Injury Response, Pain Physiology, and Thermal Modalities Vocabulary

Comprehensive vocabulary flashcards generated from the course material covering injury mechanics, tissue healing, pain processing, and thermal modality applications.

Therapeutic Modality

A form of stress applied to the body to create an involuntary physiological response.

Alarm Phase

The body's initial, sudden reaction to a change in homeostasis

Resistance Phase

The longest stage of General Adaptation Syndrome, where the body continues to adapt to a stressor

Exhaustion Phase

The stage of General Adaptation Syndrome occurring when the body cannot withstand stress, often presenting as traumatic or overuse injuries.

Microtrauma

Repeated, relatively low-intensity forces that can cause stress fractures, chronic inflammatory conditions, and muscle soreness.

Macrotrauma

Harmful physical stress caused by a single force that results in an acute injury.

Epithelial Tissue

Tissue that secretes and absorbs various substances and has the distinction of being devoid of blood vessels.

Adipose Tissue

Tissue consisting of fat cells with high water content; it acts as an ideal medium for ultrasound, but thick layers reduce the depth of thermal agents like hot or cold packs.

Connective Tissue

The most abundant tissue type in the body, produced by fibroblasts and formed by ground substance and collagen fibers.

Acute Inflammatory Response

The initial phase of healing lasting $0\text{--}14\text{ days}$, characterized by the migration of phagocytes and fibroblasts, granulation tissue formation, increased capillary permeability

Proliferation Phase

The phase of tissue healing lasting a few weeks to months, marked by an increase in fibroblast size and number, collagen collects, revascularization, and remodeling.

Maturation Phase

The final healing phase lasting $6\text{ months to } 2\text{ years}$, where capillary density and cellularity decrease, and type I collagen increases, water content reduced

Swelling

An increase in the volume of a body part as a result of fluid buildup.

Edema

The buildup of excess fluids and protein in the interstitial space resulting from an imbalance between pressures inside and outside the cell membrane.

Starling's Law

The physical law describing the movement of fluids across the capillary membrane that results in the formation or removal of swelling.

Pain

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Nociception

The neural process of encoding and processing noxious stimuli that may ultimately be interpreted by higher brain centers as pain.

Pain Threshold

The level of noxious stimulus required to alert an individual to a potential threat to tissue.

Pain Tolerance

A measure of how much pain a person can or will withstand.

Primary Hyperalgesia

An increased sensitivity to pain occurring at the initial site of tissue damage.

Secondary Hyperalgesia

An increased sensitivity to pain in the uninjured tissue surrounding the primary site of damage.

Gate Control Theory

An ascending pain modulation mechanism a-delta and c fiber are pain receptors and their activation is blocked by a-beta fibers that inhibit transmission.

Central Biasing

A pain control mechanism where the periaqueductal gray region (in the spinal cord)- tells interneurons (2^nd order neurons) to close that pain gate!! Serotonin and norepinephrine help accomplish that

Chronic Pain

Pain extending beyond the normal course of injury or illness, where the pain itself becomes the pathology in the absence of active tissue damage.

Referred Pain

Pain originating from deep or inflamed structures that is perceived at a location distant from the site of origin.

Nerve root pain - peripheral

destroys all fiber in the nerve, resulting in loss of function distal to the site of damage

Nerve root pain - spinal nerves

pattern of sensory loss changed to a dermatome pattern

sympathetically maintained pain

starts with a trauma, wounds may not heal well, the area reddens, and may sweat profusely

Myofascial Pain

A painful condition characterized by tense, sore muscles containing localized hypersensitive trigger points.

Primary Pain Control

Pain management aimed at removing or reducing the mechanical and chemical stimuli that trigger nociceptors by promoting tissue healing.

Secondary Pain Control

Pain management aimed at interrupting the transmission or central interpretation of noxious impulses to provide comfort between treatments.

pain assessment

mcgill pain, numeric rating, sensitivity pain scale

cryokinetics

The use of cold therapy in with movement is used to improve ROM by eliminating or reducing the element of pain. More macrophage activity, increased vascular growth, faster regeneration of muscle and scar tissue, and increased tensile strength of healed muscle 

Superficial Heat Modalities

Thermal agents that heat a larger area of tissue but are limited to a penetration depth of $2\text{ cm}$ or less.

Deep Heat Modalities

Thermal agents, such as therapeutic ultrasound and shortwave diathermy, capable of heating tissue structures at depths greater than $2\text{ cm}$.

Thermal modalities

Transfer energy to or from the tissues. greater the temperature, the more rapid the exchange of energy (Fourier law)

types of heat transfer

conduction, convection, radiation, evaporation, conversion

Indications for heat

Control inflammatory reaction, encourage tissue healing, promote venous drainage, reduce edema and ecchymosis, improve ROM before activity or rehab.

