Week 1: Introduction to treatment of the musculoskeletal system (Masterclass) Flashcards
Healing time: Tendon
2-12 weeks
Healing time: Muscle
3 weeks - 3 months
Healing time: Bone
6-8 weeks
Healing time: Ligament
6-12 weeks
Healing time: Fibrocartilage (meniscus, TFCC, TMJ)
8-12 weeks
Healing time: Articular cartilage (inside all joints)
3-6 months
Healing time: Nerve
2-5mm/day (several months to over a year)
Healing time: skin
3 days to 2 weeks
What does the biopsychosocial model include from a treatment perspective?
- Patient values
- Research evidence
- Therapist clinical expertise
How does exercise work… What is mechanotransduction?
Mechnotransduction: Biological process by which mechanical load is received and converted into a cellular response leading to structural change of the tissue.
How does exercise work….What is mechanotherapy?
- How therapeutic exercise is used to promote beneficial tissue adaptations e.g. repair/remodeling
Outline stage 1 of the exercise response…
Stage 1: Mechanocoupling – the loading trigger
- The physical load causes physical perturbation to cells that make up a tissue
- E.g. every step the Achilles tendon receives tensile loads. Cells in the tendon recognise this load
What is the envelope of function?
- A representation of the tissues ability to deal with loading in comparison to frequency
- Our envelope = all activities of our day to day life
- Activities that cause pain fall outside of this envelope of function
In the envelope of function what is the zone of supraphysiologic overload?
More load than the tissue can handle. The zone of supraphysiological overload zone will disrupt homeostasis but it will not instantly cause structural failure
In the envelope of function was is the zone of subphysiologic underload?
If you only perform activities in the bottom with low load and low frequency you will experience deconditioning
In the envelope of function how does structural failure occur?
Prolonged overload in the supraphysiologic zone may eventually lead to structural failure
Outline stage 2 of the exercise response…
Stage 2: Cell to cell communication
- Cells distribute the message that the tendon has been loaded
Outline stage 3 of the exercise response…
Effector cell response
- Activate production of new proteins
- E.g. in tendon there is an upregulation of insulin-like growth factor (IGF-1) which is associated with cellular proliferation and matrix remodeling
- Increased tendon stiffness and CSA*
- To maximize these effects in tendons high intensity muscle contractions (e.g. 80% max and interventions longer than 12 weeks required for optimal adaptation)
What was the initial explanation for how manual therapy worked… why was this incorrect?
Initial thoughts that manual therapy (e.g. pushing on joints) led to changes in the length of connective tissues ie increases ROM by making it looser, such as the joint capsule/ligaments and muscles
This is biomechanically not correct - the forces we apply aren’t strong enough to provide permanent changes in patients soft tissue length
How does manual therapy work?
- Complex neurophysiological response from the PNS & CNS
- Mechanical stimulation (eg pushing on joints) triggers afferent neurones located in skin/joint/muscle
- This stimulation can have several responses - pain inhibition, neuromuscular inhibition or facilitation
Manual therapy is appropriate if:
Passive movement limited by some combination of pain and stiffness
Note:
- If targeting Pain… treatment should < Pain
- If targeting stiffness… treatment should < stiffness
What is the name of the grading system for manual therapy?
Maitland
What is a grade I amplitude in manual therapy?
Small amplitude movement at the beginning of the available range of movement (small oscillation)
What is a grade II amplitude in manual therapy?
Large amplitude movement at within the available range of movement (pass mid-range)
