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Questions and Answers
Questions and Answers
Which of the following best describes an acute injury?
Which of the following best describes an acute injury?
- Results from poor footwear or biomechanical abnormalities.
- Occurs during a single, identifiable traumatic event. (correct)
- Is a result of gradual, age-related tissue degeneration.
- Develops from repetitive stress over time.
Intrinsic forces, such as direct blows, are a primary source of force leading to acute injuries.
Intrinsic forces, such as direct blows, are a primary source of force leading to acute injuries.
False (B)
What is the primary difference between acute and overuse injuries regarding the mechanism of tissue damage?
What is the primary difference between acute and overuse injuries regarding the mechanism of tissue damage?
Acute injuries involve sudden, identifiable trauma, while overuse injuries develop from repetitive stress.
In managing injuries, modifying __________ factors, such as equipment, can prevent injuries.
In managing injuries, modifying __________ factors, such as equipment, can prevent injuries.
Match each type of tissue with its timeframe for the inflammatory phase of healing:
Match each type of tissue with its timeframe for the inflammatory phase of healing:
During the inflammatory response phase, which of the following occurs?
During the inflammatory response phase, which of the following occurs?
The fibroblastic repair phase is characterized by increased pain and swelling.
The fibroblastic repair phase is characterized by increased pain and swelling.
What type of collagen is primarily deposited during the fibroblastic repair phase, providing a framework for tissue regeneration?
What type of collagen is primarily deposited during the fibroblastic repair phase, providing a framework for tissue regeneration?
In the fibroblastic repair phase, new __________ and connective tissue begin to form to improve tissue integrity.
In the fibroblastic repair phase, new __________ and connective tissue begin to form to improve tissue integrity.
Match the phases of healing with the types of collagen present:
Match the phases of healing with the types of collagen present:
Which of the following is a characteristic of the maturation-remodeling phase of tissue healing?
Which of the following is a characteristic of the maturation-remodeling phase of tissue healing?
During the maturation-remodeling phase, weaker tissue starts to weaken further.
During the maturation-remodeling phase, weaker tissue starts to weaken further.
In the maturation-remodeling phase, what replaces Type III collagen to improve tissue structure and strength?
In the maturation-remodeling phase, what replaces Type III collagen to improve tissue structure and strength?
During the maturation-remodeling phase, increased __________ forces cause the new scar tissue to undergo hypertrophy.
During the maturation-remodeling phase, increased __________ forces cause the new scar tissue to undergo hypertrophy.
Match the rehabilitation phases with their primary goals:
Match the rehabilitation phases with their primary goals:
What is the primary focus of the acute management phase of rehabilitation?
What is the primary focus of the acute management phase of rehabilitation?
The traditional acronym PRICE (Protection, Rest, Ice, Compression, Elevation) is always the best approach during the acute phase.
The traditional acronym PRICE (Protection, Rest, Ice, Compression, Elevation) is always the best approach during the acute phase.
In the acute management phase, what does optimal loading involve?
In the acute management phase, what does optimal loading involve?
During Phase 2 of rehabilitation, exercises progress from single-joint controlled actions to __________ movements.
During Phase 2 of rehabilitation, exercises progress from single-joint controlled actions to __________ movements.
Match each mechanotherapy step for tendon healing with its corresponding mechanical stimulus:
Match each mechanotherapy step for tendon healing with its corresponding mechanical stimulus:
What should be the primary emphasis when returning an athlete recovering from a knee injury?
What should be the primary emphasis when returning an athlete recovering from a knee injury?
During return to sports, achieving 70% of the uninjured side’s strength and function is sufficient before progressing.
During return to sports, achieving 70% of the uninjured side’s strength and function is sufficient before progressing.
What is the ultimate goal in the final phase of rehabilitation; prevention of re-injury?
What is the ultimate goal in the final phase of rehabilitation; prevention of re-injury?
Tendon injuries benefit from __________ loading exercises to stimulate tendon remodeling.
Tendon injuries benefit from __________ loading exercises to stimulate tendon remodeling.
Match each rehabilitation phase goal with its corresponding intervention for tendon injuries:
Match each rehabilitation phase goal with its corresponding intervention for tendon injuries:
Which of the following is a key adaptation during the inflammatory phase of tendon healing?
