Soft tissue Flashcards
how does tendinopathy occur
overload- one off or recurrent, overload detected by cells, cells activate (reactive stage), aggrecan gets produced= hydrophilic, apoptosis increases (cells die faster), matrix loose structure, providing opportunity for vascular penetration
managing risk factors
modifiable- tendon load, muscle power, obesity, cholesterol, recent injury
non-modifiable risk factor- DM, genetic factors, early menopause, rheumatological disease, recent sciatica
exercise must be specefic
strength, length, ROM, power (force and speed), endurance, shock absorption (mainly LL), graded exposure (reduces fear avoidance and analgesic), proprioception/balance/ control of limb
mechanotherapy
loading tissue, stimulates cellular response, tissue adapts, tissue improves structure, tissue able to maintain homeostasis= less pain
effective treatment
load management, increase muscle strength/co-ordination, progressive rehab, graded exposure for central and peripheral change, treat the person, continue maintenance regime
proprioceptive rehab
positional sense, reduced with injury/pain, primary treatment target for some conditions
proprioceptive rehab
positional sense, reduced with injury/pain, primary treatment target for some conditions
tissue- tendons and joints/OA and liagments
tendons- modify load/ strengthen., progress/ RTP
joint/OA- modify load/ROM//strength/progress function
lig- modify load/ROM/balance/strength/neuromuscular control
tissue- fractures and joint replacements
ROM, strengthen, rehab function
Ax soft tissue-
lengthen, strength, isometric, palp for tenderness, endurance, power, proprioception and balance, motor control/patterning
soft tissue treatment
SSTM, DTF, muscle lengthening, trigger point/myofascial release, EXERCISE, if you rest muscle for too long after injury= atrophy= substantially weaker post injury
Adapted cook and Purdum’s model- unloaded/ excessive
stress shield- normal tissue- excessive load and individual factors= tissue dysrepair= degenerative tissue
normal or excessive load +/- individual factors
Adapted cook and Purdum’s model- optimum
optimised load- optimised load= adaptation- strengthen- appropriate modified load= degenerative tissue
ACL rehab
diagnosis and assessment, mobility/ control and optimal strength, power and reactive strength, linear running, multi-directional running, reproducibility under fatigue
activity modification
Silbernagel pain monitoring model- 0-3= continue exercises, 4-5= reduce exercise, stop 6-10= stop exercise and allow to settle, then restart
activity modification- reduce external loading
volume, intensity, frequency, duration, heel raises, activities throughout the day
psychosocial factors in tendinopathy
fear avoidance, catastrophizing, pain behaviours
fundamentals of rehab and marginal gains- education
lack of protein, alcohol, lack of sleep, psychosocial factors, stress
fundamentals of rehab and marginal gains- pyramid (bottom to top)
education= understanding of the disorder, modify loading and pain monitoring model, isomated MTU= quantify/ isotonic, reduce physiological tremor, high load isometric/eccentric, SSC (strength shortening cycle- plyometrics), SSE (sports specific exercise)
management
load management- for most conditions (POLICE), increase muscle strength/co-ordination, restore ROM, progressive rehab, graded exposure for central and peripheral sensitization (pain), treat the person not the tissue, continue maintenance regime (overuse conditions)
benefits of exercise
decrease stress, increase balance and co-ordination, decrease body fat, decrease CAD, decrease osteoporosis, relaxation, increase muscle tone/flexibility/posture, increase CR and resp function, increase well being and confidence
how does a stress fracture and tendinopathy occur- wear
training load, previous injury, muscle weakness, LL biomechanics, footwear, training surface
how does a stress fracture occur- repair
bone structure, insufficient calories, diabetes, medication- steroids, increase age, gender, genetic predisposition, sedentary behaviour, sleep, stress, rheumatological disorders
why do we use eccentric exercise
sarcomeregenisis- process of adding sarcomeres, allow MTU to contract ore effectively and grow stronger
what is mechanotransduction
the process by which the body converts mechanical loading into cellular responses
3 stages- mechanocoupling (mechanical trigger), cell-cell communication (communication throughout a tissue to distribute the loading message), the effector response (the response at the cellular level to effect the response)
mechanotransduction- stage 1
mechanocoupling- the physical load causing a physical perturbation to cells that make up the tissue. tendons can also experience compressive forces, which elicit a deformation of the cell that can trigger a wide array of responses depending on the type, magnitude and duration of loading.
mechanotransduction- stage 2
cell to cell communication- the signalling proteins for this step includes calcium and insoitol triphosphate. the key point is the stimulation of one cell leads to a distant cell registering a new signal even though it is not stimulated.
mechanotransduction- stage 3
effector cell response, focuses on boundary between extracellular matrix and a single cell. this process can be harnessed by mechanotherapy to promote tissue repair and remodelling.
how do plyrometric work
generate rapid stretch in the muscles, and over time the body adapts by increasing the efficient of the movement, by redirecting the forces generated to produce more force in return
