
signs: stiffness, decreased joint mobility
symptoms: muscle fatigue, muscle cramps, decreased motor control
during which phase of tissue recovery after an injury do you start loading the area and why?
proliferation, to encourage motor control and optimal tissue remodeling
loading = contractions, stretch, mobilisations
banded active plantarflexion: name what you are stimulating on a tissue level, why do this exercise?
- stimulate protein synthesis (actin myosin more active)
- stimulate fibroblast activity (collagen deposition)
- neovascularisation
- improve tendon tissue
banded passive plantarlfexion( patient pulls the band and just resists force from the band). benefits? why do this exercise?
using stretch stimulus to work mobility and strengthening,
deficiency of vitamin k leads to what
easy bleeding, easy bruising
function vit K
blood clotting, bone health, anti-bone loss
function of magnesium
nerve transmission, nerve function, muscle function, relaxes muscles