Which of the following is a key adaptation during the inflammatory phase of tendon healing?
During the proliferative phase, the mechanical stimulus involves complete unloading of the tendon.
During the proliferative phase, the mechanical stimulus involves complete unloading of the tendon.
What mechanical stimulus is most appropriate during the remodeling phase of tendon healing to enhance tendon stiffness and functional capacity?
What mechanical stimulus is most appropriate during the remodeling phase of tendon healing to enhance tendon stiffness and functional capacity?
Muscle injuries require early __________ and gradual loading to prevent atrophy and promote healing.
Muscle injuries require early __________ and gradual loading to prevent atrophy and promote healing.
Match each phase of muscle healing with its corresponding physiological adaptation:
Match each phase of muscle healing with its corresponding physiological adaptation:
What exercise is most appropriate during the inflammatory phase of bone healing:
What exercise is most appropriate during the inflammatory phase of bone healing:
The inflammatory phase of bone healing involves decreased recruitment of osteoclasts and osteoblasts
The inflammatory phase of bone healing involves decreased recruitment of osteoclasts and osteoblasts
What is the clinical application to stimulate bone formation
What is the clinical application to stimulate bone formation
Articular Cartlidge During the inflammatory phase, protection and gentle mobilization to reduce __________ and prevent further damage.
Articular Cartlidge During the inflammatory phase, protection and gentle mobilization to reduce __________ and prevent further damage.
Match description with definition:
Match description with definition:
Which type of exercise is best use to reduce pain?
Which type of exercise is best use to reduce pain?
Chronic pain equals tissue damage but not always
Chronic pain equals tissue damage but not always
How long does acute pain last?
How long does acute pain last?
The 3 N's are used to describe pain __________.
The 3 N's are used to describe pain __________.
Match type of pain with description:
Match type of pain with description:
Which of the following is an example of an extrinsic force that can lead to acute injury?
Which of the following is an example of an extrinsic force that can lead to acute injury?
Overuse injuries are the result of a single, identifiable traumatic event.
Overuse injuries are the result of a single, identifiable traumatic event.
According to the key points, what is the primary reason for injury?
According to the key points, what is the primary reason for injury?
Examples of intrinsic risk factors include muscle strength and __________.
Examples of intrinsic risk factors include muscle strength and __________.
Match the tissue type with its typical inflammatory phase timeframe:
Match the tissue type with its typical inflammatory phase timeframe:
Which of the following is characteristic of the inflammatory response phase of tissue healing?
Which of the following is characteristic of the inflammatory response phase of tissue healing?
During the inflammatory response phase, collagen synthesis increases.
During the inflammatory response phase, collagen synthesis increases.
What type of collagen is primarily deposited during the fibroblastic repair phase?
What type of collagen is primarily deposited during the fibroblastic repair phase?
Match the tissue with the indicators of the fibroblastic repair phase:
Match the tissue with the indicators of the fibroblastic repair phase:
Which of the following best describes what occurs during the maturation-remodeling phase?
Which of the following best describes what occurs during the maturation-remodeling phase?
The maturation-remodeling phase can last from several days to weeks.
The maturation-remodeling phase can last from several days to weeks.
What type of collagen replaces Type III collagen during the maturation-remodeling phase?
What type of collagen replaces Type III collagen during the maturation-remodeling phase?
During the maturation phase, increased loading forces cause new scar tissue to __________.
During the maturation phase, increased loading forces cause new scar tissue to __________.
Match the tissue with the indicators of the maturation phase:
Match the tissue with the indicators of the maturation phase:
Which clinical observation is important for clinicians to identify in order to tailor therapeutic exercises during the healing process?
Which clinical observation is important for clinicians to identify in order to tailor therapeutic exercises during the healing process?
Healing timelines are precise and apply equally to all clients.
Healing timelines are precise and apply equally to all clients.
What acronym replacing PRICE involves carefully evaluating tissue ability to withstand mechanical load?
What acronym replacing PRICE involves carefully evaluating tissue ability to withstand mechanical load?
In Phase 3 of rehabilitation, the goal is to achieve __________ of the uninjured side's strength and function.
In Phase 3 of rehabilitation, the goal is to achieve __________ of the uninjured side's strength and function.
