PT4 - Health Flashcards
How do you recognise health?
- social & economic environment
- physical environment
- persons individual characteristics and behaviours e.g. skin, hair, nails, demeanour
What is health?
- being able to do what you need/want to do (agency)
- the context of people’s lives determines their health
- health is not always within someone’s control e.g. wealth
- ability to adapt to internal (mental/emotional, chemical, physical) and external environment
What are the 3 health categories?
- psychological (mental/emotional/social)
- chemical (disease processes e.g. diabetes)
- physical (NMS e.g. dysfunction/tissue damage/OA)
List the 3 type of patient
- simple - largely biomechanical, simple story, often young
- complex - mixed picture, yellow flags (social and psychological barriers), often older
- complicated - comorbidities (chemical), multiple flags (yellow - social, orange - psychological), chronic, shared management
What determines health?
- income + social status
- education
- physical environment
- social support network (families, friends, community)
- genetics
- personal behaviour
- health diseases
- gender - types of disease/life expectancy
What are personal health determinants?
- nutirtion
- activity
- smoking
- drinking
- coping skills/habits - locus of control
- previous experiences and outcomes - expectations
- approach to life’s stresses/challenges - opportunities/threats
How do health determinants and personal behaviour explain adaptation?
+ health domains (chemical, physical, psychological)
+ health determinants (income, status, education, physical environment, support, genetics, behaviour, disease, gender)
+ personal behaviour (nutrition, activity, smoking, drinking, skills/habits, experiences, outlook)
=> influence individual adaptability and responsiveness to challenge (domain theory + BPS model) ==> opportunity for change
What is dysfunction?
- NMS functional loss
- acute traume => weakness, reduced/increased ROM
- chronic loss of function
What is disease?
- pathophysiological change => symptoms
- subclinical (elevated BP)
- clinically present (w or w/o diagnosis)
What is maladaption?
- failure of body to function in normal fashion due to dysfunction or disease
- lack of adaptation => function loss
- loss of agency
- can involve BPS
What is the Big Picture?
- everything that contributes to a person in their ecology, agency, lifestyle and personal health determinants
John or Jayden - ideas for prognosis, who might have the more favourable prognosis and what factors influence your decision?
John & Jayden present with R medial knee pain of 3/12 duration after a mild valgus knee strain injury on a ski trip. They are both healthy with no comorbidities
John is 30 YO computer programmer who does little exercise and is a little overweight.
Jayden is a 30 YO gym instructor who trains 3 hours on 5/7 and has a good BMI
Fiona Hendry Balloon Model of Stress
John => small balloon, runs more at minimal loading, tissues are not used to load, more likely to get an injury, felt the issue more, less force, easier to treat, low grade exercises should have a big impact on him
Jayden => big balloon runs closer to ‘maximal’ loading all the time, more significant to cause injury to his tissues as they are more robust, should have probably healed by now. Need to change how they are using their body or reduce forces on his body to see change
Cross training expands the balloon for the person
What happens as a person ages?
- kyphosis due to spine becoming more osseous
- thorax gets arthritis first
- centre of gravity moves forwards
- more weight on toes
- more likely to catch toes on curb stones => PT reflexes are slow + joint Proprioception diminished => get PT to look forwards
- suggest walking heel first with older PT => heel pushed back centre of gravity
- agency very important => being able to self-care
- average life expectancy in care home = females: 3 years, males: 6 months
Where are forces most likely to be felt in bodies?
- back
- neck
- knees
- shoulders
-hips
What happens in the shoulders as we age?
- forces travel in straight lines
- rotator cuffs work in straight lines
- shoulder slump => forces felt more as harder to move through joint of rounded shoulders => compromising GH + complicated by thorax in kyphosis
How do muscles work @ a microscopic level?
- shorten on contraction (using ATP)
- actively get food (ATP) + stretching => DOMS
- overworking MM => tightness
- compresses arteries and veins as thinner walls => occludes drainage => toxins can’t drain away
- increase in metabolites
What happens when you cross fibre stretch a MM?
- drain metabolites out
- increased heat due to improved blood flow
- increase water + nutrition to replenish myotendons
What do myotendons do?
- transmit large forces from MM to tendon
- dissipitate forces (spring)
- weak link => common location for MM strain
- strain can be prevented by heavy eccentric exercise
- e.g. biceps femoris, biceps brachii, quadratus femoris
- interdigitations of MTJ shorten with age -> less contact area for force transmission => increase risk of injury
What are the grading of MTJ injuries? (Myotendonous Junction)
- 1: Mild strain => interstitial edema + fluid/hemorrhage around MTJ
- 2: Moderate strain => intramuscular hematoma + perifascial fluid/hemorrhage
- 3: severe strain: MTJ tear + laxity
How long do MM, tendons, myotendons, cartilage and bone respond to training?
- MM: 2-3 weeks
- tendons + myotendons: 4-7 weeks
- cartilage + bones: 2-3 months recovery
What is the little picture?
- local areas causing symptoms + dysfunction
