Soft Tissue Response Flashcards
what are the 2 steps to a logical process to evaluate the extent of an injury
- understand the mechanism of the traumatic sequence
- understand how to methodically inspect an injury (HOPS)
what is soft tissue?
non-bony tissue
- skin, muscle, tendon, ligament, fascia, blood vessel, nerve
- common injuries include sprains, strains, contusions, tendinosis/tendinopathy
-each tissue will have a yield point (or elastic limit)
tissue structures are…
stronger in resisting forces from certain directions compared to others
what does the anatomical design of joints mean
that they are more susceptible to injury from a given direction
how is force categorized
according to direction from which force acts
define compression + example
axial loading along an axis
landing from a jump
define tension + example
stretching, pulling along an axis
lateral ankle sprain
define shearing + example
oppositely directly loads that are parallel
plant & turn
what injuries are a result of forces applied in different directions
abrasions
incisions
laceration
avulsion
puncture
blisters
what is open wound management
control bleeding
gauze to apply pressure
clean the wound (soap and water or saline; remove debris)
dress the wound
make sure ends are approximated; use butterfly or steri-strips or stitches
what are the two physical responses to physical trauma
inflammation and healing
what is necrosis
when deprived of oxygen results in cell death
what is hematoma
pool of blood with disrupted tissue
result of trauma primary injury
bleeding and damaged tissue
result of trauma secondary injury
damage occurring secondary to the primary injury
describe the components of blood
liquid fraction: plasma
- makes up 55%
formed elements: Blood cells
- makes up 45%
- RBC
- WBC
- Platelets (thrombocytes)
what is inflammation
complex biological response of vascular tissues to harmful stimuli such as pathogens, damaged cells, or irritants
includes a complex set of events – series of interrelated physical and chemical activities
what does inflammation do
localize the extent of the injury so there doesn’t become a secondary one
remove foreign material and dying tissues so that healing can begin
what are the 3 phases of inflammation
- acute vascular response/inflammation (4-6 days)
- repair and regeneration/proliferation (2-24 days)
- re-modeling and maturation (21 days - 2 years)
define vasodilation
widening of bloodvessel
define vasoconstriction
constriction of bloodvessel
define hypertrophy
increasing cell size
define atrophy
decreasing cell size
define necrosis
death of cell
describe phase 1 (acute vascular response)
- injury
- increase blood flow
- mobilize and transport cells
- remove damaged cells
- body puts out new collagen
immediate vasoconstriction then histamine causes vasodilation and increased vascular permeability. WBC and macrophages get rid of unwanted substances and platelets seal off area. fluid leaks out of blood vessels and results in edema (swelling) causing secondary injury and then gets drained through lymphatic system
what are some signs and symptoms of inflammation
signs —> redness, swelling, heat, pain
symptoms —> loss of function, limited joint or muscle ROM, palpable tenderness
treatment for inflammation
decrease pain and swelling
prevent chronic inflammation
maintain mobility and strength in adjacent areas
injured areas rest
describe phase 2 (repair and regeneration
(proliferation)
begins once the debris is cleared
the dense capillary network will form
fibroblasts proliferate damaged areas and makes collagen
collagen forms a loose mesh network of connective tissues at the injury site
new collagen fibers a laid down in a disorganized manner - in the form of a scar
weak links between each fibre
new tissue is weak and susceptible to disruption by overly aggressive activity
signs and symptoms of proliferation
less warmth and swelling
palpable tenderness decreases
pain felt with tissue resistance or stretch of the tissue
treatment focus of proliferation
ROM exercises
joint mobilization
light loads to promote tissue remodel
describe phase 3 (remodelling and maturation)
begins once fibroblasts disappear
scar tissue collagen begins to align with direction of stress and the cross-link formation becomes more organized
scar tissue is avascular and inelastic
remodeling may take months to years to complete
signs and symptoms of remodelling and maturation
improved ROM and strength
stretching, active contraction, resistive loads
what is the therapist’s role in the three phases
minimize initial damage and promote the healing process - address the inflammatory response
ensure undue stress is avoided until tissues are ready (even on healthy tissues)
whats rehab therapy look like for muscle and tendons
muscle ~ 3 wk
tendon ~ 4-6 wk
early activity promotes full strength and ROM return. too early could cause increased bleeding and edema and decreased ROM