Match the phase of rehabilitation with its primary focus:
Match the phase of rehabilitation with its primary focus:
Which of the following is a key focus in the rehabilitation of ligament injuries?
Which of the following is a key focus in the rehabilitation of ligament injuries?
Severe injuries always allow for more aggressive loading during rehabilitation compared to mild injuries.
Severe injuries always allow for more aggressive loading during rehabilitation compared to mild injuries.
What type of exercise is recommended for tendon injuries to stimulate remodeling?
What type of exercise is recommended for tendon injuries to stimulate remodeling?
Effective rehabilitation requires detailed planning and integrating anatomical, biomechanical, and __________ knowledge.
Effective rehabilitation requires detailed planning and integrating anatomical, biomechanical, and __________ knowledge.
Match the tendon mechanotherapy phase with the appropriate mechanical stimulus:
Match the tendon mechanotherapy phase with the appropriate mechanical stimulus:
During the inflammatory phase for muscle injuries, what is the primary clinical application?
During the inflammatory phase for muscle injuries, what is the primary clinical application?
During the proliferative phase for muscle injuries, the focus is on decreasing loading to prevent further damage.
During the proliferative phase for muscle injuries, the focus is on decreasing loading to prevent further damage.
What is the recommended mechanical stimulus during the remodeling phase for muscle injuries?
What is the recommended mechanical stimulus during the remodeling phase for muscle injuries?
During the inflammatory phase for bone injuries, __________ and controlled weight-bearing are used to prevent excessive inflammation.
During the inflammatory phase for bone injuries, __________ and controlled weight-bearing are used to prevent excessive inflammation.
Match the phase of bone healing with the according stimulus:
Match the phase of bone healing with the according stimulus:
What is the application during the inflammatory phase for articular cartilage injuries?
What is the application during the inflammatory phase for articular cartilage injuries?
During the remodeling phase for articular cartilage injuries, avoiding pain and swelling is not necessary as long as you're progressively loading the joint.
During the remodeling phase for articular cartilage injuries, avoiding pain and swelling is not necessary as long as you're progressively loading the joint.
What is the more common name for motor control training?
What is the more common name for motor control training?
The goal of Phase 1 of motor control training is to establish basic joint __________.
The goal of Phase 1 of motor control training is to establish basic joint __________.
Match the concept with the according definition related to joint stability.
Match the concept with the according definition related to joint stability.
What is hypoalgesia?
What is hypoalgesia?
Different types of exercise reduce pain, with aerobic exercises having the greatest effect.
Different types of exercise reduce pain, with aerobic exercises having the greatest effect.
According to the epidemiology of pain, approximately how many Americans suffer from chronic pain?
According to the epidemiology of pain, approximately how many Americans suffer from chronic pain?
According to the epidemiology of pain, __________ is the highest ranked form of chronic pain.
According to the epidemiology of pain, __________ is the highest ranked form of chronic pain.
Match the definition for the type of pain:
Match the definition for the type of pain:
Which of the following best describes nociception pain?
Which of the following best describes nociception pain?
Allodynia is defined as increased pain from a normally painful stimulus.
Allodynia is defined as increased pain from a normally painful stimulus.
What is the name for pain that occurs in a region that is not the source of the pain?
What is the name for pain that occurs in a region that is not the source of the pain?
The LASS measures what?
The LASS measures what?
Questions and Answers
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Flashcards
Flashcards
Acute Injuries
Acute Injuries
Injuries occurring from a single, identifiable traumatic event.
Extrinsic Forces
Extrinsic Forces
External forces causing tissue damage (e.g., direct blow, collision).
Intrinsic Forces
Intrinsic Forces
Internal forces causing tissue damage (e.g., muscle contractions, joint biomechanics).
