Sprains, Healing Phases, Rehab Components

Question 1

What is rehabilitation?

Answer 1

Restoring something to it’s original state

Question 2

What is a Grade I sprain?

Answer 2

Stretching and small tears - less than 50% of tissue fibers

Question 3

What is a Grade II sprain?

Answer 3

More than 50% of fibers torn, but less than a complete tear

Question 4

What is a Grade III sprain?

Answer 4

Complete tear of the tissue in question

Question 5

What is a Grade IV sprain?

Answer 5

Complete tear of the tissue with the separation occurring at the bony attachment point

Question 6

What is an evulsion fracture?

Answer 6

When a bony attachment point breaks off its bone and tears away with the muscle or ligament. Always requires surgical intervention

Question 7

In evaluation, what does a Grade I sprain feel like?

Answer 7

Milk laxity with stable end point

Question 8

In evaluation, what does a Grade II sprain feel like?

Answer 8

Moderate laxity, with a soft end point

Question 9

In evaluation, what does a Grade III sprain feel like?

Answer 9

Significant laxity without end point. Joint is likely floppy, may bend the wrong way, etc.

Question 10

What are the patient complaints of a Grade I sprain?

Answer 10

• minimal pain and swelling
• minimal loss of function
• bruising unlikely
• no difficulty bearing weight

Question 11

What are the patient complaints of a Grade II sprain?

Answer 11

• moderate pain and swelling
• some loss of function
• bruising likely
• difficulty weight bearing

Question 12

What are the patient complaints of a Grade III sprain?

Answer 12

• severe pain and swelling
• significant loss of function
• bruising
• difficulty weight bearing

Question 13

What is the return to activity time for a Grade I sprain?

Answer 13

2 - 4 weeks

Question 14

What is the return to activity time for a Grade II sprain?

Answer 14

6 - 8 weeks

Question 15

What is the return to activity time for a Grade III sprain?

Answer 15

12 weeks - 6 months

Question 16

What are the 3 phases of healing?

Answer 16

• Inflammatory (Acute)
• Repair (Subacute)
• Remodeling (Chronic)

Question 17

What is the key to controlling Phase I of healing?

Answer 17

Controlling inflammation - not necessarily stopping it

Question 18

What are the symptoms of acute inflammation?

Answer 18

SHARP

• swelling
• heat
• a loss of function
• redness
• pain

Question 19

What is are the therapy goals in the inflammation phase?

Answer 19

• reducing pain and swelling

- movement in non-painful directions is recommended (with minimal weight bearing)

Question 20

How long does Phase I of healing usually last?

Answer 20

48-72 hours

Question 21

When is Phase II of healing?

Answer 21

72 hours - 6 weeks

Question 22

During Phase II we must be careful not to overdo it or what can happen?

Answer 22

A return to acute inflammation

Question 23

What is the primary goal of treatment in the repair phase?

Answer 23

Loading the tissue (without overloading) to ensure the maximum amount of collagen is laid down in the correct direction

Question 24

When does phase III of healing take place?

Answer 24

6 weeks - 2 years depending on severity

Question 25

What is the dominant activity during the remodeling phase?

Answer 25

The body redirects the fibers of the healing tissue to orient them along the lines of greatest stress

Question 26

What are the goals of soft tissue manipulation (fluid)?

Answer 26

- Mobilization of fluid - Reduction of edema - Increase local blood flow

Question 27

What are the goals of soft tissue manipulation (pain)?

Answer 27

- Reduce pain - eliminate MFTP (myofascial trigger points) - elimination of adhesions

Question 28

What are the goals of soft tissue manipulation (muscle)?

Answer 28

- Decrease muscle soreness / stiffness - Increase ROM - Facilitate relaxation - Reduce spasm / hypertonicity - Restore balance to a motion segment

Question 29

What are local contraindications to soft tissue work?

Answer 29

- acute inflammation - acute circulatory disturbance - acute dermatological problems - fever (systemic infection) - local infection (pus) - new burns - abdominal tumor or aneurysm

Question 30

What are the 8 parts of a rehab program?

Answer 30

1. Neutral pelvis, abdominal bracing, hip hinging 2. Directional preference 3. Posture and breath training 4. Return to activity 5. Floor exercises for stability 6. Weight bearing exercises 7. Balance global muscles 8. Proprioceptive / balance training

Question 31

What is the purpose of hip hinging?

Answer 31

Avoiding end-range load during activities of daily living

Question 32

What is directional preference?

Answer 32

Exercises and advice to modify daily activities to prevent load in the direction of mechanical sensitivity

Question 33

What are the 3 exercises most commonly prescribed to work the “physiological corset?”

Answer 33

- Quadruped - Curl up / dead bug - Side bridge

Question 34

What are the weight bearing exercises commonly prescribed to most patients? What is their purpose?

Answer 34

- Double and single leg squats - Lunges To - Reinforce core stabilization - Build endurance and coordination of anti-gravity muscles

Question 35

Rehab step 7 - balance large, global muscles - has 3 goals:

Answer 35

- Stretch tight muscles - Activate inhibited muscles - Build endurance

Question 36

Proprioceptive / balance training is performed on?

Answer 36

``` Unstable surfaces: - foam pad - rocker boards - gym ball Etc. ```

Question 37

What STM techniques are appropriate during the Acute phase?

Answer 37

- Reciprocal inhibition - MTFP (referring TP only) - Post Isometric Relaxation (in certain circumstances)

Question 38

What treatment techniques are appropriate during the Repair phase?

Answer 38

- Pin & Stretch - Post Isometric Relaxation - MFTP Release - Cross Fiber Friction And techniques that also work for the Acute phase: - Reciprocal Inhibition