Active care exam 2 pt 1

which types of interventions are recommended and most supported by evidence for treatment of MSK pain and injury

self management advice, education, and exercise

resolve pain and restore fxn

empower patients

increase self-efficacy

decrease fear of movement

reduce frequency and duration of flare-ups

are the evidence-supported benefits of what?

active care

what its the #1 predictor of successful outcomes with any exercise program

adherence

what type of motivation is needed to facilitate adherence?

intrinsic motivation (patient-centered approach)

how can we help our patients with intrinsic motivation and facilitating adherence?

find out their goals with care and what meaningful activities they want to get back to doing and build rehab program around those

law of repetitive motion

I = NF/AR

what does the "I" stand for in law of repetitive motion

insult to tissues

what does the "N" stand for in law of repetitive motion

number of repetition

what does the "F" stand for in law of repetitive motion

force/tension of each rep

what does the "A" stand for in law of repetitive motion

amplitude

what does the "R" stand for in law of repetitive motion

relaxation time between reps

what effect does weakness have on force and potential tissue insult?

F that is high (tissue insult will be higher)

what happens to the margin of safety as failure/tissue tolerance decreases?

increase

A cycle whereby an injury will induce inflammation, muscle spasm, adhesions, altered neuromuscular control, and muscle imbalances. Muscle imbalance can lead to more inflammation, and the cycle repeats.

cumulative injury cycle

constant pressure/tension injury

weak and tight tissues

friction-pressure-tension

decreased circulation (edema)

adhesion-fibrosis

Are all components of the what?

cumulative injury cycle

decrease circulation and compromise cell recovery

cellular retention of calcium, poor repair, increase acidity/inflammation

Are all examples of what?

resultant tissue changes of constant pressure/tension injury

makes muscles tight which tends to weaken it

adjacent tissues also drawn tight

Describes the idea of what?

resultant tissue changes of weak and tight tissues

as a result of weak and tight tissues, internal forces acting on the tissues rise

acute injury and inflammation can result

Describes what?

resultant tissue changes of friction-pressure-tension

when friction-pressure-tension factor is severe enough or when an acute injury occurs, what 2 additional factors come into play?

tear or crush

inflammation

injury history

activity history and physical preparedness

doing too much with too little rest and recovery

Are all factors that impact what?

the law of repetitive motion

altered activity, sensitivity, tolerance, fear

insufficient/incomplete rehab

altered motor control

deceased tissue tolerance, failure tolerance and margin of safety

Are all results after injury that may contribute what?

Future injury

why do most MSK injuries happen in the first place?

poor load management

performing an activity the individual is unaccustomed or not prepared to perform ; not having the strength, stability or capacity required to perform an activity

underprepared

SAID principle

Specific Adaptations to Imposed Demands

(body will adapt to demands placed upon it)

what effect does too little or infrequent exposure to external load an conditioning have on tissue adaptation, margin of safety and failure tolerance?

tissue tolerance never raises

what effect does too much or too frequent exposure to external load an conditioning have on tissue adaptation, margin of safety and failure tolerance?

adaptation can't keep pace

what effect does rest have on tissue adaptation, margin of safety and failure tolerance?

rest increase margin of safety and failure tolerance

are most injuries due to a single exposure to a high-magnitude load or excessive loading which gradually reduces tissue tolerance?

excessive loading

when brain senses actual or potential tissue injury this cause what to occur?

Pain

time, load, repetitions, effort, characteristics of individual

Are all factors that influence what?

tissue tolerance

what happens to tissue tolerance and pain as a protective mechanism following injury?

reduce risk of reaching tissue tolerance

do tissues get more or less sensitive following injury?

more

average tissue healing timeline

4-8 weeks

why might pain persist past healing?

misconceptions about pain

unaddressed fears, worries, beliefs, etc

lack of pain education

what is the BPS model?

bio-psycho-social model

pathology, structural, biomechanics, biochemical (input)

are all _____ examples of the BPS model?

"bio"

what are "psycho" examples of the BPS model?

behaviors, moods, beliefs, etc. (output)

what are "social" examples of BPS model?

socioeconomic, cultural, community, etc. (upstream)

cognitions, emotions, attitude/beliefs, illness behavior, physical and social environment, lifestyle factors all make up the _____ that input must be interpreted through?