Overuse Injuries
Overuse Injuries
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Intrinsic Risk Factors (examples)
Intrinsic Risk Factors (examples)
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Extrinsic Risk Factors (examples)
Extrinsic Risk Factors (examples)
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Inflammatory Response Phase
Inflammatory Response Phase
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Fibroblastic Repair Phase
Fibroblastic Repair Phase
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Maturation-Remodeling Phase
Maturation-Remodeling Phase
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Acute Management (Phase 1)
Acute Management (Phase 1)
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Restore Activities (Phase 2)
Restore Activities (Phase 2)
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Return to Sports (Phase 3)
Return to Sports (Phase 3)
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Prevention of Re-injury (Phase 4)
Prevention of Re-injury (Phase 4)
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Rehabilitation Approach
Rehabilitation Approach
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Tendon Inflammatory Phase Adaptations
Tendon Inflammatory Phase Adaptations
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Tendon Proliferative Phase Adaptations
Tendon Proliferative Phase Adaptations
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Tendon Remodeling Phase Adaptations
Tendon Remodeling Phase Adaptations
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Muscle Inflammatory Phase Adaptations
Muscle Inflammatory Phase Adaptations
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Muscle Proliferative Phase Adaptations
Muscle Proliferative Phase Adaptations
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Muscle Remodeling Phase Adaptations
Muscle Remodeling Phase Adaptations
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Bone Inflammatory Phase Adaptations
Bone Inflammatory Phase Adaptations
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Bone Proliferative Phase Adaptations
Bone Proliferative Phase Adaptations
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Bone Remodeling Phase Adaptations
Bone Remodeling Phase Adaptations
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Cartilage Inflammatory Phase Adaptations
Cartilage Inflammatory Phase Adaptations
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Cartilage Proliferative Phase Adaptations
Cartilage Proliferative Phase Adaptations
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Cartilage Remodeling Phase Adaptations
Cartilage Remodeling Phase Adaptations
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Proprioception
Proprioception
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Kinesthesia
Kinesthesia
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Dynamic Joint Stabilization
Dynamic Joint Stabilization
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Reactive Motor Control
Reactive Motor Control
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Functional Motor Patterns
Functional Motor Patterns
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Exercise induced hypoalgesia
Exercise induced hypoalgesia
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IASP Definition of Pain
IASP Definition of Pain
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Somatic Pain
Somatic Pain
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Visceral Pain
Visceral Pain
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Nociception Pain
Nociception Pain
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Neuropathic Pain
Neuropathic Pain
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Nociplastic Pain
Nociplastic Pain
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Allodynia
Allodynia
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Hyperalgesia
Hyperalgesia
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Primary Reason for Injury?
Primary Reason for Injury?
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Injury Prevention Strategies
Injury Prevention Strategies
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Goals of Acute Management
Goals of Acute Management
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Musculoskeletal injury rehabilitation
Musculoskeletal injury rehabilitation
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Muscle Injury Rehab Emphasis
Muscle Injury Rehab Emphasis
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Ligament Injury Rehab Emphasis
Ligament Injury Rehab Emphasis
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Tendon Injury Rehab Emphasis
Tendon Injury Rehab Emphasis
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Tendon Inflammatory Phase Stimulus
Tendon Inflammatory Phase Stimulus
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Muscle Proliferative Phase Stimulus
Muscle Proliferative Phase Stimulus
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Muscle Remodeling Phase Stimulus
Muscle Remodeling Phase Stimulus
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Bone Inflammatory Phase Stimulus
Bone Inflammatory Phase Stimulus
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Cartilage Proliferative Phase application
Cartilage Proliferative Phase application
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Cartilage Inflammatory Phase Stimulus
Cartilage Inflammatory Phase Stimulus
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Cartilage Remodeling Phase Application
Cartilage Remodeling Phase Application
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Motor Control Training: Initial Phase Goals
Motor Control Training: Initial Phase Goals
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Motor Control Training: Intermediate Phase Goals
Motor Control Training: Intermediate Phase Goals
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Motor Control Training: Advanced Phase Goals
Motor Control Training: Advanced Phase Goals
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Acute time frame?
Acute time frame?
