ATH501 Exam 1

Therapeutic Modalities-Pain

True or False: All modalities speed up the healing process

False: few to no modalities speed the healing process

True or False: The body heals at its own pace

True

modality

form of stress applied to body to elicit an involuntary physiological response

applying different modalities at the __ time may _ recovery

wrong; hinder

Stages of General Adaptation Syndrome

Alarm, Resistance, Exhaustion

Alarm Stage

initial reaction to a change in homeostasis

Resistance Stage

body adapts to stressor, using homeostatic resources to maintain tissue integrity

Exhaustion Phase

occurs when body cannot handle stress; overuse injury

Which stage of the General Adaptation Syndrome is the longest?

Resistance Stage

Macrotrauma

harmful stress that causes injury

Microtrauma

repeated, low intensity forces that cause stress fracture, chronic inflammation, and muscle soreness

Magnitude of the modality being too great can…

further injury may occur

Modalities being too low intensity or too short yields…

no benefits to the patient

What tissues must energy pass through to reach target tissues?

epidermis, dermis, and adipose tissues

Ischemia

lack of oxygen to a tissue

Primary Injury

tissue destruction resulting directly from traumatic forces

Secondary Injury

cell death by lack of oxygen, enzymatic damage, and mitochondrial damage

Phases of Healing

acute inflammatory phase, proliferation phase, maturation

Acute Inflammatory Phase

supply building phase; migration of phagocytes and fibroblasts, formation of granulation tissue, histamine released from damaged cells

Purpose of Granulation Tissue in Acute Inflammatory Phase

isolates and localizes trauma from healthy cells

Effects of Histamine Release

inc capillary permeability, swelling inc as proteins and water flow out into the tissues

Proliferation Phase

inc number of fibroblasts, collagen and ground substance pool in trauma area to prep for rebuilding

Components of Rebuilding Damaged Tissues

revascularization, wound contraction, wound remodeling

Maturation Phase

number of fibroblasts, myofibroblasts, and macrophages return to preinjury level; reduction in capillary vascularity and water content; type 1 collagen replaces type 3 in collagen lattice

Secondary hypoxic injury

causes cell death due to dec oxygen supply to area

Decrease of Oxygen Supply can be caused by….

hemorrhaging, reduced blood flow, hematoma pressure, muscle spasm, hydropic swelling of damaged cells

Secondary injury is first visible in what organelle

mitochondria

How quickly can secondary injury be seen in the mitochondria?

within 30 min of primary trauma

Swelling

inc volume in a body part or area; fluid buildup

Why does capillary permeability increase after an injury?

to ease movement of fluids and matter out of the area

Edema

build up of excess fluids and protein in interstitial joint space resulting from pressure imbalance around the cell membrane

edema can obstruct __ and _ return

lymphatic; venous

How can you reduce edema formation?

apply ice

How is edema removed?

inc venous and lymphatic return, gravity, circulation, and compression

Starlings Law

fluids move from areas of high concentration to low concentration

Muscle Spasm

involuntary contraction of muscle fibers, stimulating mechanical and chemical pain receptors

Causes of Muscle Spasm

direct trauma, dec oxygen, neurological dysfunction

Chronic Inflammation

caused by low intensity irritants; can be developed w/o acute trauma

Chronic Inflammation is a strong predictor of …

future disability

What are the consequences of injury?

secondary injury, swelling, edema, muscle swelling, muscle atrophy, chronic inflammation

Primary Pain Control

remove/reduce mechanical or chemical stimulation that triggers the nociceptors; encourages healing

Secondary Pain Control

interrupts the transmission or interpretation of the noxious impulse; used for comfort between treatments

Types of Therapeutic Modalities

thermal, electrical, mechanical, ultrasound, exercise, short wave diathermy

Types of Medications

analgesics, anti inflammatories, anesthetics, opiod analgesics

Sensory Pain

intensity, duration, location, frequency

Cognitive/Affective Pain

unpleasant feelings

Functional and Behavioral Pain

physical, social, emotional

Problem Solving Approach

logic based technique that uses clinical exam finding, patient long term goals, and available evidence to decide a treatment plan

