Tissue Healing & Pain

Question 1

Healing Process

Answer 1

Physiologic response of tissue following trauma

-Impacted by phase of healing and appropriate progression of therapy

Question 2

Primary Injury

Answer 2

Acute injury as a result of microtrauma or macrotrauma

Question 3

Macrotrauma

Answer 3

Produces immediate pain and disability

Question 4

Microtrauma

Answer 4

Overuse injuries and result from repetitive loading

Question 5

Secondary Injury

Answer 5

A destructive and self-propagating biological change in cells and tissues that leads to damage hours or weeks after primary injury

Question 6

5 Key Clinical signs of inflammation

Answer 6

Calor- Heat
Rubor- Redness
Tumor- Swelling
Dolor - Pain
Function laesa- loss of function

Question 7

Calor cause

Answer 7

Increased vascularity

Question 8

Rubor cause

Answer 8

Increased vascularity

Question 9

Tumor cause

Answer 9

Blockage of lymphatic drainage

Question 10

Dolor cause

Answer 10

Pressure or chemical irritation of pain sensitive structures

Question 11

Function laesa cause

Answer 11

Result of pain and swelling

Question 12

3 phases of healing

Answer 12

Inflammation
Proliferation
Maturation

Question 13

Inflammatory Phase

Answer 13

0-6 Days
Critical to entire healing process
5 signs of inflammation

Question 14

Inflammatory Process

Answer 14

• Disposal of injury by products
• Localized to trauma area
• Sets the stage for repair
• Disturbed fluid exchange
• Migration of leukocytes from blood to tissues

Question 15

Proliferation Phase

Answer 15

3-20 Days
Cover the wound and impart strength to the injury site
Injured site has greatest amount of collagen, but tensile strength may be 15% of normal

Question 16

Proliferation Process

Answer 16

Growth of capillary beds into wound stimulated by lack of O2
Increased blood flow
Collagen fibers deposited in random fashion

Question 17

Proliferation clinical picture

Answer 17

Signs and symptoms of inflammation subside
Tenderness to touch
Typically pain during stressing movements

Question 18

Maturation Phase

Answer 18

20 days to 3 years

Realignment or remodeling of the collagen fibers that make up scar tissue

Question 19

Maturation Clinical Picture

Answer 19

No signs of inflammation present
Contractures or adhesions may limit motion
Pain felt after tissue resistance w/ passive overpressure
Weakness; Poor endurance; Poor neuromuscular control

Question 20

Wolff’s Law

Answer 20

Tissues respond to the demands placed upon them causing remodeling or realignement along lines of tensile force

Question 21

Pain

Answer 21

Unpleasant sensory and emotional experience associated with actual or potential tissue damage, and described in terms of such damage

Question 22

Types of Pain

Answer 22

Acute; Chronic; Referred; Radiating; Deep Somatic

Question 23

Acute Pain

Answer 23

Experienced after injury when tissue damage is occuring

Question 24

Chronic Pain

Answer 24

Pain lasting longer than 6 months; low-grade inflammation

Question 25

Referred Pain

Answer 25

Pain perceived to be in an area that has little relation to the pathology

Question 26

Kehr's Sign

Answer 26

Pain in the shoulder can be coming from the spleen

Question 27

Radiating Pain

Answer 27

Caused by irritation of nerves and nerve roots

Question 28

Deep Somatic Pain

Answer 28

Pain emmanating from bone | Often discrepancy from site of pain and location of pathology

Question 29

What do we gain from rating pain?

Answer 29

Improves communication Directs clinician testing Standard measure for monitering progress Provides documentation of progress

Question 30

What does the patient gain from rating pain?

Answer 30

Reassurance | Reinforce the commitment to the plan of treatment

Question 31

Visual Analog Scales

Answer 31

Completed daily or pre/post treatment | Patient places mark on 10 cm line, therapist measures

Question 32

Pain Charts

Answer 32

Establishes spatial properties of pain | Draws/colors areas corresponding to nature and location of pain

Question 33

McGill pain questionairre

Answer 33

78 words that describe pain Takes ~20 minutes to complete Commonly used for Pt w/ LBP Effectively shows change every 2-4 weeks

Question 34

Activity Pattern Indicators Pain Profile

Answer 34

64 question, self report tool Functional impairments associated w/ pain Frequency of behaviors

Question 35

Numeric Pain Scales

Answer 35

Most Common acute pain profile Before and after Tx 0-10

Question 36

Encourage what types of activities to Pt in pain?

Answer 36

Ones that influence the perception of pain

Question 37

Patient education of pain

Answer 37

What Pt should expect during recovery | Signs of inflammation, dysfunction, atrophy

Question 38

Should a Pt's pain be thrown out the window?

Answer 38

No; validate their pain

Question 39

How to treat a Pt with pain

Answer 39

Incorporate pain modulating modalities where appropriate

Question 40

How to guide treatment sessions w/ Pain

Answer 40

Use patient response | Needs an established baseline to be effective