Therapeutic Exam

What is the primary intention for healing>

healing where a small separation of tissue is brought together by a bridge of cells

What are examples of injuries that heal by primary intention?

Minor wounds and surgical incisions

What is secondary intention healing?

healing where the tissue ends are too far apart to be bridged, grows from the bottom and sides to fill the gap

What type of injuries typically heal by secondary intention?

More severe wounds and some 2nd-degree sprains

What are the three phases of healing?

Inflammation, proliferation, and remodeling (maturation).

How long does the inflammation phase generally last?

About 3–5 days.

What is the main goal during the inflammation phase?

Allow inflammation to occur while minimizing excessive inflammation

What are four ways to minimize inflammation?

Ice, compression, elevation, and rest.

What happens to blood vessels during inflammation?

Vasoconstriction occurs first, followed quickly by vasodilation.

What cells help clean up damaged tissue?

Neutrophils and macrophages.

What role do platelets play in healing?

They help with clotting and form part of the initial protective response.

What is vascular permeability?

Increased ability of blood vessels to allow fluids and substances to move into the injured area.

When does the proliferation phase generally occur?

About 2–4 weeks.

What happens during the proliferation phase?

New blood vessels and new tissue develop and grow.

What cells are especially abundant during proliferation?

Fibroblasts

What do fibroblasts produce?

Collagen and other components needed to form new tissue.

What gives new tissue tensile strength?

Collagen formation.

What is the extracellular matrix?

A structure formed around cells that helps provide support and shape to healing scar tissue.

How long does the remodeling phase usually last?

About 12 months, but it can range from 6–18 months.

What happens during wound contraction?

The scar becomes smaller.

What happens to collagen during remodeling?

Collagen becomes stronger and more cross-linked.

What happens to overall healing activity during remodeling?

It decreases as the injured area becomes more stable and permanent.

Do all tissues heal in exactly the same way?

No. All tissues follow the same general healing phases, but their different structures cause variations.

What cells help muscles regenerate?

Satellite cells.

How can cartilage heal?

Through regeneration or scar tissue formation.

Approximately how long can bone fractures take to heal?

About 3–4 months.

What is tensile strength?

The maximum stress or force a structure can withstand before failure.

Does injured tissue return to 100% of its original strength?

No

What happens to tensile strength during inflammation?

It can decline to about 50%.

When does tensile strength begin to increase?

Around day 5.

What increases tensile strength?

Increasing collagen production and collagen cross-linking.

Approximately how strong can muscle tissue become by week 6?

About 90%.

Approximately how strong can bone become by week 12?

About 83%.

How long can ligament and tendon healing take?

Approximately 17–50 weeks.

What does ice do during rehabilitation?

Reduces inflammation caused by rehabilitation.

What are some effects of electrical stimulation?

Enhances protein synthesis, reduces muscle spasms and pain, and facilitates muscle contraction.

What are some effects of heat and ultrasound?

Promote relaxation, increase circulation, and help remove waste products.

What do NSAIDs do?

Reduce edema and pain, allowing ROM and exercise to begin sooner.

When are NSAIDs commonly used during healing?

During the first two phases of healing; they may slow healing during the third phase.

Name factors that can affect healing.

Age, disease, wound size, infection, nutrition, swelling, muscle spasms, and surgical repair.

Why must therapeutic exercise be coordinated with healing phases?

To avoid damaging healing tissue and to provide the appropriate amount of stress at the right time.

What should be avoided during the inflammation phase?

Excessive stress that could cause reinjury, disrupt the fibrin clot, or increase edema.

What type of exercise is appropriate during early inflammation?

Light range-of-motion exercises with little or no strengthening.

What is the goal of exercise during inflammation?

Maintain overall conditioning, especially the cardiovascular system and uninjured side.

What type of stress can tissues tolerate during proliferation and remodeling?

Controlled stress and gradual strengthening.

What is an important exception to early strengthening?

Tendon repairs, depending on the physician's instructions.

What type of strengthening is often started first?

Isometric exercises.

How are overuse injuries different from acute injuries?

They require different treatment strategies and generally heal more slowly.

What should be done first with an overuse injury?

Eliminate the aggravating factor before beginning therapeutic exercise.

What are common signs of an overuse injury?

Increased edema, pain, and decreased function.

Why should clinicians ask patients about their symptoms?

Individual responses to injury and treatment can vary.

What is force?

Something that causes motion and has both direction and magnitude.

Give an example of an internal force.

Muscle force.

Give an example of an external force

Gravity.

What is Newton's First Law?

An object at rest stays at rest and an object in motion stays in motion unless acted upon by an external force.

What concept is associated with Newton's First Law?

Inertia.

What is Newton's Second Law?

Force equals mass times acceleration (F = ma).

What concept is associated with Newton's Second Law?

Acceleration and the relationship between force, mass, and motion.

What is Newton's Third Law?

For every action, there is an equal and opposite reaction.

What is the therapeutic exercise application of Newton's Third Law?

When a person pushes against a surface, the surface produces an equal and opposite force.

What is the center of gravity?

The point around which an object's weight is balanced.

Approximately where is the human body's center of gravity?

Around the S2 vertebra.

What factors affect stability?

The line of gravity and base of support.

What is fixation?

Stabilizing a body part so another body part can move effectively.

What are the three classes of levers?

First-class, second-class, and third-class levers.

What can body levers change?

Force production, speed of movement, and range of motion.

When does a muscle have its greatest ability to produce force?

At its resting length.

What is resting length?

The length a relaxed muscle can be stretched to without producing tension or additional stretch.

What is an advantage of multi-joint muscles?

They can have a better physiological advantage when stretched at one joint while moving another joint.

Why is stabilization important during rehabilitation?

It allows forces to be properly transferred and helps improve functional movement.

What is work?

Force multiplied by distance (W = F × d).

What is power?

Work produced per unit of time (P = Fd/t).

What is energy?

The capacity to do work.

What is velocity?

The rate of change of position.

What is acceleration?

The rate at which velocity changes.

What is elasticity?

The ability of an object to return to its original shape after being deformed.

What is creep?

A low level of stress applied over a long period of time that causes strain.

Why are stress and strain important in rehabilitation?

They help clinicians understand how tissues respond to forces and how injuries can be prevented or treated.

What are the two main parts of an examination?

Subjective and objective examination.

What is subjective information?

Information provided by the patient, such as medical history and pain.

What is objective information?

Information observed or measured by the clinician.

What are examples of objective examination techniques?

Visual inspection, ROM, strength testing, special tests, neurological testing, palpation, and functional testing.

What is palpation?

Using touch to examine tissues and identify abnormalities.

What is functional testing?

Testing movements or activities to determine how well the patient can perform functional tasks.

What happens during assessment?

The healthcare professional analyzes the examination findings, identifies problems, determines progress and potential, and develops goals and a treatment plan.

When should examination and assessment occur?

Before treatment, after treatment, and periodically throughout rehabilitation.

Why is assessment performed after treatment?

o determine whether the treatment was effective.

What is a functional examination used for?

To determine whether the patient is ready to return to full participation.

What question should functional testing answer for an athlete?

Can the patient safely meet the demands of their sport or position?

Why is record keeping important in rehabilitation?

It tracks progress, helps maintain consistent treatment, provides a reference if reinjury occurs, and serves as a legal document.

What is a common format used for recording treatment?

SOAP notes

What are examples of additional rehabilitation records?

Progress notes, discharge summaries, and outcomes.

What should be recorded during the examination?

Subjective findings, objective findings, assessment, and plan of action.