principles of intervention Flashcards
discuss the characteristics of acute stage
aka reaction or inflammatory stage
lasts 4-6 days from injury; unless re-injured
cardinal signs of inflammation
pain at rest and before tissue resistance
impaired ROM d/t pain or muscle guarding
dec use of assoc parts
discuss the characteristics of subacute stage
aka proliferation, repair or healing stage
lasts 10-17 days; 6 wks if tendon
signs of inflammation dec or absent
paint during tissue resistance and end range
impaired ROM d/t contractures, tightness, atrophy
dec function and strength from disuse
discuss the characteristics of chronic stage
aka maturation and remodeling stage
lasts for 6 mon - 1 yr
(-) signs of inflammation
pain after tissue resistance
impaired ROM d/t weakness, poor endurance, poor muscle control
dec or unable to function
what are the signs of inflammation
paint at rest - dolor
swelling - tumor
redness - rubor
heat - calor
loss of function - functio laesa
when does scar retraction occur
day 21 - chronic stage
remodeling time is influenced by factors that affect ________
density and activity of fibroblasts
give factors that affect density and activity of fibroblasts
time of immobilization
stress placed on tissue
location of lesion
vascular supply
differentiate the state of healing between late subacute and chronic
late subacute - formation of collagen and tissue; fragile and poorly oriented
chronic - improved quality of collagen tensile strength and orientation and reduction of wound size
area at high risk of injury in skeletal muscle
myotendinous junction
common MOI for muscle injuries
high demand or high impact activity - strain
direct trauma - contusion
discuss classification of muscle injuries
grade 1 (minor) - tearing few fibers; minimal strength loss
grade 2 (moderate) - tearing of more fibers (partial); loss of contractile strength
grade 3 (severe) - cross sectional rupture; complete loss of strength
characteristics of destruction phase in muscle injuries
necrosis of torn fibers
hematoma and inflammation
fibrin and fibronectin provide support against contraction
characteristics of repair phase in muscle injuries
after few days to few weeks post-injury
phagocytosis of necrotic tissue
regeneration of contractile elements
myofiber formation and scar formation
characteristics of remodeling phase in muscle injuries
after 4-6 wks post-injury
re-organization of tissue integrity and functional maturation
compare the healing of small and large muscle injuries
small - muscle tissue
large - scar tissue
give clinical implications for rehab of muscle injuries
rest vv important in early phase to promote healing
use modalities to control inflammation, edema, stiffness, pain
early activity at available range to prevent adhesions, contracture and dec strength
no active stretching 3-7 days post-injury to prevent re-injury
when can active stretching can be done in rehab of muscles ?
bawal 3-7 days post-injury pero pwede na after
common MOI tendinopathy
repetitive motions, loading (overuse) = microtears or abrupt forceful contraction
usual time frame for achilles tendon rupture in terms of healing and return to sports
12-16 wks to heal after injury
return to sport after 3-6 months
characteristics of inflammatory phase in tendinous injuries
acute - few days to wks after injury
(+) signs of inflammation
characteristics of proliferative phase in tendinous injuries
few days to few weeks after injury and up to 6 wks
collagen synthesis
correct faulty biomech and compensatory posture/motions
characteristics of remodeling phase in tendinous injuries
about 6 wks after injury
fibrous repair; collagen aligns based on direction of stress placed on tendon (strengthening starts but no too intense)
characteristics of scar formation phase in tendinous injuries
10 wks to 1 yr
decline of tendon metabolism and vascularity
strengthening in tissue continues (pwede na higher intensity)
give clinical implications for rehab of tendinous injuries
avoid prolonged immob
identify postural dysfunction or biomech fault to reduce improper loading on tendon
strengthening and stretching designed for remodeling then progress if in scar formation na
common MOI for ligamentous injuries
from excessive lengthening of ligament
most commonly injured ligaments
lateral ankle ligaments tas ACL
discuss grade 1 ligamental injury
stretched ligament; no excessive motion
few fibers in plastic range ruptured; intervention and protection
discuss grade 2 ligamental injury
partial tear in ligament; moderate joint laxity
surgery is dependent on instab and goals of pt
discuss grade 3 ligamental injury
complete ligament rupture; significant joint laxity
surgical intervention
discuss inflammatory phase in ligamental injuries
starts within 72 hrs after injury
(+) hematoma and signs of inflammation
deposition of ground substance and disorganized collagen
discuss regenerative phase in ligamental injuries
few days up to 6 wks after injury
fibroblast proliferation and collagen formation
discuss remodeling phase in ligamental injuries
6 wks post-injury up to 1 yr
remodeling of ligament and improved collagen orientation
clinical implications for ligamental rehab
avoid prolonged immob
stress ligament during proliferative and remodeling = more organized collagen
