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rehabilitation of sports injuries > PowerPoint 1 > Flashcards

PowerPoint 1 Flashcards

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1
Q

rehabilitation

A

restoration, following disease, illness, or injury, of the ability to function in a normal or near-normal manner

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2
Q

the rehabilitation team

A 
athletic trainer & ATS
athlete/patient
physician
coaches
strength and conditioning coaches
patient's family
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3
Q

the sports medicine approach to rehab

A
  • more aggressive because of the competitive nature of sports
  • seasons are relatively short in duration
  • goals are to return to play (RTP) as soon but as safely as possible
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4
Q

objectives of rehab

A

prevent de-conditioning

rehabilitate injury

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5
Q

objectives of rehab: prevent de-conditioning

A

minimize the impact of lost training/competition time and help athlete be ready to return ASAP

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6
Q

objectives of rehab: rehabilitate injury

A

restore back to greatest extend possible

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7
Q

goals of rehab

A
  • utilize appropriate long-term and short-term goals to motivate patient and track progress
  • be SMART in your goal setting
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8
Q

the evaluation process

A

observation
assessment
plan

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9
Q

any rehabilitation plan is only…..

A

as good as the accuracy of the diagnosis

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10
Q

good diagnosis begins with…..

A

accurate history (subjective)

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11
Q

evaluation: observation

A

inspection
R/A/R/ROM (flexibility, mobility, strength)
special tests (proprioception, neuro - sensory motor reflex)

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12
Q

evaluation: assessment

A 
contributing factors
complete
base the rehab plan on the evaluation
include problem list (everything abnormal)
include STG & LTG here or in P
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13
Q

evaluation: plan

A

usse time-specific objectives

functional tx goals

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14
Q

after the evaluation & intervention

A

modalities as an adjunct

re-evaluate the patient

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15
Q

rehabilitation of special populations

A 
hospital patient
pediatric patient
social factors
industrial patient
adolescent athlete
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16
Q

special populations: social factors

A

home
support system
work
transportation

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17
Q

special populations: industrial patient

A

cumulative trauma disorders (CTD)

workmen’s comp issues

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18
Q

adolescent athlete

A

epiphyseal plates

other developmental conditions (OSD, SCGE etc)

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19
Q

it is impossible to accelerate the process, however…..

A

we can create an environemtn that we maximize the body’s ability to heal

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20
Q

early motion has been shown to …….

A

maximize these efforts by decreasing swelling, maintaining muscle tone, minimizing bone and connective tissue weakness

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21
Q

immobilization is detrimental to…..

A

the healing process and may result in permanent impairment

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22
Q

connective tissue

A

composed of collagen, elastin, reticulin, and ground substance

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23
Q

connective tissue: quantities of these substances vary….

A

according to the structure and determine characteristics of structure

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24
Q

connective tissue: collagen

A

group of proteins that provide strength & rigidity
major component of endomysium
breaks down with age

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25
Q

four main types of collagen connective tissue

A

I: skin, tendon, bone (scar tissue0
II: cartilage
III: granulation tissue
IV: Cell membranes

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26
Q

elastin connective tissue

A

elastic portin that provides extensibility or return to shape after deformation

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27
Q

elastin connective tissue is found in

A

skin, arteries, ligaments, cartilage, & bladder

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28
Q

reticulin connective tissue

A
  • structurally similar to Type III collagen (granulation tissue)
  • weaker, less orderly than collagen
  • important during healing as an intermediate tissue
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29
Q

ground substance connective tissue

A
  • areolar (loose) versus dense connective tissue
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30
Q

ground substance: connective-tissue continuum, function depends upon organization

A

parallel: strength
randon: movement
dense irregular: strength in multiple directions

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31
Q

mechanical properties of connective tissue, all occur simultaneously within connective tissue