Aspects of Treatment and Rehab Programming

knowledge of clinical exam skills, pathology, and physiology of treatment techniques, and knowing patient functionality, restrictions, and motivation

Outcomes

success of surgery, therapeutic modalities, and/or exercise to solve Px restrictions

Disease-oriented approach

treats pathology or injury directly

Patient-oriented approach

focuses on meaningful recovery based on Px preference

Clinician Based Measures

assesses impairments

Patient Based Measures

self-evaluations of activity limitations and restrictions

Outcome Scales should have values consistent with…

determining improvement in patient condition

Minimum Detectable Change (MDC)

smallest clinically significant change in scores after two trials; determines efficacy

Minimally Clinically Important Change (MDIC)

smallest change that is important/beneficial to the patient; measures responsiveness

Evidence-based Practice

provide most efficient and effective treatment to maximize Px outcomes

Factors to Consider while Choosing a Modality

can the modality directly or indirectly affect target tissues, produce physiological response required to promote healing, and does it improve outcomes better than placebo/no intervention

PICO question

patient, intervention, comparison, outcomes

You should always validate the use of modalities with…

research to back it up

Step 1 of Problem Solving Approach

obtain Px medical history

Step 2 of Problem Solving Approach

identify Px activity limitations and restrictions

Step 3 of Problem Solving Approach

Prioritize Px problems

Step 4 of Problem Solving Approach

Establish treatment goals

Step 5 of Problem Solving Approach

Review evidence for treatment

Step 6 of Problem Solving Approach

Plan therapeutic interventions and treatment

Step 7

reexamine Px and assess outcomes

How to use Medical Histories

review existing records (tests, operative reports, referrals) to identify contraindication

Problem Recognition

conduct examinations and interviews with Px prior to each treatment to assess effectiveness of treatment and to adapt as needed

Always consider the ____ relationship between Px complaints to best aid the Px

cause and effect

Long Term Goals

identify and quantify final outcome/ restore participation

Short Term Goals

goals for periods of 2 weeks or less at a time, projects progress to help achieve long term

Treatment Planning

applying knowledge of physiology, modalities, and exercise to resolve problems and reach goals

Final Modality Decisions should be based on…

scientific evidence, personal comfort, the modality itself, and patient input

Patient Self Treatment

educate Px on injury, treatment, and benefits; no more than 3 exs; provide clear written and visual instructions

Reexamination

track Px progress towards goals, develop new treatment, and readminister outcome measurements

If patient does not reach short term goals…

create new ones

If patient does not reach long term goals…

identify why they are struggling to reach it

Influences on Px Care

treatment setting, experience of staff, equipment, insurance constraints, Px time for treatment, Px support system, Px motivation

pain

unpleasant sensory and emotional experience associated with actual or potential tissue damage

Nociception

neural process of encoding and processing noxious stimuli

Battlefield conditions

athlete being so focused on competition that magnitude of the injury is not immediately processed

pain threshold

level of noxious stim required to alert an individual to a potential threat to tissue

pain tolerance

measures how much pain a person can withstand

pain is processed by…

higher brain centers

First Order Neurons

peripheral nerves

Second Order Neurons

transmit stimuli up spinal cord to high brain centers

Higher Centers of the Brain

cerebral cortex, amygdala, sensory homunculus

Hyperalgesia

following injury, a normally non-painful stim easily activates nociceptors

Primary Hyperalgesia

initial damage to the site

Secondary Hyperalgesia

increased pain around injured tissue

Primary Control Theory

resolving the physiological pain triggers; dec mechanical or chemical irritation

Secondary Pain Control

targets transmission and perception of pain

Melzak and Walls Gate Control Theory-Ascending Mechanism

inc non-nociceptive stim from peripheral to the spinal cord to elicit pain relief

Melzak and Walls Gate Control Theory-Descending Mechanism

small diameter nociceptive path and stim are transmitting to higher centers; initiated by specific higher center structures

Endogenous Opiates

hypothalamus controls release of beta-endorphins that inhibit pain perception

Chronic Pain

pain that extends beyond normal length of injury or illness; pain in absence of a pathology

Referred Pain

pain presenting in an area outside of the place of injury

Peripheral Nerve Root Pain

peripheral nerve damage that destroyed all nerve fibers causing loss of function distal to the site