whats rehab therapy look like for ligaments
ligaments ~ 6-12 months
stress during remodeling increase collagen strength
too early could increase length of fibers and increase joint laxity
define shock
diminished amount of blood available to the circulatory system. As a result, not enough oxygen-carrying blood cells are available to tissues
describe hypovolemic shock
caused by too little blood volume
define cardiogenic shock
due to heart problems
define anaphylactic shock
caused by severe allergic reaction
define septic shock
due to infection
describe neurogenic shock
caused by damage to the nervous system
describe obstructive shock
caused by embolism, pneumothorax
signs and symptoms of shock
signs
pulse; rapid or weak
skin; cool, clammy, pale
breathing; rapid, shallow
sweating; profusely
pupils; dilated, dull eyes
BP; steadily falling
unconsciousness
symptom
nausea
whats the treatment for shock
comforting the athlete and screening the injury
maintain body heat, so warm blanket
elevate feet and legs
continue to monitor vitals
what does RICE mean
Rest - prevent further damage (10min - 10 months)
Ice - only if huge injury or violent response reduces blood flow and increases stiffness
compression - reduces swelling, comfort
elevation - reduces swelling, limits blood, encourages venous return
support - stabilization and immobilization will prevent further injury
what does POLICE mean
Protect
Optimal Loading
Ice - only if huge injury or violent response
compression
elevation
what is return to play (RTP)
able to return to playing sports or participating in an activity at a pre-injury level
what is return to sport (RTS)
if seen by physician and received medical clearance;
pain free
no swelling
no tenderness
80-100% strength
80-100% balance and coordination
what is the interdisciplinary approach to functional mechanics
injury occurs due to failure of some biological structure (application of force > adaptation by body)
what is the interdisciplinary approach to physiology
if tissues are strong, moderately flexible and not fatigued, there is a better chance of not getting injured
what are 3 things to look at in psychological perspective
- predisposition to injury - identify those at risk
- reaction to injury - understand typical responses of athletes
- rehabilitation - optimizing recovery - speed of recovery and maintenance of performance levels
what are some psychological issues relative to athletic injury
loss of social aspects
loss of identity
loss of importance
depression, anxiety, other behavioral factors (ED, grades, anger)
what is the psychological response
injury occurs —- athlete has realized the severity of the injury —- thought process begins (cognitive appraisal)
what questions are asked during cognitive appraisal
how bad?
how long will i be out?
surgery?
rehab/treatment?
can i get back to where i was athletically?
am i finished?
what else is there the do?
what are the stages of the coping model
denial
anger
grief or desperation
depression
acceptance or reintegration
but EVERYONE reacts differently
describe cognitive appraisal model
personal/situational factors influence cognitive appraisal of injury
appraisal influences emotional/behavioral responses, including recovery outcomes
takes into account individual differences in response to injury
what is cognitive appraisal model influenced by
personal factors
- personality traits, locus of control, goals, what the athlete brings to the situation
situational factors (anxiety, focus, worry, emotion, confidence etcc)
- related to the athletes social context - sport, social, environment (familiarity, star player? length of rehab? social support etc..)
what are 3 coping strategies
- appraisal focus - athlete modifies the way they think
- problem (action) focus - athlete makes an effort to do something active to alleviate stress
- emotion focus - athlete tries to regulate emotional consequences
how to AT and coaches fit into injury
AT see athlete first (positive or negative for athlete)
coaches’ reaction to injury
WORDS HAVE A POWERFUL IMPACT
what prevents athletes from being able to successfully cope with their injuries
adherence and positive attitude
psychosocial strategies for athletes
keep the athlete involved with the team
use short term goals
create variety in rehabilitation
understand motivation
use effective communication
setting realistic goals
positive reinforcement
how to use positive self talk
identify what
identify when
replace with positive
how to use imagery
facilitate relaxation
facilitate healing process
control pain
maintain skill
block replay of injury
what are other rehab interventions
education
goal setting
awareness
spare time
providing social support
what is the rehab wheel
assesses areas to reduce stress to facilitate restoration of physiological and psychological states
PERSONAL and PHYSICAL
