Wounds/burns/scar Tissue/ Infalmmatory Process

Question 1

CONTRAINDICATIONS FOR WOUNDS AND BURNS

Answer 1

ACUTE STAGE- active resisted exercise if area large enough
- DIRECTION and PRESSURE of techniques must be modified in EARLY STAGES
- DRAG &TORQUING OF TISSUE AVOIDED

PRESSURE of TECHNIQUES directed TOWARDS the INJURY SITE -

HYDRO- MODIFICATIONS MADE- SENSITIVITY TO TEMPS- INABILITY TO DISSAPATE HEAT

AVOID DIRECT CONTACT

Question 2

GOALS FOR ACUTE AND EARLY SUBACUTE WOUNDS AND BURNS

Answer 2

PROMOTE RELAXATION
REDUCE PAIN
REDUCE EDEMA
DIAPHRAGMATIC BREATHING- ENCOURAGED THROUGHOUT TREATMENT

Question 3

ACUTE AND EARLY SUBACUTE
WOUNDS AND BURNS
THINGS TO ADD TO PROTOCOL

Answer 3

MASSAGE OF UNAFFECTED AREAS TO PROMOTE COMFORT ANSWERS STRESS REDUCTION
AFFECTED LIMB IS ELEVATED
DISTALLY ONLY- techniques that DO NOT INCREASE CIRCULATION through the injury ARE PERFORMED
- MUSCLE SQUEEZING OR STROKING

Question 4

WOUNDS AND BURNS
ACUTE AND SUB ACUTE
BEFORE SCARE TISSUE HAS MATURED TO REDUCE EDEMA…YOU CAN

Answer 4

SWEDISH MASSAGE
TISSUE JUST PROXIMAL TO WOUND CAN BE STABALIZED WITH ONE HAND
HAND MONITORS THE DRAG PLACED ON INJURY SITE

TECHNIQUES THAT DO NOT HAVE SHEAR FORCE- PRESSURE TOWARDS THE INJURY SITE

Question 5

FRICTIONS
CONTRAINDICATIONS

Answer 5

CLT TAKING ANTI-INFLAMMATORY MEDICATION

NOT OVER KELOID SCARS (STILL GROWING) OR PROUD FLESH SCARS (WOUND DOES NOT RE-EPITHEALIZE- CHRONIC INFLAMMATION)

Do not do ischemic compressions and frictions in the same appointment- make a plan for 2 appointments

Question 6

GOALS FOR SCAR TISSUE
Acute

Answer 6

ACUTE scar tissue-
massage for decreasing EDEMA
Collagen form in EDEMA - removal of EX fluid can REDUCE SCAR TISSUE THAT DEVELOPS

STRETCHING AFTER MASSAGE IS ESSENTIAL

Massage BEFORE collagen matures can prevent hypertrophic scarring

Question 7

Latent trigger points are

Answer 7

Produces pain when palpated
Are more common than active ones

Can be reverted to an active trigger point state by any reffered pain- overuse-overstretching or chilling of the muscle containing it

Question 8

Primary trigger point

Answer 8

Directly activated by acute or chronic mechanical strain or overload of the affected muscle

Question 9

Secondary trigger points are activated by…

Answer 9

A overworked synergistic or antagonist muscle

Question 10

Satellite trigger points are found

Answer 10

In muscle that lies within the referral pattern of another trigger point

Question 11

SYMPTOMS
TRIGGER POINTS

Answer 11

Pain and tenderness is continuous
Contraction of the affected muscle is painful
Upon Palpation the TWITCH RESPONSE is present in the muscle fibers of the taut band

Passive stretching of the muscle affected will be painful

Question 12

TRIGGER POINTS
HEALTH HISTORY QUESTIONS

Answer 12

Have you had any injury or OVERUSE INJURY to the affected muscle?

Where is the pain located? DOES IT REFER ANYWHERE?

What aggravates or alleviates the trigger point?

Question 13

TRIGGER POINTS
CONTRAINDICATIONS

Answer 13

AVOID
- VIGOROUS TECHNIQUES
- DEEP PRESSURE. To avoid kick-back pain
- avoid prolonged chilling of a muscle containing TP
- AVOID ISCHEMIC COMPRESSIONS AND FRICTIONS AT SAME APPOINTMENT

Question 14

WHAT IS A MYOFASCIAL TRIGGER POINT?

