KINE 427 Morton Exam 1

Spring25

Therapeutic Modality def.

A device or technique that delivers a physical agent to the body for therapeutic purposes

What are the 5 physical agents?

1. Heat

2. Cold

3. Light

4. Electricity

5. Exercise

Name 4 therapeutic purposes

1. Wound healing

2. Pain relief

3. Flexibility and Range of Motion

4. Muscular Strength / Endurance

Classification of the 7 Therapeutic Modalities (C THE LME)

Cryotherapy

Thermotherapy

Hydrotherapy

Electrotherapy

Light Therapy / Phototherapy

Mechanotherapy

Exercise

Simple Squamous Epithelium

1 layer, thin, flat

Used for diffusion + filtration

Easily damaged

Simple Cuboidal Epithelium

1 layer, cube shaped

Central spherical nucleus

Secretion in glands, absorption in kidneys

Simple Columnar Epithelium

1 cell, elongated

Protective of underlying structures

Secretes digestive fluids, absorbs nutrients

Can have microvilli

Pseudostratified Columnar Epithelium

appears layered, but is not

Nuclei stacked at different levels

Lines respiratory tract and repro systems

Stratified Squamous Epithelium

thick, many layers

keratin causes old cells to harden and die, forming protective layer

Stratified Cuboidal Epithelium

2-3 layers lining lumen

larger ducts like mammary glands

Stratified Columnar Epithelium

layers of cells

superficial layers are elongated, basal layers are cuboidal

Transitional Epithelium

changes in response to tension (stretchy)

inner lining of bladder and urinary passages

several layers of cuboidal cells

flat when stretched, cube when relaxed

Glandular Epithelium

specialized to make and secrete a product

found mostly within cuboidal and columnar epithelia

Types of Exocrine glands

Merocrine, Holocrine, Apocrine

Merocrine glands secrete…

watery, protein-rich secretions

Holocrine glands function by…

cell bursting during secretion

Apocrine glands lose…

cytoplasm during secretion

General Adaptation Syndrome stages

1. Alarm Stage

2. Resistance Stage

3. Exhaustion Stage

GAS Alarm Stage

fight or flight

increased BF, HR, SV, arterial shunting occurs, cortisol released

GAS Resistance Stage

plateau in body’s adaptation

longest phase of GAS

GAS Exhaustion Stage

Body can no longer withstand stressor

may present as traumatic or overuse injuries

Types of Body Tissues

1. Epithelial

2. Adipose

3. Muscular

4. Nervous

5. Connective

Order in which therapeutic energy must pass to affect a given tissue

Epithelial → Adipose → Muscular → Nervous → Connective

Connective Tissue function

Binds structures together

Provides support and protection

fills spaces

produces blood cells

stores fat (energy, insulation, protection)

Structure of connective tissue (3 components)

Ground Substance, Fibers, Cells

Connective Tissue Matrix

Hydrophilic Ground Substance + Fibers (high tensile strength)

Connective Tissue cells

the “living” component of CT

Blasts: build

Clasts: cleave (destroy)

Fibers of the CT Matrix

White — contain collagen, flexibility and strength

Yellow — contain elastin, more elastic but not as strong as collagen

Reticular — thin, highly branched collagenous fibers that provide support

Collagen Fibers

fibrous protein in CT structure

derived from greek word meaning “to glue together”

constitutes 50% of proteins in man

Collagen Structure

pyridinium corss-link bonds @ microfibril level

Reticular Fibers

very find collagen fibers

formed in a network

fill space

Elastic fibers

contain protein elastin

molecules look like coiled springs

Types of Fibrous Connective Tissue

Loose (areolar) CT — adipose

Dense CT — Regular & Irregular

Reticular

Loose areolar CT

contain many white fibers and yellow fibers

adipose tissue is a type of loose CT

Dense CT

Regular: parallel bundles of collagenous fibers, tendons and ligaments, binds organs together

Irregular: bundles run in different directions, inner portion of skin

3 Types of Cartilage

Hyaline (trachea), Elastic (ear), Fibro-cartilage (ACL)

