DPT 742 Quiz 2 STUDY GUIDE 13 SG Metabolic, MSK disorders, transplantation

Factors that have increased MSK injury at a population level (3)

Participation in high-speed travel

Complex industry

Competitive and recreational sports

Documenting the influence and effects of exercise at the molecular and cellular levels has resulted in... (3 things)

Early functional rehabilitation

Prevention exercise programs

Use of exercise as a first-line intervention

What percentage of total injuries in the US are MSK injuries?

More than 50% of all injuries in the US are MSK injuries.

Out of ALL MSK injuries, what percentage of injuries are fractures, sprains and dislocations?

Nearly half of all MSK injuries in the US are fractures, sprains, or disolocations.

Name the leading chronic condition reported Americans over age 65:

Arthritis

3 weeks of bed rest has a more profound impact on physical work capacity than...

3 decades of aging!

What percentage of adults in primary care only report physical symptoms (and not psychosocial)?

40-80% only report physical symptoms

What is the relationship between ovulation and rates of MSK injury?

Women who are ovulating (highest estrogen levels) have 2x risk for MSK injury.

How can we prevent MSK injury in women who are ovulating?

Change training and conditioning strategies during different times of the month.

Men increase muscle volume ____x as much in response to strength training when compared to women.

2x as much muscle volume increase (hypertrophy)

Who experiences more deconditioning: Men or women?

Men

After tissue trauma, describe movements of the involved area: (2 words)

Slow and guarded

Components of passive movement testing that suggest acute inflammation (per Cyriax) (2)

Spasm end-feel

Pain reported before resistance

Most effective interventions for acute inflammation include: (2 factors)

Pharmacotherapy (Drugs)

Physical therapy

Class of most commonly administered drugs for pain and inflammation (2)

Salicylates

NSAIDs

Cellular methods of reducing inflammation via drugs (4)

Inhibition of the biosynthesis of prostaglandins

Decreasing release of granulocytes, basophils and mast cells

Decreasing vessel sensitivity to bradykinin and histamine

Reversing/ controlling vasodilation

Function of osteoblasts vs osteoclasts

Osteoblasts: Form new bone

Osteoclasts: Break down bone

Primary influences affecting bone remodeling (3)

Mechanical stresses

Calcium and phosphate levels in extracellular fluid

Hormonal levels: PTH, calcitonin, Vit D, cortisol, HGH, thyroid hormone, sex hormones

By what age has bone loss generally progressed to predispose older people for fractures?

Age 65

Define sarcopenia

Age-related loss in muscle mass

Rate of muscle loss (per decade) for women/men

Women: 4-6% each decade, beginning at age 40

Men: 4-6% each decade, beginning at age 60

How long can muscle strength be maintained in men and women via exercise training?

Well into the eighth decade

Loss of flexibility of these tissues (4) causes increased fall risk in older adults:

Fascia

Articular cartilage

Ligaments

Tendons

Fibrinogen hypothesis for decreased tissue flexibility during older age:

Increased circulating fibrinogen + decreased physical activity causes adhesions of muscle and fascia

Collagen hypothesis for decreased tissue flexibility during older age:

Aging collagen increases cross links between molecules, decreasing mechanical stability and increasing stiffness

Effect of physical activity on tissue stiffness

PA decreases tissue stiffness

Articular cartilage factors that lead to increased incidence of osteoarthritis (3)

Degeneration of cartilage

Shinning (damage or thinning) of cartilage

Loss of water content

By age 60, percent of population with evidence of OA? Percent who show symptoms?

80% show evidence of OA

15% symptomatic

How can PTs help prevent OA?

Education and exercise!

Effects of strength training on skeletal muscle fibers (4)

Increases strength

Increases mass (hypertrophy)

Increases power

Increases quality

Benefits of strength training (specific to older adults) (8)

Increases endurance performance

Normalizes BP

Reduces insulin resistance

Decreases adipose

Increases BMR

Prevents loss of BMD

Reduces fall risk

Reduces pain d/t OA

Initial strength gains (first 8 weeks) vs. subsequent gains (after 8 weeks)

First 8 weeks: Enhanced neuromuscular efficiency

8 weeks +: Increased fiber density, hypertrophy

Strength training minimum recommendation for older adults (days/week)

At least 1-2 days/week, better if it's 3

Does strength training typically improve VO2 in older adults?

No

Benefits of endurance training in older adults (2 main)

Reverse decline in physical conditioning associated w/age

Moderate PA can reverse 100% loss of CV capacity (returning older adults to levels of aerobic power seen in young adulthood)

Aerobic exercise less than (what threshold?) is generally NOT a sufficient stimulus for older adults? (days/week, %VO2, total time)

Less than 2 days per week

Less than 40-50% VO2 max

Less than 10 min/day

Metabolic disorders specific to the skeletal system (3)

Osteoporosis

Osteomalacia

Paget Disease

What percent of total adult skeleton experience metabolic turnover each year?