Indications for cold

When acute inflammatory response is active, before ROM exercises, after physical activity

local response to cold modality

range between 32-65 degrees, vasoconstriction, decreased metabolic rate, decreased pain and inflammation

Order of tissue heat loss

Skin cools, draws heat from underlying tissues, adipose tissue, fascia, and muscle

blood vessels cold

13 minutes,rate of blood flow decreases

lymphatic vessels cold

59 degrees, cross-sectional area decreases

tissues cold

50-59 degrees to decrease in cell metabolism

neurological cold

changed occur at 9 degrees

effects of cold on cellular

slows metabolism, reduces cellular reactions, decreases amount of oxygen cells require to survive. keeps the cell viable

effects of cold on inflammation

reduces the release of inflammatory mediators, decreases prostaglandin synthesis, and decreases capillary inflammation, decreases creatine kinase

effects of cold on blood vessels

arteriole vasoconstriction, increased blood viscosity, reduced blood flow

effects of cold on edema formation

Limits formation of edema by reducing cell metabolism, doesn’t promote removal of edema.

effects of cold on nerve conduction

decreases the rate that nerve impulses are transmitted and increased depolarization threshold

effects of cold on pain

Primary: removing the chemical and mechanical pain trigger, reducing inflammation, and limiting swelling

Secondary: occurs at the application site by interrupting nerve transmission

effects of cold on muscle spasm

reduces spasm by suppressing the stretch reflex by two mechanisms: reducing the threshold of afferent nerve endings, decreasing the sensitivity of muscle spindles

effects of cold on muscle function

decreased nerve conduction velocity, decreased sensitivity of muscle spindles, increased fluid viscosity

tissue temperature

remains elevated for 30 minutes after treatment

contraindications of cold application

circulatory insufficiency, DVT, cold hypersensitivity, anesthetic skin, advanced diabetes, chronic wounds, lupus,

cautions of cold application

carotid sinus, area of infection, near the eyes, infection, hypertension, cardiac or respiratory

106 and 02 release?

The release of O2 is twice as great as at baseline temperature

102 and enzymatic activity?

enzymatic activity increases at 102 degrees and continues up to 122 degrees

104 to 113 degrees

more easily allows for plastic deformation of collagen-rich tissues when stretched

higher than 113 degrees

protein damage occurs and tissues are destroyed

Paraffin Bath

A conductive thermal modality consisting of a $7:1$ mixture of wax to mineral oil, ideal for treating irregularly shaped distal body parts.

Enkephalin

An endogenous opiate released by descending pain control mechanisms to block the transmission of noxious impulses at the spinal cord.

Contraindications to heat

acute injuries, sleeping or unconscious patients, patients with tumors, closed infection (cautions: pregnancy, hypertension)

Cold pack types

bags, reusable gel, cold compression therapy units, chemical instant cold pack

Ice bags duration

20-30 minutes

cold compression

-15 minutes, 40 mmHg of compression, indications: musculoskeletal injury, post op/after rehab. Contraindications: post op with strong compression, DVT, advanced diabetes, circulatory insufficiency

Ice Massage

indications: muscle spasms, contusions; contraindications: circulatory problems, CRPS, fractures

Ice immersion

treatment time 2-5 minutes, temperature range 50-60 degrees, indications: post exercise, acute inflammation, chronic pain; contraindication: cold-induced myocardial ischemia, advanced diabetes

cryostretch

(ethylchloride),Indications: combine stretching to relieve muscle spasm; reduce pain with trigger points. Contraindications: cold hypersensitivity, open wounds, neuropathy (lasts about a minute)

whirlpools

Hubbard Tanks: 90–102 degrees F, Maintenance: quarterly, 6-month, and annual maintenance is required, including thermometer calibration 

• Indications: 

  • Joint stiffness 

  • Muscle spasms and tension 

  • Sprains and strains 

• Contraindications: 

  • Severe circulatory problems 

  • Uncontrolled hypertension 

  • Neuropathy 

• Treatment time: ranging from 10-20 minutes

Heat packs

Maintained at a temperature ranging between 160-166 degrees, heated packs contain energy for a 30-minute, reheat for 30-45 minutes before next use. Indications: Relaxes muscle spasm, Reduces chronic aches and pains, pre-exercise warm up. Contraindications: Acute injuries, Open wounds or infections, Fever, Tumors 

• Treatment time: 15-20 minutes

contrast therapy

Hot: 105-110 degrees F, Cold: 50-60 degrees F 

• Possible treatment modalities: heat and cold packs, tandem whirlpool, stationary water immersion 

• Indications: Soft tissue injuries, edema and swelling control, chronic joint pain 

• Contraindications: Uncontrolled hypertension, Cardiovascular disease, Neuropathy, DVT 

• Common ratios/treatment time: 

  • 3:1 and 4:1 (hot to cold)