A

elasticity
visoelasticity
plasticity

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32
Q

elasticity

A

return to normal length after elongation

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33
Q

viscoelasticity

A

resists deformation, but not completely

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34
Q

plasticity

A

permanent deformation

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35
Q

physical properties of connective tissue

A

force deformation

creep

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36
Q

physical properties of connective tissue: force deformation

A

amount of force applied to maintain change of length/deformation and is time dependent

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37
Q

physical properties of connective tissue: creep

A

low level of force over time causes plastic deformation
influence of heat, time
fatigue failure, stress fracture

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38
Q

muscle spindle fibers (MSFs)

A

sensitive to stretch and activate muscle in response to lengthening and the rate of change in the muscle’s length

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39
Q

muscle spindle fibers: two types of intrafusal fibers

A
  • nuclear bag fibers: sensitive to stretch and velocity of stretch
  • nuclear chain fibers: sensitive to stretch only
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40
Q

Golgi Tendon Organs (GTOs)

A
  • long, delicate tubular capsules, located at the distal and proximal muscle-tendon junctions, that contain a cluster of nerve fibers
  • less sensitive to stretch than muscle spindle
  • very sensitive to muscle contraction
  • perform autogenic inhibition of muscle when stimulated
  • simultaneous activitation of antagonistic muscle
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41
Q

effects of muscel spindle and GTO

A
  • both function as protective mechanisms
  • if stretch is applied too quickly, muscle contracts due to MSF activiation
  • when stretch is applied slowly, muscle relaxes due to inhibition mediated by GTO
  • contraction of antagonist inhibits agonist contraction
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42
Q

inflammation: the reaction to injury

A
  • body’s natural & necessary response to injury
  • may become problematic with repeated injury or microtrauma
    care must be taken during the inflammatory phase, to not allow excessive activity
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43
Q

inflammation: may become problematic with repeated injury or microtrauma

A

cumulative effect causes increased pathology to the joint and/or surrounding structures

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44
Q

inflammation; care must be taken during the inflammatory phae, to not allow excessive activity

A

gentle ROM, isometrics, posture are all that should be allowed
RICE

45
Q

reaction to injury: inflammatory response is the same, regardless of the …..

A

location and nature of the injurious agent, and consists of chemical, metabolis, permeability, and vascular changes, followed by some form of repair 9primary & secondary injury)

46
Q

soft tissue healing

A

inflammation (0-7 days)
repair/regeneration (4-21 days)
remodeling/maturation (up to 2 years)

47
Q

fracture healing

A

acute (0-7 days)
repair/regeneration (8-12 weeks)
remodeling (up to 2 years)

48
Q

peripheral nervous tissue healing

A

wallerian degeneration (3-5 days) in distal axon
remyelination may start 8 days after injury
regeneration occurs at 2-4 mm/day

49
Q

muscle tissue healing

A

inflammation (7 days)
repair/regneration (4-21 days)
remodeling/maturation (up to 2 years)

50
Q

reaction to injury: secondary ischemic death problematic not simply because of loss of cells

A
  • increased hematoma
  • histamine, bradykini, leukotrienes & prostaglandins increase vascular permeability and allow fluid and cells to escape into the interstitial spaces
  • net result: increase edema
51
Q

response of joint structures to injury (synovial)

A

synovial membrane proliferates synoviocytes, increases vascularity and graudal fibrosis

52
Q

continued irritation of synovial membrane may lead to a chronic synovitis

A

chronic synovitis causes cell dealth (synoviocytes)
WBCs ingest lysosomes and proteolytic enzymes
WBCs die releasing what was ingested
enzymes cause further damage to the joint structures

53
Q

management of chronic synovitis

A

conservative (NSAIDs & steroidal anti-inflammatories, rest, aspiration, cold)
synovectomy

54
Q

cartilage injury usually leads to

A

synovitis (activity mediated effusion)

