Tissue Healing & Pain Flashcards
macrotrauma
produces immediate pain and disability
large trauma, tissue disrupted
microtrauma
-overuse injuries and result from repetitive loading or incorrect mechanics from normal or abnormal loads
-small event to tissue over and over to lead to tissue damage
secondary injury
what happens after injury
-if the body gets through it or gets stuck in this process
what is 5 key clinical signs of inflammation?
heat
redness
swelling
pain
loss of function
what is inflammation?
protective response to remove the irraitating stimulus and initiate healing
what is the cause of heat and redness during inflammation?
increased vascularity
what is the cause of swelling during inflammation?
blockage of lymphatic drainage
what is the cause of pain during inflammation?
pressure or chemical irritation of pain sensitive structures
what is the cause of loss of function during inflammation?
a result of pain and swelling
chronic inflammation
acute inflammatory response does not eliminate the injury agent and restore tissue to its normal state
what can low grade inflammation process cause?
-damage to connective tissue
-tissue necrosis & fibrosis
-appears to be related to microtrauma
-resistant to physical & pharmacologist treatment
what is the 3 main phases of healing?
-inflammatory/acute/protective Stage
-proliferation/subacute/controlled motion Stage
-maturation/chronic/return to function Stage
describe the inflammatory phase: time frame & clinical picture
-0-6 days
Clinical picture:
-characterized by 5 signs of inflammation
-painful movement, constant
-patient guarding, limited function
- increased tissue tension
-increased edema
describe proliferation phase: time frame and clinical picture
Time: 3-20 days
Clinical Picture:
-decreased signs of inflammation
-localized tenderness to touch (early)
-complain of pain when movement stresses injured tissue
describe the 3 stages of proliferation phase
-Early: decreased swelling, major increase
-Mid: stagnant, symptoms still there but show later in ROM
-Late: very little pain only at end of ROM
describe maturation phase: time and clinical picture
Time: 20 days to 3 years
Clinical picture:
-no signs of inflammation
-contractures or adhesions limit motion
-pain felt well with passive overpressure
-function limited by weakness, decreased endurance and/or poor neuromuscular control
-function is not limited pain
rehabilitation consideration in maturation phase
-Wolff’s Law
-aggressive AROM and strengthening key at the start of this phase
What is Wolff’s Law?
tissues respond to the demands places upon them causing remodeling or realignment of fibers along lines of tensile force
Name some factors that impact the rate of healing
-extent of trauma
-edema
-hemorrhage
-poor vascular supply
-separation of tissue
-muscle spasm
-atrophy
-corticosteriods
-keloids and hypertrophic scars
-infection
-humidity, climate, oxygen tension
-health, age, nutrition
what is pain?
unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
what are some things that is known about pain?
-individual
-past experience impacts perception of pain
-warning mechanism
-protects against injury
-prevents further injury
-can persist long after it is no longer useful
what is acute pain?
experienced after injury has taken place and tissue damage is occurring
what is chronic pain?
defined as pain lasting longer than 6 months
persistant pain (extension of chronic pain & described as pain that does not respond to intervention of a treatable condition)
what is referred pain?
pain perceived to be in an area that has little relation to the pathology
can be long lasting (altered reflex patterns, continued mechanical stress on muscles, learned habits of guarding, & development of trigger points)
what is radiating pain?
caused by irritation of nerves and nerve root
what is deep somatic pain?
-pain coming from a sclerotome (sclerotome is a segment of bone innervated by spinal segment)
-often a difference between the site of pain and the location of pathology
how do you measure pain?
many tools;
-type of pain
-quantify of pain intensity
-evaluate effect of pain on function
-psychological impact of pain
assess the psychological response to pain and injury
how do pain charts work?
-established spatial properties of pain
-asses location of pain and the number of subjective components
-draws/colors areas corresponding to nature & location of pain
-could complete daily
explain numeric pain scales
-used before & after intervention
-other associated questions
-helps clinician assess changes in pain, appropriate intervention, and communicate clearly about recovery
explain McGill pain questionnaire
-78 words that describe pain (group into 20 sets & 4 categories describing pain)
-takes 20 minutes
-commonly used for those with lower back pain
-effectively shows change when administered every 2-4 weeks
When doing pain management strategies explain how to encourage activities that influence the perception of pain?
motivation techniques
relaxation techniques
meditation
diaphragmatic breathing
when using pain management strategies how can you give a patient extension education?
-explain what the patient should expect during recovery process
-discuss the signs of inflammation, dysfunction, & atrophy
-encourage gentle progression of activity to;
(Improve blood flow to tissue, promote nutrition of tissues, reduce stiffness and guarding)
how can you validate a patients pain?
-throw judgement out the window
-all pain is very real to patient, even if it begins as psychosomatic
how can you use the patients response as an intervention to guide treatment sessions?
-constantly reassess patient’s response to intervention
(establish baseline, inquire during activity about symptoms, re-assess pain level post activity)
what are the 5 pain management strategies?
- encourage activités that influence the perception of pain
- give patient extension education
- validate patients pain
- incorporate pain modulating modalities where appropriate
- use patient response to intervention to guide treatment
