Physiology and Pain Theory

ATP-PC system

this energy system is used for ATP production during high intensity, short duration exercises (like sprinting 100 meters)

phosphocreatine decomposes and releases a large amount of energy used to contruct ATP. creates ATP almost instantaneously

can provide up to 15 seconds of muscle contraction

anaerobic glycolysis

this energy system is a major supplier of ATP during high intensity, short duration activities (like sprinting 400-800 m)

stored glycogen is split into glucose and then split again into pyruvic acid and released throughout to form ATP

can provide 30-40 seconds of muscles contraction

aerobic metabolism

used predominantly during low intensity, long duration exercise (like running a marathon). yields the most ATPs but requires several series of complex chemical reactions.

provides energy through oxidation of food and uses the combination of fatty acids, amino acids, and glucose with oxygen to form ATP

will provide energy as long as there are nutrients to utilize

If someone were to sprint 50 meters, which energy system are they predominantly using

ATP-PC system

if someone were to be running an 800 meter race, what energy system are they predominantly using

anaerobic glycolysis

if someone were to go run a marathon, what energy system are they predominantly using

aerobic metabolism

when weightlifting, how are the energy systems being used

typically

anaerobic systems (strength - anaerobic glycolysis, power - ATP-PC) work while lifting

aerobic system takes over during rest

How is a class 1 lever set up

ex. seesaw

How is a class 2 lever set up

example wheelbarrow or tricep dip

How is a class 3 lever set up

example around the world with weight

what are the different types of fibrous joints?

sutures (like the skull), syndesmosis (like between tib-fib), gomphosis (connecting tooth in its socket)

Characteristics of fibrous joints

composed of bones that are united by fibrous tissues and are nonsynovial, movement is minimal to none with amount of movement permitted at the joint dependent on the length of the fibers uniting the bones

suture

union of two bones by a ligament or membrane

immovable joint

eventual fusion is term synostosis

syndesmosis

bone connect to bone by a dense fibrous membrane or cord

very little motion

gomphosis

two bony surfaces connect as a peg in a hole

the teeth and corresponding sockets in the mandible/maxilla are the only gomphosis joints in the body

the periodontal membrane is the fibrous component of the joint

types of cartilaginous joints

synchondrosis (sternum and true ribs)

symphysis (pubic symphysis)

characteristics of cartilaginous joints

have hyaline cartilage or fibrocartilage that connect one bone to another. slightly movable joints

synchondrosis

hyaline cartilage

cartilage adjoints two ossifying centers of the bone

provides stability during growth

may ossify to a synostosis once growth is completed

slight motion

symphysis

generally located at the midline of the body

two bones covered with hyaline cartilage

two bones connected by fibrocartilage

slight motion

what are the types of synovial joints

uniaxial joint

biaxial joint

multi-axial joint

characteristics of synovial joints

provide free movement between the bones they joint. they have five distinguishing characteristics: joint cavity, articular cartilage, synovial membrane, synovial fluid, fibrous capsule

uniaxial joints

one motion around a single axis in one plane of the body

hinge and pivot joints

biaxial joints

movement occurs in the two planes and around two axes through the convex/concave surfaces

condyloid and saddle joints

multi-axial joints

movement occurs in three planes and around the tree axes

plane (gliding) joints

ball and socket joints

what are the different types of joint receptors

free nerve endings

golgi ligament endings

golgi-maxxoni corpuscles

pacinian corpuscles

ruffini endings

location, sensitivity, and primary distribution of free nerve endings

location: joint capsule, ligaments, synovium, fat pads

sensitivity: to non-noxious and noxious mechanical stress, and biochemical stimuli

primary distribution: all joints

location, sensitivity, and primary distribution of golgi ligament endings

location: ligaments, adjacent to ligaments, bony attachment

sensitivity: tension or stretch on ligaments

primary distribution: majority of joints

location, sensitivity, and primary distribution of golgi-mazzoni corpuscles

location: joint capsule

sensitivity: compression of joint capsule

primary distribution: knee joint, joint capsule

location, sensitivity, and primary distribution of pacinian corpuscles

location: fibrous layer of joint capsule

sensitivity: high frequency vibration, acceleration, high velocity changes in joint position

primary distribution: all joints

location, sensitivity, and primary distribution of ruffini endings

location: fibrous layer of joint capsule

sensitivity: stretching of joint capsule, amplitude and velocity of joint position

primary distribution: greater density in proximal joints, particularly in capsule regions

characteristics of type 1 muscle fibers

aerobic, red, tonic, slow twitch, slow-oxidative

low fatigability, high capillary density, high myoglobin content, smaller fibers, extensive blood supply, large amount of mitochondria

characteristics of type 2 muscle fibers

anaerobic, red/white, phasic, fast twitch, fast-glycotic

high fatigability, low capillary density, low myoglobin content, larger fibers, less blood supply, fewer mitochondria

what are muscle spindle’s function

to send information to the nervous system about muscle length and/or the rate of change of its length.

