Ligaments Injuries: Topic 3

Topic 3 Ligaments Injuries 1 R1 LIGAMENTS AND JOINTS INJURIES SPRAIN./ ENTORSE / ESGUINCE LUXATION : Joint Dislocation Joint instability : lack of support in the joints, which puts a person at risk for the joints to become displaced or dislocated, leading to injury 2 2 1 40-60% >90% < 30%...

Topic 3 Ligaments Injuries 1 R1 LIGAMENTS AND JOINTS INJURIES SPRAIN./ ENTORSE / ESGUINCE LUXATION : Joint Dislocation Joint instability : lack of support in the joints, which puts a person at risk for the joints to become displaced or dislocated, leading to injury 2 2 1 40-60% >90% < 30% Not present 3 3 THE LIGAMENTS : Insertion atachment Nearly to mechanic joint axis : Isometrics ligaments Away to mechanical joint axis Ánisometrics Ligaments • Mobility Guidance Maintain stability throughout the ROM 4 4 2 THE LIGAMENTS BIOMECHANICS • • The ligament injury represents a failure of the elastic properties Its consequence is a joint instability 5 5 LIGAMENTS SPRAIN Acute ligament injury : action of external force , which causes plastic deformation PULLING FORCE 75% -Limb Weight bearing (supporting) +rotation forces SHEARING FORCES 25% Unaligned forces pushing one part of a body in one direction, and another part of the body in the opposite direction. 6 6 3 Severity Physical Examination Findings Impairment Pathophysiology Treatment Grade 1 Minimal tenderness and swelling Local pain if moves ROM normal Minimal Microscopic tearing of collagen fibers No splinting/casting Isometric exercises Full range-ofmotion and strengthening exercises as tolerated Grade 2 Moderated tenderness and swelling Moderate Partial tear of some collagen fibers in the ligament Immobilization with splint/cast Physical therapy with range-ofmotion and stretching/ strengthening exercises Severe Complete tear/ rupture of ligament Immobilization Physical therapy similar to that for grade 2 sprains but 7 over a longer period Possible surgery Decreased range of motion Possible instability Grade 3 Significant swelling and tenderness Instability 7 P.TREATMENT : PHASES Phase 1 includes resting, protecting the joint and reducing the swelling (one week). Phase 2 includes restoring range of motion, strength , flexibility and stability (one week to two weeks). Phase 3 gradually returning to activities that require turning or twisting the joint and doing maintenance exercises. 8 8 4 Evolution of Therapeutics in Ligaments Injuries 9 9 10 10 5 INFLAMATORY PHASE PHASE I MAXIMAL PROTECTION PROLIFERATIVE PHASE PHASE II MODERATE PROTECTION MATURATIVE PHASE PHASE II MINIMAL PROTECTION Muscle Strain Rest + compression Limit painfull motion Control pain Isometrics Mechanical stimulus : US, stretching Isotonics Increase stenght Eccentrics : plyomtretics Tendinopathy Limit tendón stress Reduce pain Isometrics contraction Promote tissue reparation Eccentrics Increase muscle loads Functional training Ligament Sprain Protect ligament Reduce swelling Pain control Restor range of motion, strength and flexibility Basic propioception Increase functional level Advanced propioception 11 11 JOINT DISLOCATION Joint dislocation, or luxation, : abnormal separation in the JOINT, where two or more bones meet. A partial dislocation is referred to as a subluxation • AETIOLOGY: – Congénital – Traumá. – Repeated sprains 12 12 6 JOINT DISLOCATION • COMPLICATIONS • Tearing of the muscles, ligaments and tendons that reinforce the injured joint 10% • Nerve or blood vessel damage in or around your joint 30% • Susceptibility to reinjury if you have a severe dislocation or repeated dislocations or innfective PT protocole 60% 13 13 14 14 7 P.T Protocole • Maximal protection: 1 week ( 3 x week) • Aimed to control the pain and oedeme caused by the dislocation. • Isometric strength exercise with 12–15 reps and 30% intensity of one-repetition maximum Re-establish full motion Retard muscular atrophy Decrease pain and inflammation Allow capsular healing 15 15 • Moderate Protection: (2 weeks / 3 x week) • Isotonic and Proprioception • 5 sets with 8–10 reps and 60%– 70% of 1RM Increase dynamic stability Increase strength Maintain full motion 16 16 8 P.T Protocole • Minimal Protection ( 3 weeks / 2 per week) • Designed for the endurance, plyometric, and strength exercises . • 5 sets of with 3–6 reps using variable resistance: one at 75% of the 1RM, and two at 95% of the 1RM. • Intensive stability Programm Increase neuromuscular control (especially in apprehension position) Progress dynamic stability Increase overall strength 17 17 9