treatment principles

Question 1

key questions to ask for intervention planning?

Answer 1

What is the stage of healing?
How long do you have to treat the patient?
What does the patient do for activities?
How compliant is the patient?
How much skilled physiotherapy is needed?
What needs to be taught to prevent recurrence?
Are any referrals needed?
What has worked for other patients with similar problems? Are there any precautions?
What is your skill level?

Question 2

what is often associated with soft tissue damage?

Answer 2

pain, inflammation and edema

Question 3

what are pain and edema part of?

Answer 3

part of the healing process

Question 4

what clinical findings are associated to pain and inflammation?

Answer 4

Swelling
◦ Redness
◦ Heat
◦ Impairment or loss of function
◦ Pain at rest or with active movement or when specific stress is applied to the injured structure ◦ Pain if severe enough can result in muscle guarding and loss of function
◦ With PROM pain is reported before tissue resistance is felt by the clinician

Question 5

what is the objective of pain?

Answer 5

serves as a protective mechanism

Question 6

what are the goals of the inital intervention phase in acute lesions?

Answer 6

Decrease pain - Avoid painful positions
◦ Control edema and inflammation
◦ Protect the damaged structures from further damage
◦ While attempting to increase function – Improve ROM (may require education)
◦ Reduce muscle atrophy through gentle isometric setting
◦ Maintain aerobic fitness

Question 7

what is PRICEMEM

Answer 7

Protection 
◦ Rest
◦ Ice
◦ Compression
◦ Elevation
◦ Manual therapy
 ◦ Early motion
◦ Medications

Question 8

what needs to be avoided with protection associated with pain and inflammation?

Answer 8

excessive tissue loading must be avoided (crutches, slings, splints)

Question 9

what do we need to be weary of of rest associated to pain and inflammation?

Answer 9

absence from abuse vs absence from activity – prolonged immobilization can have a detrimental effect on muscles, ligaments, bones, collagen, and joint surfaces

Question 10

when is ice used in pain and inflammation?

Answer 10

until swelling has decreased

Question 11

what can be used to provide compression to pain and swollen area?

Answer 11

elastic bandage

Question 12

what is the aim of elevation of the extremity that is swollen and painful?

Answer 12

aids in venous return and helps minimize swelling

Question 13

when should elevation and compression be used to control swellling and pain?

Answer 13

used until the swelling has completely disappeared

Question 14

what is manual therapy in the control of pain and inflammation?

Answer 14

controlled application of a variety of manual techniques have therapeutic benefits

Question 15

how can manual therapy help control pain and inflammation?

Answer 15

Stimulation of the large-fiber joint afferents of the joint capsule, soft tissue, and jointcartilage which aids in pain reduction
◦ Stimulation o fendorphins–pain reduction
◦ Decrease on intra-articular pressure–pain reduction
◦ Mechanical effect–increases joint mobility
◦ Remodeling of local connective
tissue
◦ Increase of
the gliding of tendons within theirs heaths
◦ Increase in
joint lubrication

Question 16

how can early motion help control pain and inflammation?

Answer 16

reduce muscle atrophy
◦ maintain joint function
◦ prevent ligamentous creeping
◦ reduce the chance of excessives carring
◦ enhanced cartilage nutrition and vascularization–early recovery and enhanced comfort
◦ ROMexercises–passive or active–while protecting the healing tissue

Question 17

how can meds help reduce pain and inflammation?

Answer 17

can help with healing process
NSAIDS can control inflammation
corticosteroid injections can serve to decrease pain at the site of inflammation (requires education as it decreases symptoms but won’t heal)

Question 18

interventions to promote and progress healing inflammation

Answer 18

PRICEMEM
electrotherapeuthic and physical modalities to help contrpl pain swellin, however heat and US are introduced once the acute stage is done
manual therapy such as masse or mobilization.

Question 19

Tissue repair can be viewed as an adaptive life process in response to what?

Answer 19

intrinsic and extrinsic stimuli

Question 20

promotion and progression of tissue repair involves a delciate balance between what?

Answer 20

protection and application of controlled functional stresses to the damaged structure

Question 21

does physical therapy accelerate the healing process?