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Chronic pain duration
Chronic pain duration
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Flashcards
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Study Notes
Study Notes
Mechanisms of Acute Injury
- Acute injuries happen during a single, identifiable traumatic event
- The cause is when force to a tissue exceeds its capacity
- This leads to tissue failure, macroscopic damage, and rapid symptom onset like pain and loss of function
- Sources of force are either extrinsic or intrinsic
- Extrinsic forces are external like a direct blow or collision
- Intrinsic forces are internal like muscle contractions or joint biomechanics
- Prevention involves modifying extrinsic and considering intrinsic factors
Mechanisms of Overuse Injuries
- Overuse injuries result from repetitive stress over time
- This leads to microscopic tissue damage
- Assessment involves comprehensive history and risk factor assessment like training and technique
- Causes include a sudden increase in training volume, poor footwear and biomechanical abnormalities
- Treatment involves addressing the cause, modifying activity, and specific exercises
Key Points for Revision
- A primary reason for injury is when demand on tissue exceeds its capacity
- Intrinsic risk factor examples: Muscle strength, endurance, flexibility, motor control, joint range, biomechanics, proprioception
- Extrinsic risk factor examples: Equipment, playing surface, sport rules, and training errors
Stages of Healing
- The healing process has three main phases
- The inflammatory response phase
- The fibroblastic repair phase
- The maturation-remodeling phase
- Each phase has varying characteristics and timelines depending on tissue type, age, lifestyle, and injury severity
Tissue Type: Indicators of Inflammatory Phase
- Muscle tissue indicators: pain, swelling, redness, warmth, loss of function
- Muscle signs and symptoms: Localized pain, swelling, redness, increased temperature, and limited range of motion
- Muscle Timeframe is 0-4 days
- Tendon tissue indicators: Swelling, pain, redness, warmth, and tenderness
- Tendon signs and symptoms: Localized swelling, pain, redness, warmth, and limited range of motion due to pain
- Tendon Timeframe is 1-7 days
- Ligament tissue indicators: Pain, swelling, redness, warmth, loss of function
- Ligament signs and symptoms: Localized pain, swelling, and increased redness
- Ligament Timeframe is 1-7 days
- Bone tissue indicators: Hematoma formation, pain, swelling, and redness
- Bone signs and symptoms: Pain, swelling, redness, warmth, and hematoma at the fracture site
- Bone Timeframe is 0-7 days
Inflammatory Response Phase
- This initial phase of the healing process is critical for normal tissue healing
- Redness, swelling, increased blood flow, and capillary permeability occur
- Chemical mediators like histamine and bradykinin are released
- Typically lasts less than a week and is marked by pain, swelling, and limited function
- Initial reaction includes both systemic and local inflammation
- Decreased collagen synthesis and an increase in inflammatory cells
- Tissue damage will trigger the release of chemical mediators
- This increases blood flow and capillary permeability, letting edema break down
- Edema inhibits contractile tissues and limits function
- Blood flow is needed for phagocytosis to clear tissue debris and pathogens
- It lasts about 2-3 days or longer depending on the extent of the damage
Fibroblastic Repair Phase
- Tissue repair begins with the formation of new capillaries and connective tissue (scar tissue)
- Type III collagen is deposited, providing a framework for tissue regeneration
- Reduced pain and swelling, and scar tissue formation characterize this phase
- Phase lasts from a few days to several weeks
- Catabolism of damaged tissue and its replacement
- New capillaries and connective tissue form to improve tissue integrity
- Type 3 collagen gets deposited in random spots
- It is a framework for rebuilding tissues
- Weakness is due to new and unused tissue
- Collagen fibres lie transversely instead of longitudinally
Tissue Type: Indicators of Fibroplastic Repair Phase
- Muscle tissue indicators: Decreased pain and inflammation, formation of scar tissue
- Muscle signs and symptoms: Reduced pain, minimal swelling, easier movement, and formation of scar tissue
- Muscle Timeframe is 2 days to 6 weeks
- Tendon: Collagen synthesis, reduced inflammation, increased strength.
- Tendon: Decreased pain, minimal swelling, improved range of motion, scar tissue formation.
- Tendon Timeframe: 2 to 8 weeks.
- Ligament: Collagen deposition, reduced inflammation, increased stability.
- Ligament: Reduced pain, minimal swelling, improved joint stability, scar tissue formation.
- Ligament Timeframe: 2 days to 8 weeks.
- Bone: Callus formation, reduced inflammation, increased stability.
- Bone: Decreased pain, minimal swelling, soft callus formation, improved stability.
- Bone Timeframe: 1-6 weeks.