10% of the entire skeleton is replaced each year

Latin root word meaning of osteoporosis

Porous bone

General factors that lead to osteoporosis (2)

Decreased bone mass

Micro-damage to bones

Define primary osteoporosis:

Most common type of osteoporosis, occurs in both genders (but typically women), subtypes include: Postmenopausal/ estrogen deficient (Type 1) and age related/ senile (Type 2)

Define secondary osteoporosis:

Associated w/medications, comorbidities or diseases

Define osteopenia:

Low bone mass, without the microdamage that's present in general osteoporosis

Diet/nutrition and osteoporosis

High dietary ratio of animal to vegetable protein increases risk of femoral neck fracture (aka eat more veggies)

Female athlete triad

Depression and osteoporosis

Increases cortisol

List all risk factors for developing osteoporosis (8)

Genetics

Ethnicity (white)

Sedentary lifestyle

Tobacco use

Alcohol use

Corticosteroids

Poor diet

Depression

Medical management of osteoporosis (5)

No cure available

Regular exercise

Meet vitamin and nutrient requirements in first 2-3 decades of life

Eat dairy, calcium, magnesium

Daily sunshine for vitamin D

SIFTTs for osteoporosis (6, general)

Educate

Screening assessments

Exercise

Fracture prevention

Quality of life

Precautions

SIFTT for osteoporosis: Exercise

Reduces chronic pain and depression

Benefits discontinued if exercise stops

SIFTT for osteoporosis: Fracture prevention

Identify hazards at work/at home

Choose appropriate gait assistive device

SIFTT for osteoporosis: Quality of ilfe

Needs to be considered

80% of women over 75yo would rather die than have a hip fracture and be put in SNF

SIFTT for osteoporosis: Precautions and considerations

Take caution with certain evaluation or treatment techniques

BMD of spine correlated w/strength of spine extensors

Flexion exercises contraindicated

Posterior pelvic tilt, partial sit-ups don't cause anterior compressive force

Clinical manifestation of osteomalacia (5)

Diffuse generalized aching + fatigue

Anorexia and weight loss

Proximal myopathy + sensory polyneuropathy

Bone pain + periarticular tenderness

Postural deformities (thoracic kyphosis, heart-shaped pelvis, bowed femur + tibia)

Barriers to working with organ transplant populations (3)

Many have been sedentary for a long time

Often have long-term health conditions that cause severe deconditioning

Need to consider daily life and activity requirements

Pre-hab goals for pretransplantation:

Functional exercises

Focus on pelvis (glutes and quads) for bed mobility and dressing

Focus on shoulder girdle and trunk for transfers and breathing

Main benefit of participating in pre-hab before transplantation:

More likely to have a faster recovery

Can transplant recipients ever return to PLOF?

Can progressively return to a normal life

Return to work

Can safely participate in some sports and exercise

Transplant recipients who engage in ____ months of specific resistance exercise training will... (2 benefits)

6 months

Restore fat-free mass

Increase muscular strength

Why is it important for transplant recipients to gain muscle mass in their lumbar spine?

35% of transplant recipients develop lumbar spine bone fractures

Exercise guidelines for transplant recipients (2)

Exercise should continue until fatigue begins

Add 1-2 mins per day

Exercise to fatigue at least 2x daily until 30 min continuous activity is tolerable

Limitations for exercise and sport in transplant recipients

No contact sports

Evaluated case-by-base

Vigorous PA not contraindicated

CV and strength training should progress gradually

SIFTT for liver transplant (5) acute

Pts have painful abdominal incision (4-5 inches) - Contraindication for resistive exercise

OOB activity + mobility 1 day post-op

Upper ROM activities to prevent adhesive capsulitis

Mobility training to avoid edema

Ambulation asap

Define osteomyelitis

Inflammation of bone d/t infectious organism (bacteria, fungi, parasites, viruses) that enters open wound. Usually develops d/t open injury to bone or surrounding tissue. Rapidly destructive pyogenic infection

Incidence of osteomyelitis

Increased incidence d/t:

Drug resistant organisms

IV drug abusers

Increased use of implantable prosthetics

Pathogenesis of osteomyelitis

Inflammatory response

Metaphysis allows exudate from infection to spread easily

Tension builds and forces pus through Haversian canals

Infection disrupts and weakens cortex, predisposes bone to fracture

Clinical manifestations of osteomyelitis (3)

Pain, edema, erythema, tenderness

Easier to detect in extremities

In initial phases of infection, pain may not be a factor d/t lack of pain fibers in cancellous bone

Stages of osteomyelitis (3)

1. Initial infection. Bacteria ->metaphysis.

2. First stage. Bone destruction, abscess forms.

3. Second stage. Pus spreads. New reactive bone forms.

SIFTTs for osteomyelitis (4)

Monitor for infection in pts post-op for 12 months

Inspect wound for drainage, pain during exercise, low-grade fever, swelling, redness

Increased chance of infection

Prevent complications (ex. contractures, atrophy)

Incidence of infection of bursae and tendons

Uncommon, must be treated appropriately to avoid complications

Risk factors for infections of bursae and tendons (4)

Those that lie closer to surface of skin more susceptible to injury

Trauma to elbow and knee

Staph infection most common cause

Hand infections 60% related to trauma, 25% human bites, 10% animal bites

Pathogenesis for infections of bursae and tendons

Bursae lined w/fluid similar to synovium, therefore subject to same pathologies caused by acute or chronic infections

Clinical manifestations of infections of bursae or tendons

Pain, loss of function, swelling, cellulitis

Medical management of infections of bursae or tendons (3)

Exam reveals localized swelling

Aspiration needed

Antibiotics, sometimes drainage, sometimes bursectomy

SIFTTs for infections of bursae and tendons (3)

Splinting and early immobilization necessary

Wrist placed in 30-50 extension, MCP joints in 75-90 flexion, IP joints in full extension

AROM exercises begin early (48hrs)