Tx Protocols

Question 1

Stretch technique

Answer 1

stretches should be held for 15-30 seconds and performed after a mild warm up or activity

long held stretches prior to vigorous activity INCREASE the chance of injury

Question 2

Lifestyle factors to address

Answer 2

sleep
nourishment
blood supply, movement
smoking
alcoholism
diabetes, blood sugar control 
social support, community
lower toxic load

Question 3

Basic treatment flow

Answer 3

PRICE: protect, rest, ice, compression, elevation
then METH: move, exercise, traction, heat

METH increases blood flow, collagen formation and ROM while decreasing healing time.

When pain decreases, begin pain-free PROM and active-assistive ROM.
Normalize ROM and biomechanics, perform symptom-free ADLs, improve neuromuscular control and muscle strength.
Warm up prior to activity.
Isometric exercises, then concentric exercises, then eccentric exercises, finally to activity/sport-specific exercises.
Aquatic therapy may be used to increase activity without weight bearing.
Ice may decrease pain/inflammation post activity.

Question 4

Myofascial healing

Answer 4

Acute:
PRICE/METH, avoid aggravating activities, pain control, increase protein, zinc, magnesium, manganese, calcium and water intake

Post-acute:
PFROM asap, switch to heat to improve local blood flow, soft tissue mobilization and manipulation to improve ROM and reduce contracture (regular stretching)

Remodelling:
Work toward functional recovery, proprioception improvement, proper warm-up before activity, address technique issues or biomechanical imbalances that predispose to injury, strengthening exercises, stretch after exercise for flexibility

Question 5

Ligament healing

Answer 5

Acute:
PRICE/METH, avoid aggravating activities, pain control, short term immobilization (tensor bandage, ice), NSAIDs short term, avoid re-injury

Post-acute:
PFROM asap, switch to heat to improve local blood flow, soft tissue mobilization and manipulation to improve ROM and reduce contracture (regular stretching), consider prolo if unstable

Remodelling:
Work toward functional recovery, proper warm-up before activity, address technique issues or biomechanical imbalances that predispose to injury, slowly move from isometric to eccentric and then activity specific activities

surgical consult warranted w/ failure to repsond to conservative care, marked joint instability or severe cases which may have multifactoral causes

Question 6

Joint cartilage healing

Answer 6

Acute:
PRICE/METH, avoid aggravating activities, pain control, short term immobilization (1-2 days max), avoid re-injury

Short term meds: aspirin, naproxen, ibuprofen
(glucocorticoids increase cartilage degeneration with long-term use)

Post-acute:
PFROM asap, switch to heat to improve local blood flow, soft tissue mobilization and manipulation to improve ROM and reduce contracture (regular stretching) and increase synovial fluid movement, improve diet and weight control, glucosamine sulfate and GAG supplementation, consider PRP injections

Remodelling:
Work toward functional recovery, address biomechanical imbalances that predispose to injury, slowly move from isometric to eccentric and then activity specific activities

surgical consult warranted w/ failure to respond to conservative care or severe

Question 7

Bone injury (fracture) healing

Answer 7

protect from re-injury (soft cast), adequate calcium, Mg, Zn, phosphate, carbs, protein
address systemic diseases like diabetes (also thyroid hormone) that slow healing

Question 8

Fracture complications

Answer 8

neurovascular damage, compartment syndrome, fat embolism, thrombus formation, infection (gas gangrene)

refracture, synostosis, delayed union, osteomyelitis, reflex sympathetic dystrophy, myossitis ossificans

osteonecrosis, nonunion, malunion, DJD, osteoporosis