Maturation-Remodeling Phase
- Newly formed tissue is strengthened and remodeled
- Type I collagen replaces Type III to improve tissue structure, strength, and function
- This phase can last from months to years with minimal pain and improved function
- Weaker tissue begins to strengthen and collagen shifts to stronger type 1 fibers to withstand loading
- Increased loading forces the new scar tissue to hypertrophy, therefore, get stronger and withstand load
Tissue Type: Indicators of Maturation Phase
- Muscle tissue indicators: Realignment of collagen fibers, increased tensile strength, return to full function
- Muscle signs and symptoms: Minimal pain, improved strength, flexibility, and full range of motion
- Muscle Timeframe is 3 weeks to 1 year
- Tendon: Collagen maturation and alignment, increased tensile strength, return to full function.
- Tendon: Minimal pain, improved strength and flexibility, full range of motion.
- Tendon Timeframe: 6 weeks to several months to beyond a year.
- Ligament: Collagen maturation and alignment, increased tensile strength, return to full function.
- Ligament: Minimal pain, improved joint stability, full range of motion.
- Ligament Timeframe: 6 weeks to several months.
- Bone: Bone remodeling, increased strength and stability, return to full function.
- Bone: Minimal pain, full weight-bearing capacity, full range of motion.
- Bone Timeframe: Several months to 1 year.
Clinical Observations and Variability
- Clinicians should identify signs and symptoms of each healing phase
- Swelling, redness, warmth, and changes in range of motion and function
- Observations help tailor exercise approaches to match the injury's severity and healing stage
- Healing timelines are general guides, not exact timeframes for all clients
- Age, lifestyle, and injury severity influence the progression through healing phases
- Clinicians should consider these when informing clients
Common Injuries and Rehabilitation
- Familiarity with common injuries across the musculoskeletal system helps with diagnosis and management
- Musculoskeletal injury rehabilitation is dynamic and structured
- It aims to restore function/performance, ensure safe return to activities, and minimize re-injury risk
- Process divided into phases with specific goals and interventions for tissue type and severity
- Knowing the goal of a phase will indicate the exercise stimulus
Phases of Injury Management
- Phase 1: Acute Management protects injured tissue and promotes optimal loading for healing
- PRICE, is often replaced with POLICE
- POLICE: Protection, Optimal Loading, Ice, Compression, Elevation
- Optimal loading balances regain of ROM and minimizes inflammatory processes
- Activation exercises start within 24 hours, depending on injury severity
- Phase 2: Goal is to Restore Activities of Daily Living and physical function
- Restore client's ability to perform daily activities, sports-specific, or occupation
- Exercise complexity gradually increases from single-joint to multi-joint movements
- Improve motor control, strength, and endurance while maintaining secondary functions like hip stability and ankle mobility
- Phase 3: Returning to Activities
- Reintroduce client to physically demanding and sport-specific activities
- Involves traditional strength and conditioning with higher complexity and velocity
- Achieving 90% of the uninjured side's strength/function is the goal
- This is monitored through tests like single-leg hop tests
- Readiness for this phase is critical for increased motor control around joints
- Phase 4: Prevention of Re-injury
- Focuses on addressing residual impairments improving performance and includes ongoing training
- Enhances muscle activation patterns, landing strategies, and overall endurance
Approach based on tissue, injury, severity
- Rehab depends on tissue type, injury and severity
- Early activation and gradual loading are essential to prevent muscle atrophy and promote healing
- Ligament injuries need focus on restoring joint stability and proprioception
- Tendon injuries benefit from eccentric loading exercises to stimulate tendon remodeling
- Severe injuries need longer periods of protection and gradual progression
- Mild injuries can tolerate more aggressive loading and faster progression
- Individual variability requires personalized plans, evaluation and adjustment to the patient's progress
Effective Planning and Goal Setting For Effective Rehab
- It requires detailed planning and integrates anatomical, biomechanical, sport-specific/occupational task knowledge
- Early goal setting and collaboration with the client are crucial
- Goals should be realistic, measurable, and adaptable
- Regular communication and reassessment keeps plan dynamic and focused
Challenges and Continuous Evaluation For Effective Rehab
- Rehab has challenges like recurrent pain, effusion, and range of motion deficits
- Reassess the rehab program, ensuring interventions target the intended impairments when progress stalls
- Multidisciplinary collaboration helps address underlying challenges and adjust the plan
Mechanotherapy Steps Across The Tissue Healing Phases
Tendon
- Inflammatory Phase