2 Types of Bones

Compact & Spongy

Bone Matrix makeup

mostly calcium and phosphate

65% of bone weight in calcium hydroxyapatite

Contains tropocollagen subunits giving elasticity and fracture resistance

Compact bone

outer portion of long bones

consists of many osteons

Spongy bone

found on ends of long bones

Osteopenia vs. Osteoporosis

Osteopenia = bone loss but not severe

Osteoporosis = decreased bone density with increased fracture risk

causes of osteoporosis

anorexia nervosa

prolonged treatment with corticosteroids

inadequate diet, especially during pregnancy or breast feeding

estrogen metabolism disturbances

Blood and Lymph CT

composes of cells suspended in liquid matrix called plasma

• RBCs (erythrocytes) carry oxygen

• WBCs (leukocytes) fight infection

• Platelets (thrombocytes) found in bone marrow

WBCS + Platelets = ~1%

Hematocrit

RBC volume, 45% of total vol for men, 40% for women

Anemia = crit < 40% for men or 30% for women

Erythrocytes are formed

in bone marrow

production and homeostasis regulated by tissue o2 levels

Thrombocytes function

sticky cells that function in all aspects of hemostasis

Plasma makeup

90% water

metabolic byproducts

nutrients like glucose, ffas, lipids, cholesterol

electrolytes

gases

Proteins in plasma

60% albumin (made by liver)

36% globulin (from liver)

number of myofascial lines

12

3 kinds of muscle tissue

smooth (involuntary)

cardiac (involuntary)

skeletal (voluntary)

Skeletal muscle

voluntary, little to no ability to reproduce LOST cells (only repair)

responsible for locomotion, voluntary contraction and relaxation

Muscle structure

made of bundles (fasciculi) containing individual muscle fibers that contain myofibrils which are divided into sarcomeres

Sarcolemma

plasma membrane of muscle

Satellite cells

muscle growth and development

active in response to injury, training, immobilization

Sarcoplasm

fluid of muscle fiber (cytoplasm)

Transverse (T) Tubules

carry action potential deep to muscle fiber

Sarcoplasmic Reticulum (SR)

Calcium storage necessary for contraction

Sarcomeres

everything between 2 Z-Discs

basic functional unit of myofibril

Actin

thin filament, lighter color, I band ONLY actin

Myosin

thick filament, show darker A band both actin + myosin

Myosin contains…

2 intertwined filaments with globular heads

Actin is composed of…

3 proteins (G actin, tropomyosin, troponin)

Motor Unit Excitation structures

Alpha Motor neurons innervate muscle fibers

Motor unit is a single alpha motor neuron + all the affected fibers

Neuromuscular junction (NMJ) is the site of communication between neuron and muscle (Ach across synapse)

Muscular Dystrophy (MS)

inherited disorder with progressive proximal muscle weakness with destruction of muscle fibers and replacement with connective tissue

Skeletal Muscle Contraction Steps

1. AP starts in brain

2. AP arrives at axon terminal, releases acetylcholine (ACh)

3. ACh crosses synapse and binds to receptors

4. AP travels down plasmalemma to T Tubules

5. Triggers Ca2+ release from SR

6. Ca2+ enables actin-myosin contraction

Role of Calcium in muscle contraction

binds to troponin on the thin filament, causing movement of tropomyosin, freeing blocked binding sites

Sliding filament theory

Relaxed state:

• no interaction at binding site, myofilaments overlap a little

Contracted state:

• myosin head pulls actin toward sarcomere center (power-stroke), filaments slide past each other

After Power Stroke Ends:

• Myosin detaches from active site, head moves to original position, myosin attaches to another active site further down

• Process continues until Z disk reaches myosin filaments or when AP stops (Ca2+ pumped back to SR)

Energy for muscle contraction

ATP binds to myosin head, ATP → ADP + Pi + energy

Muscle Relaxation

AP ends, Ca2+ pumped back to SR, without Ca2+ troponin and tropomyosin return to resting form (conformation)

Muscle relaxation takes energy (rigor mortis)

Muscle Fiber types

Type I (slow twitch)

Type IIa

Type IIx

CNS is composed of…

brain and spinal cord (cells destroyed cannot be replaced)

PNS contains…

Afferent (sensory) nerves, Efferent (motor) nerves, (regeneration via schwann cells

Neurons

transmit electrical impulses from one site in the body to another, receive and process information

