Healing
What is the best treatment for a ligament injury?
Depends on the vascular supply to the ligament
An intra articular ligament (ACL) has LIMITED blood supply so it results in poor healing, surgery is usually recommended
An extra articular ligament (MCL) has better blood supply so conservative care is usually recommended
During inflammatory phase: focus on palliative treatment
During proliferative phase: focus should be on biomechanics and restoring proper gliding with early passive motions
What is unique about healing a fracture? When can you mobilize?
NEED to immobilize so that both ends of the bone are in the right spots to heal
Can mobilize when there is a callous formation present on an x-ray, treat pain, ROM defecits
What are some effects of immobilization?
ONLY immobilize for a few days after injury (except for fractures)
If longer, can lead to fibrosis and atrophy of healthy fibers
Early mobilization promotes regrowth of capillaries, fiber regeneration and earlier return of strength
LOW threshold for injury, HIGH tissue vulnerability
Generally has symptoms, precautions and restrictions which limits the exam
May be post-surgical or have an acute injury
Level of stress to injured tissue should be MINIMAL
Emphasis of treatment is to protect vulnerable tissue
What is the average resting HR for adults, children, infants and neonates?
Adults: 60-100
Children: 80-100
Infants: 100-120
Neonates: 120-160
What is the treatment for a tendon injury?
Depends on severity: surgery or external protective care
Tendons do NOT repair with tendon tissue- they are repaired with dense connective tissue
Tendons have less consistent blood flow than ligaments- lowers their ability to heal
What is the difference between radicular pain and referred pain?
Referred pain: pain that is felt in a location that is not the source of the pain
How does a tissue respond to repetitive stress?
Think load deformation curve: toe region- uncrimping of collagen fibers, Elastic region: stretches a little bit but can return to normal length, Plastic region: there is some amount of deformation and CANT return to normal length, Failure: macroscopic failure (complete tear)
Repetitive load causing damage has to be reduced for healing to occur
Describe someone on the Stage 2 of rehabilitation?
MODERATE threshold for injury
Complete exam can be performed
Usually NO precautions or restrictions
Limited FUNCTIONAL mobility secondary to pain or other symptoms
Treatment should focus on appropriate physical stress to the tissue
Adults: 12-20 breaths/min
Children: 15-30 breaths/min
Infants: 25-30 breaths/min
How should a muscle injury be treated?
Small injuries repair with muscle tissue
Larger injuries will fill with scar tissue
Initially should rest and avoid stretching for 3-7 days, by day 10 the scar tissue is stronger than the intact muscle
What is a grade 1 muscle injury? Grade 2? Grade 3?
Grade 1: tearing of a few fibers, MINIMAL loss of strength
Grade 2: tearing of more fibers, Loss of strength
Grade 3: complete tear of fiber, COMPLETE loss of contractile strength
What are the 4 key variables in considering staging of an injury?
Time since injury
Symptoms
Outcome scores
Functional mobility
Describe someone in stage 3 of rehabilitation
HIGH threshold for injury, LOW tissue irratibility
Objective exam includes assessment of high-level sport or work activities
Treatment should emphasize gradual addition of physical stress to promote tissue adaptation or hypertrophy
What are the different categories/levels for blood pressure?
Normal: Less than 120/Less than 80
Elevated: 120-129/Less than 80
Hypertension Stage 1: 130-139/80-89
Hypertension Stage 2: 140>/90>
Hypertensive crisis: Higher than 180/Higher than 120
What is a complication to muscle healing?
Scar tissue doesn't have contractile properties like muscle tissue
Less tissue regeneration as age increases
Myofibrils can't withstand contractile force for approx. 10 days until collagen starts to form
What is a grade 1 ligament injury? Grade 2? Grade 3?
Grade 1: ligament stretched, NO fiber damage, NO joint laxity- there is pain when applying tension but NO excessive range of motion
Grade 2: Ligament stretched and some fibers torn, MODERATE joint laxity, pain with SOME laxity when applying tension
Grade 3: Almost complete tear, results in A LOT of joint laxity
What is the general guidelines for treatment stages?
Restore ROM, Restore strength, Restore overall function without adding excessive stress to injured tissue
Why do we do a systems review?
Patients who come to us via direct access
Look for things that prompt for a more thorough investigation or red flags to be referred out
What are the normal values of pulse oximetry? When would someone need supplemental oxygen? What might indicate CVP disease?
97-99%
<88% needs supplemental oxygen
90-95%- CVP disease
Most cartilage can't heal back to its original tissue- avascular and aneural
A decrease in weight bearing can lead to loss of cartilage
Arthritic joints respond well to motion but poorly to excessive weight bearing (think aquatic therapy)
A patient presents to outpatient physcial therapy 1 week post ankle injury. Exam results: pain and excessive/significant ROM is present with ligament testing. What is the grade of the patients injury?
Grade 3 Sprain
What are the general stages of healing?
Inflammatory phase: removes foreign debris to decrease chance of infection, increases redness/swelling, 0-14 days (greatest in first 48 hours)
Proliferative/reparative phase: formation of scar tissue- scab formation from fibrin and collagen (first 48 hours), neovascularization: formation of new blood vessels (2-5 days), Wound closure: decrease size of wound (4-21 days)
Remodeling Phase: strengthening of new tissue in response to applied stress- consolidation (21-60 days), Maturation: (4-6 months post injury)
What is the 6th vital sign?
Walking speed
What is included in the MSK screen part of the systems review? How is gross strength and MMT different from each other?
can include posture (can also be done with integ), gross ROM, gross strength- these are individualized to patient and their needs
Gross strength: tells us patients ability to recruit muscle groups to produce force in planes
MMT: isolates individual muscle