"Lens"

contextual, cognitive, emotional, comorbidities are all drivers of what?

pain and disability

relationships, cultural beliefs, work attitudes -> disability and perception of pain, access to care and outcomes are all what?

contextual drivers

beliefs, expectations, perceptions of illness, fear, catastrophising, low self efficacy are all what?

cognitive drivers

assessment tool that allows for accurate estimates of individual, full-length psychological scores

yellow-flag questionnaire

check part for chemical/mechanical inflammation or ischemia

check peripheral nerve

check brain's threat center for misinterpretation

check brain's emotional and social centers

autonomic/motor check

These are things you should do when what?

When a body part is hurt

how is pain like an alarm?

motivates action

all aspects of a persons life can influence sensitivity and pain

(catastophizing, fear of movement, expectations, stress) all explain why pain considered _________.

multi-factorial

what is the relationship between hurt and harm?

there is no strong relationship between amount of pain someone feels and tissue damage

how does exposure to feared or painful activities increase tolerance and facilitate return to full function?

person adapts to applied stress

(exposure to feared/painful activities in slow graded manner can increase tolerance)

what rehab approach recognizes that care must be individualized?

N=1 approach

restore function, prevent disability and maintain sustainable relationship with activity are the central goals of what?

Rehab

what is the "ARG" principle of rehab?

awareness, regain control, gradually expose

what are the 6 R's of rehab?

red flags, reassure, reconceptualize, recalibrate, robust, reassess

assess, remove cause, exercise program design

are the 3 overall streps of what?

evidence-informed active care process

clinical audit process which is the framework of patient-centered rehab where we are trying to understand patients baseline and ceiling

needs based assessment

what is a pain audit (mechanical sensitivity)?

how do we use it clinically?

patient's basement (where they're currently at)

determines where you start

what is a functional audit (abnormal motor control)?

how do we use it clinically?

patient's ceiling (what do they need to be able to do) ;

determines goals

what does "removing the painful trigger" refer to?

allowing pain trigger to desensitize

what is the "rule of 10" for exercise dosing when pain is present?

as VAS goes down, RPE goes up

volume, intensity, frequency, recovery

Are all retraining variables that we can ______.

Modified

adherence, progressive overload, individualization, picking the appropriate target

are all _______ for any training or rehab program to be successful?

non-negotiables

adaptive process of the human body will only respond if continually called upon to exert a greater magnitude of force to meet higher physiological demands

-in order to stress healthy tissue adaptation we must progressively over load the tissues through graded exposure

progressive overload

sudden high acute workloads and low chronic workloads are described as ____ risk factors for injury?

High

acute management, protection, education

(build up a tolerance for basic movements and low loads)

Are all types of load management that is involved in stage 1 of rehab?

1

desensitize pain generator

treat the source (manual hands-on and passive therapies)

begin addressing underlying dysfunctions

build tolerance for basic movements

are all defining characteristics of phase ____ rehab?

1

building control, competence and providing continued education

load introduction and reintroduction of normal movement

progressive loading

Are all types of load management that involved in stage ___ of rehab?

2

stabilize foundation

build up tolerance for more load

focus on simple functional movements

are defining characteristics of phase __ rehab?

2

capacity and graded exposure

functional integration

return to full performance

Are all type of load management that is involved in stage __ of rehab?

3

adding load and volume with little-to-no pain

return patient to higher tolerance (build resilience)

complex dynamic movements

full return-to-function

are defining characteristics of what?

phase 3 rehab

what are some characteristics of selecting the best exercise for an injury

one body can tolerate

one that loads injured or sensitive tissues

one that you can increase/decrease intensity easily

one that builds confidence back up

one that you'll actually do

what are the ABC's of good exercise prescription?

ability, beliefs, capacity, dose, expectation, frequency, goal

what is meant by "the doing is the fixing"?

you don't need fixing before you start doing, the doing is the fixing

-the goal task people miss becomes "rehab exercise"

what are meaningful activities?

goal/task that people miss

a little bit of movement to increase physical activity, help manage pain, lubricate joints and give people control back describes what?

movement snacks