Answer 21

no, but With correct education and supervision it can ensure that the healing process is not delayed or disrupted and that it occurs in an optimal environment

Question 22

the rehabilitation procedures used to assist with repair differ depending on

Answer 22

Type of tissue involved
◦ Extent of the damage
◦ Stage of healing

Question 23

clinical findings associated with the promotion and progress during the proliferative phase

Answer 23

◦ Decrease in pain and swelling
◦ Increase in pain-free active and passive ROM
◦ During PROM pain and tissue resistance occur at the same time
◦ ROM still not WNL – stress applied to the injured structure still produces pain, but less

Question 24

intervention goal for proliferative healing phase?

Answer 24

Protect the forming collagen, direct its orientation to be parallel to the lines of force it must withstand, and prevent cross-linking and scar contracture
◦ Make scar strong and flexible

Question 25

how to intervene in the case of a proliferative phase of healing?

Answer 25

• progressive increase in movement; aim to have full ROM in 3-4 weeks
• Progress from PROM –> AAROM –> AROM
• Strengthening move away from isometric
• as ROM and joint play increase, concentric exercises are initatied
• manual therapy to mobilize the joint, transverse frictions fro scar healing

Question 26

what happens in the even of an overly aggressive approach in the proliferative phase of healing

Answer 26

result in delay or disruption in the repair process through an increase in the stimulation of the inflammatory chemical irritants and exudates

Question 27

when is pain generally felt during the remodeling phase of healing?

Answer 27

Pain typically felt at the end of range with PROM, after the tissue resistance has been encountered

Question 28

interventions executed by the PT to promote healing in the remodeling phase?

Answer 28

• apply SAID principles
• exercises should include OC (non weight bearing) or CC (weight bearing)
• concentric and eccentric contractions
• functional and sport specific exercises
• manual therapy; joint mobilization, passive stretch and myofasical release

Question 29

how can a pt’s functional status be improved or maintained?

Answer 29

by strength, endurance and flexibility exercises

Question 30

how should the exercises be in the aim to strengthen or increase flexibility?

Answer 30

reate exercises that are safe yet challenging, progressive, systematic,proprioceptively enriched, activity specific and based on evidence based science

Question 31

why is it important to work on proprioception

Answer 31

knowing where limbs are in space
for balance
avoid falls

Question 32

what is the goal in correcting posture in pt, especially if cause of symptoms

Answer 32

Alleviate symptoms

◦ Educate pt against habitual abuse

Question 33

what interventions are executed by the PT when assessing and correcting posture

Answer 33

◦ restoration of normal length of the muscles
◦ Strengthening of the muscles that have become inhibited and weak
◦ Establishing optimal motor patterns to secure the best possible protection to the joints and surrounding soft tissues

Question 34

what does CKC?

Answer 34

when the distal aspect of the limb pushes onto something

Question 35

why is CKC commonly used?

Answer 35

replicated functional tasks
enhance joint congruency
decrease shearing force

Question 36

what is an advantage of OKC rather than CKC

Answer 36

better muscle isolation

Question 37

what are CKC exercises used to help?

Answer 37

Are used to help reinforce the synchronization of the necessary muscle-firing patterns for both antagonist and agonist ms groups used during stabilization and ambulation

Question 38

what is open kinetic chain

Answer 38

distal end of the limb is free to move

Question 39

what is neuromuscular reeducation?

Answer 39

method of training the enhancement of unconscious motor responses, by stimulating both afferent signs signals and central mechanisms responsible for dynamic control`

Question 40

what are the goals of incorporating NMR?

Answer 40

improve the ability of the nervous system to generate a fast and optimal muscle-firing pattern ◦ Increase joint stability
◦ Decrease joint forces
◦ Relearn movement patterns and skills

Question 41

when should NMR be added in rehab?

Answer 41

Initiated as early as possible in the rehab process

Question 42

what is the ultimate goal in improving functional outcome of the patient?

Answer 42

• restore pt confience
• improve fct without harming healing structures
• begin with simple tasks and progress to complex one
• SAID principle to meet specific vocational demands, ADLs or recreation

Question 43

help pt maintain or improve overall fitness what shoulld try to maintain what

Answer 43

cardiovascular endurance

Question 44

what is one of the most important aspect of pt treatment

Answer 44

pt education in any treatment intervention

Question 45

what should be aborded in pt education

Answer 45

• things that can be controlled and changed
• educate about the pt condition so they understand their own role in the rehab process
• discuss strategies to adopt and discuss goals of treatment

Question 46

what is the ultimate goal of the PT in terms of treatment?

Answer 46

safely return a pt to their preinjury state with as little risk of reinjury as possible

Question 47

what type of approach is used in the case of a chronic injury or pain?

Answer 47

biopsychosocial approach