55
Q

response to joint structures to injury

A
  • loss of proteoglycan in articular cartilage results in physical changes
  • collagen fibers become more susceptible to mechanical damage
  • synovial fluid viscosity goes down (hyaluronic acid influences viscosity directly)
56
Q

hemarthrosis can result in irreversible damage to the joint

A
  • can cause articular cartilage damage
  • irreversible decrease of PG synthesis
  • slower return to normal rates of synthesis
57
Q

joint capsule reacts to inflammation similar to synovial tissue

A
  • can become fibrotic/scarred

- chronic swelling may lead to permanent stretch of the capsule and ligaments

58
Q

effects of immobilization on connective tissue: general changes is soft tissue

A
  • ground substance is reduced, leading to increased collagen cross-links, reducing mobility
  • the fiber meshwork contracts so that the tissue becomes dense, hard, and less supple
  • with injury, new collagen formation encourages new/excessive cross-link formation, restricting movement of collagen tissue
  • wound contraction reduces range of motion
59
Q

effects of immobilization on connective tissue

A
  • with edema and immobilization, fibrosis increases as a result of increased tissue fluid protein and deficient local metabolism
  • normal collagen replacement and reorganization occur, producing a dense meshwork
  • collagen fibers bind to other strucutres and limit tissue mobility
  • without stress, structure becomes weaker secondary to decrease in collagen mass
  • end result is loss of range of motion
60
Q

effects of immobilization on muscle

A

decreased muscle fiber size
reduced number of myofibrils
reduced oxidative capacity
increase in fibrous and fatty tissue in the muscle

61
Q

effects of immobilization on muscle: decreased muscle fiber size

A

atrophy is primarily from decreased cross-sectional area and not loss of fibers (sarcopenia), as seen in elderly

62
Q

effects of immobilization on muscle (numbers)

A
  • 6 weeks of elbow cast immobilization resulted in greater than 40% decrease in muscle strength
  • quads cross-sectional areaa can decrease 21%-26% duirng 4-6 weeks of immobilization in non-pathological subjects
  • trainiing before immobilization dramatically decreases the amount of atrophy during immobilization
  • reduced intramuscular capillary density
  • atrophy can be seen in two weeks
  • with prolonged immobilization, the normal neural feedback system of movement is lost
63
Q

effects of immobilization on muscle ( histological changes)

A

decreased ATP, ADP, CP

fewer mitochondria

64
Q

effects of immobilization muscle: fiber type & atrophy

A
  • both type I and type II fibers atrophy during immobilization
  • the contractile ability of type I seems to be more adversely affected than the Type II
  • exercise with decreased intensity and increased frequency will be more beneficial to the patient (also beneficial for healing)
65
Q

more effects of immobilization: muscle

A
  • immobilization results in changes to myotendinous junction
  • 50% decrease of collagen and muscle cells
  • therefore, a dramatic increase in activity after immobilization may lead to tendopathy or even ruptue at the myotendinous junction
66
Q

effects of immobilization of connective tissue: articular cartilag

A
  • changes dependent on position of immobilization, duration of immobilization, and weight-bearing status of joint
  • reduced proteoglycan concentration
  • less matrix organization
  • necrosis of areas of constant pressure
  • increased fibrofatty tissue within the joint that becomes scar tissue
  • irreversible damge occurs with continued immobilization
67
Q

effects of immobilization of connective tissue: periarticular connective tissue

A
  • this is soft tissue surroundign the joint, such as ligaments, the joint capsule, fascia, tendons, and synovial membranes
  • connective tissue becomes thick and fibrotic
  • reduced GAG and water in ground substance decrease extracellular matrix
  • diminished tissue mobility secondary to changes in ground substances, increased collagen cross-links, and continued collagen processing
  • clinical result is decreased range of motion
68
Q

effects of immobilization on articular cartilage

A
  • articular cartilage undergose structural, biochemical, and physiological changes during immobilization
  • decrease in glycosaminoglycans (GAGs) decreases ability to resist compressive force
  • joint motion is key to diffusion rate of synovial fluid whihc maximizes articualr cartilage nutrition
  • weight-bearing w/o ROM can cause severe articular cartilage damage
  • intermittent joint loading is important
69
Q

effects of immobilization on articular cartilage: articular cartilage undergoes structural, biochemical, and physiological changes during immobilization