what are golgi tendon organs

encapsulated sensory receptors through which the muscle tendons pass immediately beyond their attachment to the muscle fibers. they provide the nervous system with instantaneous information on the degree of tension in each small muscle segment.

what are nociceptors activated by

thermal, mechanical, or chemical stimuli

nociceptors are the terminal portion of what two types of afferent neurons

A-delta and C fibers

what kind of information does A-delta fibers transmit

detailed information rapidly from peripheral cutaneous structures (skin, muscle)

what kind of information does C fibers transmit

information from deeper tissues more slowly (joints, viscera)

A-delta fibers are more likely to transmit pain signals that are (list descriptor words)

sharp, localized

C fibers are more likely to transmit pain signals that are (list descriptor words)

dull, aching, diffuse

pathway of pain

nociceptors → afferent neurons (A-delta, C) → dorsal horn of the spinal cord → spinothalamic tract → thalamus → sensory cortex

What is the gate control theory explain

explains the regulation of pain, specifically how other stimuli can help to decrease the sensation of pain.

how does the gate control theory work

A-delta and C fibers synapse with inhibitory interneurons from A-alpha and A-beta fibers.

A-alpha and A-beta fibers can stimulate inhibitory signals to prevent pain

(think massage, modalities, pressure, foam rolling)

endogenous opioids

opiopeptins (aka endorphins) can inhibit GABA which inhibits A-beta fibers

aka if GABA inhibits inhibitory fibers…endorphins can override GABA to let A-beta fibers work

What are the 5 sources of pain

cutaneous/superficial

deep somatic

visceral

neuropathic

referred

what are the 4 pain mechanisms

nociceptive

neuroplastic

nociplastic

motor and psychosocial

cutaneous/superficial pain source

superficial somatic pain - caused by structures within the skin or subcutaneous tissue. The pain tends to be well-localized and is described as stabbing or sharp, though it can be a dull ache/throb when the patient is at rest

deep somatic pain source

caused by deep somatic structures such as bone, muscle, fascia, tendons, ligaments, joint capsules, and blood vessels. the pain may be diffuse and may be referred to other areas. it is described as dull, aching, cramping, or gnawing and can be associated with muscle spasms or trigger points

visceral pain source

caused by internal organs. Pain is poorly localized and often produces referred pain to more superficial structures. visceral pain can be associated with autonomic symptoms

neuropathic pain source

caused by damage to the peripheral or central nervous system. thep ain is described as sharp, burning, shooting, tingling, or electrical and will likely follow a peripheral neurve or dermatomal pattern. symptom provocation occurs with tests that move, load, or compress neural tissues, may be evoked by stimuli that are not generally noxious (light touch)

referred pain source

pain that is felt in an area distant to the site of injury. referral of pain occurs due to the sharing of ascending pathways between visceral and somatic structures. referred pain is well-localized though it does not have sharply defined borders. localized tenderness and muscle hypertonicity are common in referred pain area.

nociceptive pain mechanism

due to injury, inflammation, or mechanical irritation to non-neural tissue in the body and results from the activation of nociceptors. Pain is proportionaly to the level of stimulus applies

neuropathic pain mechanism

due to a lesion or disease of the peripheral or central nervous system. Referred in a dermatomal or cutaneous distribution. may be associated with sensory signs such as tingling, numbness, and burning or associated with sympathetic signs such as color, temp, and trophic changes

nociplastic pain mechanism

due to abnormal pain processing withing the central nervous syems. Pain is disproportional to the level of stimulus, non-mechanical, and unpredictable. Pain and tenderness tend to be diffuse and not related to specific anatomical structures. Strongly associated with psychosocial factors. (or can be mechanical pain that has lasted longer than what is expected for normal tissue healing)

Chronic pain is defined as

pain that lasts longer than 3 months or pain that lasts longer than what would be expected for true physiological healing to occur