- Increased blood flow, inflammatory cell infiltration, and release of growth factors
- Protection and controlled loading to prevent excessive inflammation
- Gentle isometric contractions to maintain tendon integrity without overloading
- Proliferative Phase
- Collagen synthesis, fibroblast proliferation, and matrix formation
- Progressive loading to stimulate collagen alignment and tendon strength
- Eccentric and concentric-eccentric exercises at moderate intensity (40-60% of maximum)
- Remodeling Phase
- Collagen maturation, increased tendon stiffness, and improved mechanical properties
- High-intensity loading to enhance tendon stiffness and functional capacity
- High-intensity muscle contractions (70-90% of maximum), including eccentric, concentric-eccentric, and isometric exercises
Muscle
- Inflammatory Phase
- Inflammatory response, removal of damaged tissue, and initiation of repair:
- Protection and gentle mobilization to reduce inflammation and prevent atrophy:
- Gentle passive and active range of motion:
- Proliferative Phase
- Satellite cell activation, muscle fiber regeneration, and collagen deposition:
- Progressive loading to stimulate muscle hypertrophy and alignment of regenerating fibers:
- Progressive resistance exercises, starting with low intensity and gradually increasing:
- Remodeling Phase
- Muscle fiber maturation, increased muscle strength, and improved neuromuscular control:
- High-intensity resistance training to maximize muscle strength and functional recovery:
- High-intensity resistance exercises (70-90% of maximum), including concentric, eccentric, and isometric contractions:
Bone
- Inflammatory Phase
- Inflammatory response, recruitment of osteoclasts and osteoblasts, and initiation of bone repair
- Protection and controlled weight-bearing to prevent excessive inflammation and promote healing
- Partial weight-bearing and gentle loading to stimulate bone repair
- Proliferative Phase
- Osteoblast proliferation, collagen deposition, and formation of new bone tissue
- Progressive loading to stimulate bone formation and remodeling
- Progressive weight-bearing and dynamic loading exercises
- Remodeling Phase
- Bone maturation, increased bone density, and improved mechanical properties
- High-intensity loading to enhance bone strength and functional capacity
- High-intensity dynamic loading exercises, including weight-bearing and impact activities
Articular Cartilage
- Inflammatory Phase
- Inflammatory response, removal of damaged cartilage, and initiation of repair
- Protection and gentle mobilization to reduce inflammation and prevent further damage
- Gentle range of motion exercises to maintain joint mobility
- Proliferative Phase
- Chondrocyte proliferation, matrix synthesis, and formation of new cartilage tissue
- Progressive loading to stimulate cartilage repair and improve mechanical properties
- Moderate resistance training and neuromuscular exercises
- Remodeling Phase
- Cartilage maturation, increased proteoglycan content, and improved stiffness
- High-intensity loading to enhance cartilage quality and functional capacity
- High-intensity resistance and neuromuscular training while avoiding pain and swelling
Motor Control Training
- Neuromuscular training targets specific deficits from a clinical assessment
- Begins with smaller movements progressing to bigger movements; should be pain-free
- Develops neuromuscular control due to potential joint damage
- Strengthening neuromuscular control improves function and stability, despite sensory feedback impairment
- There are 4 components to joint stability for neuromuscular control
- Proprioception is body awareness and kinaesthesia is sensation of joint motion or acceleration
- Dynamic joint stabilization is muscles maintaining joint stability during movement, preparatory and reactive
- Reactive motor control is muscles reflexively responding to changes
- Functional motor patterns are sport- or activity-specific movement patterns
- Motor control training integrates into rehab programs; tailored to individual and injury
- Phase 1: Initial Phase focuses on Basic Stability and Proprioception to establish joint stability, improve proprioception, and reduce pain/inflammation
- Phase 1 takes place during the inflammatory, proliferative, and post-operative phases
- Phase 2: Intermediate Phase focuses on Dynamic Stability and Coordination to improve joint stability, enhance muscle coordination, and begin functional movement
- Phase 2 takes place from end of the inflammatory to the end of the proliferative stage
- Phase 3: Advanced Phase focuses on Function and Sport-Specific Training for reactive neuromuscular Control, and Functional Motor Patterns
- Goals: restore functional motor patterns, improve reactive neuromuscular control and prepare for return to sport or activity
- When: end of proliferative and remodelling phase of healing
Exercise Induced Hypoalgesia and Pain
- Hypoalgesia relieves pain through exercise, triggers release of pain reducing substances
- Different types of exercise have all shown to reduce pain, with isometrics have the greatest outcome
- Moderate to high intensities for both aerobic and isometric exercise have the greatest affect.