A

ribrillation, fraying, cyst formation, varying degrees of chondrocyte degeneration, atrophy, sclerosis, and cartilage resorption

70
Q

effects of immobilization on ligaments

A
  • ligaments undergo same structural changes during immobilization that other tissues undergo
  • some unique changes, however, because of the bone-ligament interface
  • ligament does not necessarily atrophy
  • immobilization leads to decrease collagen leading to decreased tensile strength of the ligament
  • ligaments respond positively to stress
71
Q

effects of immobilization on ligaments: ligament does not necessarily atrophy

A

there is a resorption of tissue at the bone-ligament junction

72
Q

effects of immobilization on ligaments: ligaments respond positively to stress

A

important not to “over-stress” the ligament during rehabilitation

73
Q

effects of remobilization of muscle

A
  • principle of overload
  • quadriceps is more predisposed to atrophy than hamstring
  • EMS is a valuable tool to help minimize atrophy
  • biofeedback another good tool
74
Q

effects of remobilization of muscle: Quadriceps is more predisposed to atrophy than hamstrings

A
  • BTB grafts seem to weaken quads more than hamstring graft weakens hamstring muscles
  • research suffests that quad strength is slower to return with BTB than with ham graft
75
Q

effects of remobilization on articular cartilage

A
  • return to normal structure and function is much longer than immobilization period required to inhibit structure and function
  • remobilization must consist of controlled stresses
76
Q

effects of remobilization on articular cartilage: signs of damage due to rehab include

A

effusion/edema, erythema, pain, or inability to complete task correctly

77
Q

early treatment

A
  • helps prevent synovitis, damaged joint capsule, and damge to the articular cartilage
  • it also allows return of normal joint kinematics
  • AROM & PROM, compression, massage, and electric stimulation work well to help reduce swelling
  • ice is important for tissue health
  • reduction of post-traumatic joint effusion is paramount in the early rehabilitation process and is important in the restoration of joint kinematics
  • prolonged effusion, if left unchecked, can result in reactive synoviutis, damage of the joint capsule, and degradation of articular cartilage
78
Q

Quadriceps shutdown

A
  • decreased activity of the quadriceps due to increased fluid volume within the knee joint
  • small volumes (20-30 ml) have been shown to result in 60% decrease in quad function
79
Q

quadriceps shutdown: decreased activitly of the quadriceps due to increased fluid volume within the knee joint

A

will lead to atrophy and weakening

80
Q

quadriceps shutdown: small volumes (20 - 30 ml) have been shown to result in 60% decrease in quad function

A
  • 50 - 60 ml for vastus lateralis and rectus

- VMO is most sensitive to small volumes

81
Q

effects of remobilization on connective tissue

A
  • enhanced recovery
  • prevents abnormal collagen corss-link formation
  • increases fluid content in the extracellular matrix of connective tissue
82
Q

effects of remobilization on connective tissue: positive impact on most structures

A
  • effects on muscle fibers
  • effects on articular cartilage
  • effects on periarticular connective tissue
83
Q

arthrofibrosis

A
  • excessive formation of scar tissue around a joint after injury or surgery
  • usually within the joint capsule, synovium, or intra-articular spaces
  • most commonly affects the knee joint
  • characterized by a lack of flexion as well as extension
  • prolonged immobilization for any injury puts the joint at risk for arthrofibrosis
84
Q

arthrofibrosis: induced primarily by immobilization

A
  • results in significant decrease in GAGs, water loss, abnormal cross-link formation, and joint restriction
  • scar tissue forms within the joint spaces and recesses further limiting ROM
85
Q

arthrofibrosis: often a complication of ACLR

A

delaying surgery until the hemarthrosis and synovitis have resulved, ROM restored, quad control; decreases risk of arthrofibrosis