Neuroglia

non conducting cells that are in intimate physical contact with neurons (schwann cells)

Cell body of neuron

cell nucleus + cytoplasm, single prominent nucleolus

Axons and Dendrites

Axons: frequently injuried, commonly referred to as nerve fibers, impulse away from cell body

Dendrites: numerous, highly branched, terminate near cell body, impulse towards cell body

myelination production cells in CNS and PNS

PNS- schwann cell

CNS- oligodendrocytes

Peripheral nerves contain

afferent and efferent nerve fibers

1 or more fascicles of nerve fibers

endoneurium inside fascicle

Astrocytes

most numerous glial cell in CNS

2 types of astrocytes

Fibrous (white matter), Protoplasmic (grey matter)

NEUROVASCULAR REGENERATION DAYS AND STEPS

Day 0: schwann cells and fibroblasts die by apoptosis

Day 2: axons degenerate due to action of Ca and Na release

Day 7: macrophages eax axonal and myelin debris, release VEGF-A leading to formation of neovessels, schwann cells secrete NGF, CNTF, BDNF (vascular endothelial GF, nerve GF, ciliary neutrophic factor, brain-derived, NF)

Day 14: BDNF and GDNF stimulate formation of NEW schwann cells, o2 and nutrients supplied by neovessels allow formation of bands of bungner (physical guide for axon regrowth)

Day 14-21: general appearance of nerve is almost normal

Muscle spindles

detect change in muscle length and rate of change

Myotatic Stretch reflex

dampens movements, stabilizes body during fine motor tasks

Golgi Tendon Organs

detect magnitude and rate of tension in muscle, decreases agonist while increasing antagonist to prevent damage

hypothesized cramp mechanisms

fatigue → incr. spindle firing rate + decr. GTO firing rate + incr. alpha motor neuron reflex

overproduction of alpha motor neuron activity = cramp

The inflammatory response purpose

defend body against foreign substances + dispose of dead and dying tissue

5 signs of inflammation

Redness

Heat

Fluid Accumulation (edema)

Pain

Loss of Function

Phases of inflammation

1. Injury

2. Ultrastructural changes

3. chemical mediation

4. hemodynamic changes

5. metabolic changes

6. permeability changes

7. leukocyte migration

8. phagocytosis

Primary injury definition

any occurance that impair tissue structure and function

Other causes of injury include

physical agents (trauma, burns)

metabolic processes (hypoxia)

biological agents (virus)

chemical agents

endogenous chemicals (normal secretions in abnormal location)

Ultrastructural changes def.

cell membrane is disrupted and eventually breaks down, causing contents to spill out = cell death

• direct trauma

• indirect hypoxia, enzymes, or in cells adjacent to primary injury

Lysosome

supplies chemicals that digest foreign material within cell

Chemical mediation of inflammatory resposne

Histamine and Bradykinin

hemodynamic changes of inflammation

arteries dilate, increasing bloodflow to injured area

leukocytes adhere to vessel wall near an opening

metabolic changes of inflammation

decr. energy and oxygen, causes cell to switch to anaerobic metabolism

membrane fxns are slow

sodium pump maintains conc. of intracellular sodium at a low lvl

• sodium retention → water retention → cell burst

Permeability changes of inflammation

histamine and bradykinin incr. permeability

gaps are left through which WBCs can move out of vessel and to injury site

Leukocyte migration

adhering to endothelium (vessel wall) and/or to other WBCs

Neutrophils first, then larger macrophages (attracted by neutrophil death)

Neutrophils - arrive first and provide 1st line of defense

M1 Macrophages clean debris

M2 macrophages promote healing and matrix formation

Chronic inflammation

results from microtrauma but does not necessarily involve inflammatory reaction

Primary to Secondary injury steps

1. Immediate Ultrastructure change (primary)

2. Hemorrhage

3. Swelling

4. Plug forms to seal damage vessel

5. Chemical mediators released from dying cells

6. Secondary enzymatic injury begins

7. Hemodynamic changes

8. phagocytosis

9. hypoxic injury, enzymatic injury continues

10. TOTAL INJURY

decreased metabolism theory

energy need = energy available before injury

energy need > energy available after injury

Cryotherapy decr. energy need (metabolism) thus decreasing O2 demand thus decreasing secondary injury