Answer 14

Hyperirritable spot, usually within a taut band of skeletal muscle or its fascia. It is point tender on site, often exhibits a predictable pain referral and causes shortening of the affected muscle

Question 15

INFLAMMATORY PROCESS
ACUTE STAGE

Answer 15

• time- moment of injury to 3-4 days post injury
  -Redness, swelling, heat, possible loss of function, muscle spasm and guarding
• if bruising- will be red, blue or purple

Question 16

TREATMENT GOALS
FOR
ACUTE STAGE INFLAMMATORY PROCESS

Answer 16

• reduce pain and swelling
• decrease SNS firing
• Prevent reinjury

Protective spasms are reduced but not removed
Compensatory structures are treated

Question 17

TREATMENT GOALS
INFLAMMATORY PROCESS
SUBACUTE AND EARLY SUBACUTE STAGES

Answer 17

DECREASE- INFLAMMATION- PAIN- SWELLING AND SPASM
While
Maintaining available ROM and STRENGTH

General treatments remain the same as ACUTE
Can BEGIN to treat the tissue peripheral but NOT distal to the lesion site

Question 18

Inflammatory process
Signs in early subacute stage

Answer 18

2 days- 3 weeks timeframe
Signs of inflammation- pink-warm
No spasms

Question 19

Inflammatory process
Signs in subacute stage

Answer 19

2 days- 3-6 weeks after injury
Signs of inflammation diminish over this time
Wound closure takes an
average of 5-8 days - MUSCLE AND SKIN INJURIES
3-5 weeks TNEDON AND LIGAMENT INJURIES

Question 20

INFLAMMATORY PROCESS
SIGNS IN
LATE SUBACUTE

Answer 20

Begins 2-3 weeks of the subacute stage
‘There may be residual swelling
Minimal discomfort - but potential loss of range of movement due to adhesions and muscle weakness
If bruising present changes to yellow, brown or green
Pain is experienced with overpressure to affected tissue

Question 21

Inflammatory process
LATE SUBACUTE STAGE
TREATMENT GOALS

Answer 21

Decrease remaining EDEMA
Reduce trigger points
Reduce pain and adhesions
Improves ROM and muscle strength

Question 22

INFLAMMATORY PROCESS
CHRONIC STAGE

Answer 22

2-3 weeks post injury - continues up to 1-2 years

Inflammatory process is resolved
Likely no EDEMA- but loss of full ROM
Decrease in function is possible

Chronic inflammation may result as a
Part of the self-perpetuating cycle- if irritating agent persists
Ex- inflammatory arthritides or inflammation from REPEATED MICRO-TRAUMA- EX TENDINITIS

Question 23

INFLAMMATORY PROCESS
CHRONIC TREATMENT GOALS

Answer 23

Reduce restrictive adhesions and trigger points
Restore ROM and strength to the affected areas

Question 24

What can be a part of a hydro protocol?

Answer 24

CBAN- EXPLAIN TO CLT
ELEVATE/POSITION
EYES ON SKIN
SANITARY BARRIER
APPLICATION OF COLD
CHECK IN WHILE APPLICATION IS ON
REMOVE WHEN NEEDED- SEE IF GOAL OF TREATMENT IS REACHED
FLUSH AREA IF APPROPRIATE

Question 25

When is cold hydrotherapy not advised?

Answer 25

Cold is also not advised if you have
insufficient circulation
(as with Raynauds disease
or
diabetes,
especially when applying ice to extremities).

If you feel chilled, do not apply cold hydrotherapy until your temperature has returned to normal.

Question 26

When is hot illadvised

Answer 26

In general, hydrotherapy is contraindicated for individuals who have
serious heart,
circulatory,
nervous system,
or systemic conditions.

Open wounds and skin rashes
are also contraindications
for using extremes of hot or cold.

Question 27

When is contrast hydrotherapy contraindicated?

Answer 27

It should also be noted that it is contraindicated to apply
Contrast Hydrotherapy to an
Acute injury
or an
injury that is still swollen, red, hot and/or inflamed.

Question 28

Contraindications of Swedish massage

Answer 28

There are several contraindications to Swedish massage, some of which are absolute.
These include fever (+ 37.5°C),
infectious or contagious diseases,
hemophilia
and a history of heart disease.

Question 29

Contraindications for golgi tendon organ release

Answer 29

Locally painful conditions
Locally acute conditions affecting the tendon to be treated
Hypotonic or atonic muscles
Tissue facility
Pathologies of CT
Skin lesions including healing incisions

Question 30

Reasons to do diaphragmatic breathing?

Answer 30

Increases lymph flow
And efficiently of gas exchange
Decreases pain and stress