86
Q

effects of remobilization on ligaments

A
  • bone-ligament junction recovers much slower than mid-substance of ligament
  • endurance type activities seems to increase ACL strength and stiffness the best
  • immobilization not only weakens the injuryed ligament but also non-injured ligament
  • it can take > 1 year for ligament to return to pre-injury levels
87
Q

effects of remobilization on bone

A

premanent bone loss can occur after 12 weeks of immobilization

88
Q

effects of remobilization on bone: this can be prevented with exercise

A

isometric or isotonic

89
Q

benefits of identifying “injury prone” atheltes early:

A
  • identification
  • intervention
  • prevention
  • sport selection/sport avoidance
90
Q

risk factors: early research in the 70’s-90’s personality traits

A
  • introverts vs. extroverts
  • internal vs. external locus of control
  • self-concept
  • anxiety
  • aggressiveness
  • dominance
91
Q

bottom line to be determined from trait studies

A
  • no two athletes are alike
  • impossible to group by gender, sport, or other factor
  • even still, clinician should not overlook the importance of the influence that the patient’s personality will have on healing outcomes, rates, etc
92
Q

more contemporary life stress model says that the psychological response to injury varies and is most dependent upon a number of factors, with personality being just one

A
  • personaltiy
  • coping strategies and resources (include prior injury/history)
  • nature and magnitude of outside stressors
  • intervention
93
Q

risk factorsL negative stressors

A 
death
injury
illness
breakupo
loss of sport
previous injury
academics
daily hassles/finances
94
Q

risk factors: stress (in its various forms) has a high correlation with athletic injurys

A
  • seems to hold true across sports, experience levels, and genders
  • seems to hold true for eustress or distress (signigicant life changes, relationships, “the madden curse”)
95
Q

risk factors: negative influences of stress

A
  • compromises in motor coordination and timing
  • delayed reaction time
  • concentration problems
  • increased muscular tension
  • increased respiration, heart rate, BP
96
Q

risk factors: other factors

A
  • narrow internal focus
  • fatigue
  • social support networks
97
Q

injury occurence

A
  • emotional responses can and do impact healing & recovery

- more recent work has suggested that copign is far less predictable and stepwise

98
Q

initial thoughts of coping: KLubler-Ross stages of grief

A
  • denial (not me)
  • anger (why me)
  • bargaining (if me, then…)
  • depression (why)
  • acceptance (okay. now what?)
99
Q

injury occurence: gender differences

A

females tend ot be less irritable and move toward positive thoughts patterns sooner than male counterparts

100
Q

injury occurrence: social support system

A

develop approach to ensure that athletes are invested in your system and recognize that they are valuable contributors

101
Q

recovery: malingerers

A

often times atheltes discover that others treat them with more attention and respect in an injured state than a healthy one

102
Q

recovery: adherence

A
  • may be mandated

- can be nurtured/improved

103
Q

adherence to rehab

A
  • self-motivation
  • explain the process
  • develop rapport
  • task involvement
104
Q

adherence to rehab: self-motivation

A

prevalent belief that “you either have it or you don’t”

  • activating the support network
  • often in the absence of a qualified professional, the AT is teh best qualified to help
105
Q

adherence to rehab: taks involvement

A
  • believe in clinician
  • believe in plan
  • see opportunities to return
106
Q

adherence to rehab: activating the support network

A

teammates
friends
relationships
teachers

107
Q

adherence to rehab: often in the absence of a qualified professional, the AT is the best qualified to help

A
  • goal setting
  • visualization/imagery
  • self-talk
108
Q

other issues to consider during rehab

A
  • chronic pain
  • RTP
  • career-ending/altering injuries
  • refer prn
  • don’t be overwhelmed
  • at the end of the day, their pain is not your pain and you can’t help them best unless you are at yiour best!

rehabilitation of sports injuries (4 decks)

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