common MOI for bone injuries
trauma or accident
overuse
aging or osteoporosis
cancer
metabolic abnormalities
discuss hematoma formation phase in bone healing
initial 48-72 hrs post-injury
hematoma = fibrin meshwork where fibroblasts and capillaries surround
discuss cellular proliferation phase in bone healing
osteogenic cells proliferate = forms fibrocartilage collar
discuss callus formation face in bone healing
cont proliferation turns collar into callus
healing of bone begins; slower in geriatric tas faster sa kids then adult
discuss ossification face in bone healing
osteoblasts replace cartilage = ossification of callus
discuss consolidation and remodelling face in bone healing
up to a teat to complete
callus is reabsorbed and bone remodels based on stress placed
clinical impli for bone rehab
immob until may callus na - repeat xrays; callus = mob; if atrophy na tas wala pdin callus consult ortho
treat soft tissue damage with modalities
once mobilization is allowed dapat may progressive strength regime to reverse atrophy
controlled WB as reco ng ortho
common MOI for cartilage
trauma or degeneration or overuse from faulty biomech
discuss grade 0 cartilage injury
normal cartilage
discuss grade 1 cartilage injury
superficial lesions, rough surface and chondral softening
intact surface
discuss grade 2 cartilage injury
lesions extending < 50% of cartilage depth; abnormal
irreg surface defects < 50% of cartilage depth; ulcerations, fissuring, fibrillation
discuss grade 3 cartilage injury
lesions extending > 50% of cartilage depth; severely abnormal
irreg surface defects > 50% of cartilage depth; ulcerations, fissuring, fibrillation
discuss grade 4 cartilage injury
extends to subchondral bone; full thickness injury
cartilage loss and exposes bone
discuss healing process of cartilage damage
lack of blood supply impedes regeneration
exp how cartilage injury cause pain
aneural in general but
OA - no cartilage = bone to bone contact (may nociceptors) = pain
meniscal tear - pain d/t abnormal biomech, plica or inflammation of soft tissue
clinical impli for rehab of CARTILAGE damage
focus on restoring normal joint mob, dec inflammation and pain and correcting faulty biomech and postures as well as dysfucntions in muscle activation
avoid excessesive WB
usual MOI for nerve damage
direct - compression, tension, laceration, stretch, electricity, radiation
indirect - poor circulation, temp, chemicals
discuss nueropraxia
segmental demyelination
AP is slowed or blocked; no muscle atrophy and temporary sensory loss
d/t mild ischemia from compression
complete recovery
discuss axonotmesis
loss of axonal cont; wallerian degen
muscle atrophy and sensory loss
d/t prolonged compression and stretch = necrosis and infarc
incomplete recovery and may require surgery
discuss nuerotmesis
complete severance of nerve fiber; wallerian degen
muscle atrophy and sensory loss
d/t GSW, stabs, avulsion rupture
no recovery w/o surgery
discuss sunderland type 1
neuropraxia, minimal disruption
complete recovery
discuss sunderland type 2
axonotmesis; wallerian and disruption of axon
usually complete recovery
discuss sunderland type 3
axonotmesis or neurotmesis; wallerian and disruption of axon, endoneurium
poor prognosis s surgery
discuss sunderland type 4
neurotmesis; wallerian and disruption of axon, endoneurium, peri
poor prognosis s surgery
discuss sunderland type 5
neurotmesis; wallerian and disruption of axon, endoneurium, peri, epi - complete disruption
poor prognosis s surgery
discuss acute phase in healing PNI
immed after injury or surgery
minimize inflammation and tension to promote healing
discuss recovery phase in healing PNI
signs of re-innervation
focus on re-training and re-education of muscle
discuss chronic phase in healing PNI
re-innervation potential peaked
focus on training of compensatory techniques
clinical impli for rehab of PNI
observe if pt regains strength and sense ona rea
provide favorable environment for healing
maintain normal ROM and neural mobilizaition to prevent contractures and promote nerve gliding
use modalities for sensory or motor re-education (ES)
goals of treatment in the protection phase
control effects of inflammation
faci wound healing
maintain normal function in assoc areas
goals of treatment in the controlled motion phase
promote healing
nondestructive exercises
restore mob and function
goals of treatment in the return to function phase
inc strength and flexibility
return to functional and work activities
goals of treatment if post op
max, mod and min protection phase
interventions in protection phase
PRICES, immob to control inflammation
passive movement to promote mon
massage to reduce swelling
interventions in controlled motion phase
AROM, isometrics, endurance and stabilization exercise, functional training
hold-relax stretching, passive stretching and massage
interventions in return to function phase
progressive stretching and cross fiber massage
indep = strengthening, endurance, aerobic training
specificity drills
precautions and contraindications in protection phase
pre - proper dosage of rest and movement
contra - stretching and resistance
precautions and contraindications in controlled motion phase
pre - proper dosage of rest and movement, eccentric and heavy resistance exercises