Epidemiology of Pain
- In Australia, 1/5 of adults >45 years have chronic pain
- In America, 100 million Americans suffer chronic pain
- Lower socioeconomic status, education, and unemployment are associated with experiencing pain
- Those with chronic pain are less likely to participate in recreational activity than those with acute pain
- Lower Back Pain (LBP) is the highest ranked form of chronic pain. Neck pain, migraines, and knee/shoulder pain listed after
Understanding Pain
- IASP definition of pain: "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage"
- Pain is subjective and always real; it will vary from person to person
- Some require less intervention than others, but some require a multidisciplinary approach
Pain Classifications By Duration
- Acute pain: less than 3 months; recent onset; decreases, tissues heal; related tissue damage; sub-acute = 6 weeks -> 3 months
- Chronic pain: longer than 3 months; persists beyond healing; pain alarm dysfunction
Pain Classifications By Cause
- Somatic pain: skin, muscles, bones, joints
- Visceral pain: organs
- Cancer pain: due to treatment, often progressive, chronic and acute
- Non-cancer pain: chronic and acute, surgery, trauma, disease, headache, childbirth, nerve injury
- Idiopathic pain: unknown event/cause
Pain Classifications By Mechanisms
- Nociception Pain: Damage to non-neural tissue, triggers nociceptor activation, normal nervous system
- Neuropathic pain: Lesion/disease to somatosensory nervous system, abnormalities/trauma, e.g. spinal cord injury
- Nociplastic pain: Nerve damage, ongoing inflammation/damage, altered nociception, lasts >3 months, general region and increased pain sensitivity(light, sound, sleep, fatigue, cognitive)
Other Pain Terminology
- Allodynia: touch-related pain from non-painful stimulus; central sensitization and neuropathic pain
- Hyperalgesia: increased pain from normally painful stimulus; possibly central/peripheral sensitization if in affected area
- Hypoalgesia: diminished pain response to normal/painful stimulus
- Phantom pain: no tissue; amputation
- Referred pain: not the source; cardiac = arm
- Radicular pain: nerve-related irritation
Chronic Primary versus Secondary Musculoskeletal Pain
- Primary pain has one or more regions in body, emotional distress, interrupts ADLs, multiple times of subcategories
- The diagnostic criteria are more than 3 months, conjunction with emotional distress or interference of ADL, not another condition
- Secondary musculoskeletal pain is, bones, tissues, joints, tendons, vertebral column and related soft tissues, local/systemic etiologies
- The diagnostic criteria is chronic pain for more than 3 months, musculoskeletal disease and trigger nociceptors, pain unaccounted for by diagnosis
Factors Influencing All Pain Types
- Nerve Signals
- Past Experiences
- Emotional State
- Context and Environment
- Beliefs and Expectations
- Social and Cultural Factors
Brain Feedback Loop for Pain
- Increased Sensitivity
- Persistent Pain Signals
- Psychological and Emotional Factors
- Discrepancy in Evaluation
- Mismatched feedback loop
Pain Assessment
- Distinguishing nociceptive pain from neuropathic
- Nociceptive: acute sharp/throbbing pain recently with identical cause
- Neuropathic pain: burning, shooting, pins/needles, or electric-shock like
- Nociplastic pain diagnosis given last, lasts > three months and absence with identical cause
Methods for Pain Assessment
- Numerous methods include.
- Numerical, Visual Analogue, and Facial Pain Scales
- The neonatal infant pain scale is used for infants (facial expressions, body movements, arousal, breathing patterns)
- Face pain scale: older adults with cognitive deficits
- Behavioural pain scale: critically ill patients/ventilated, looks facial expressions, movement of the upper limbs and compliance with mechanical ventilation.
- Brief pain and West haven-yale inventories
- The LASS is able to classify patients with neuropathic pain
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