EXSC1600 Exam 2 Study Guide

Soft Tissue Response to Injury 

3 phases 

  • Continuum 

  • Overlap 

  • No definitive beginning or end 

Clinician goals 

  • Recognize what physiological events are taking place during the sequence 

  • Don't interfere with the process 

Phases of healing 

  1. Inflammatory response  

  1. 24-36 hours 

  1. Begins immediatly after injrury 

  1. Chemicals are released causing a cascade of effects 

  1. Most critical to healing process 

  1. Repair (fibroblastic repair phase) 

  1. 4-6 weeks 

  1. maturation-remodeling 

  1. Can take months – years 

3 layers of lacerations 

  • Skin 

  • Fat 

  • Muscle 

4 stages of healing lacerations 

  1. Bleeding 

  1. Blood clot 

  1. Holds and closes wound 

  1. Macrophages 

  1. Fibroblast 

  1. Neutrophils 

  1. Clotted 

  1. Scabs 

Phase 1 

  • Chemical mediators released 

  • Histamines 

  • Leukotrienes & prostaglandins 

  • Cytokines 

  • Vascular Response 

  • Vasodilation 

  • Increased cell permeability 

  • Exudate 

  • Edema 

  • Amount of edema/swelling is directly related to extent of vessel damage 

  • Secondary injury due to hypoxia 

  • Cell death due to lack of oxygen 

  • Cell permeability is the ability to allow things to go in and out of cells 

  • Physiological Goals of phase 1 

  • Localize the extent of area injured 

  • Rid area of waste products 

  • PREPARE FOR PHASE 2 

  • 5 cardinal Sx 

  • Redness  

  • Swelling 

  • Pain 

  • Increased temperature 

  • Loss of function 

Phase 2 

  • Scar tissue formation 

  • Replaces torn tissue sites 

  • General timeline: acute phase is about 3-6 weeks 

  • Begins when area has been cleaned by removal of cellular debris 

  • Fibroplasia: SCAR TISSUE formation 

  • Nutrients delivered for tissue regeneration 

  • Increase blood flow by movement: ROM 

  • Granulation tissue fills gaps in tissue 

  • Fibroblast begin producing COLLAGEN 

  • Randomly deposited throughout forming scar 

  • Occurs at about the 6th or 7th day 

  • Strength of the scar tissue increases 

  • Length of phase 2 is dependent on: 

  • Extent of the injury 

  • Proper immediate care and progression of care 

  • Type of tissue 

  • Fine line between enough stress and too much! 

Phase 3 

  • Scar tissue begins strengthening and realigns to tissue fibers 

  • Maximal efficiency of scar tissue 

  • Appropriate stress and strain is required to produce this effect 

  • Long term process (6 months to years) 

  • Scar tissue is RARELY as strong as the normal uninjured tissue 

  • Factors that impede healing 

  • Extent of the injury 

  • Edema/hemorrhage 

  • Separates tissue, inhibits NM control, hypoxia 

  • Muscle spasm 

  • Atophy 

  • Immobilization? 

  • Infection 

  • Health, age, nutrition 

  • Soft tissue healing 

  • Cartilage 

  • Articular cartilage 

  • Ligament 

  • Instability 

  • Muscle 

  • Active contraction 

  • Lengthy rehab – paitience 

  • Tendon 

  • Adhesions 

  • Bone healing 

  • Immobilization 

  • Remodeling 

  • “wolff’s law” - adaptations to stress & strain 

  • As a muscle becomes stressed and strained, it will grow and adapt 

  • Stress Fx: d/c activity, eliminate factors 

Therapeutic Injury Management 

  • POLICE (RICE) 

  • Rest, Ice, compression, elevation 

  • NSAIDs 

  • Nonsteroidal Antiinflammatory drugs 

  • Indications 

  • Minimize pain and swelling 

  • Contraindictions 

  • Allergies, adverse GI tract rxn, prolonged clotting times, alcohol use, risk of adverse CV events 

  • Ibuprofen 

  • Aspirin 

  • Superficial thermal agents 

  • Cryotherapy – therapeutic use of cold 

  • Vasoconstriction 

  • Metabolic rate goes down 

  • Free nerve ending excitability goes down 

  • Nerve conduction velocity goes down 

  • Initial 48-72 hours: ICE 

  • CBAN – four stages of icing 

  • Cold 

  • Burn 

  • Ache 

  • Numb 

  • Ice, Heat 

  • Use ice in the IPE 

  • Use heat in the FPE and MPE 

  • Therapeutic modalities 

  • Modality – something you use in addition 

  • Therapeutic ultrasound 

  • K tape 

  • cupping 

  • Mobilization 

  • Exercise and rehabilitation 

  • Nutrition and hydration 

  • Mental health 

  • Sleep 

  • Protect 

  • Cast, sling, brace 

  • Optimal Loading 

  • Progress to mechanically loading tissue to promote healing 

  • Early safe functional loading = early recovery 

  • Ice 

  • 45-60 minutes initially, then 20-30 minutes every 1.5-2 hours 

  • Compression 

  • Mechanically reducing the space available for swelling and hemorrhage 

  • Secondary Hypoxic Injury – not controlling the swelling of an injury 

  • Elevation 

  • Eliminate the effects of gravity on blood and edema pooling 

  • Cryotherapy techniques 

  • Ice massage 

  • Ice water immersion: 50-60 degrees F 

  • Ice pack vs. Ice bag 

  • Spray coolant 

  • Thermal Agents 

  • Thermotherapy – therapeutic use of heat 

  • Vasodilation 

  • Increased metabolic rate 

  • Increased extensibility of collagen 

  • Capillary permeability 

  • Analgesic 

  • Decreases joint stiffness 

  • Relieves muscle spasm 

  • Can be used to decrease swelling/edema 

  • Electrical Stimulating Currents 

  • Reduces pain, M reeducation and strengthening, retard M atrophy 

  • Iontophoresis 

  • IASTM – instrument assisted Soft Tissue Massage 

  1. Recognize what physiological events are taking place during the sequence 

  1. Don't interfere with the process 

  1. Create an environment conductive to healing 

 

  • Knock knees is valgus 

  • Bowlegged is verus 

 

 

Week 7 

Foot and ankle 

  • 26 bones in each foot 

  • 7 tarsals 

  • 1-5 metatarsals 

  • Long bones of the foot 

  • 14 phalanges 

  • Form determines function & function determines form 

  • Free floating bones are sesamoid bones 

  • 2 in your feet just for leverage 

  • Pes Planus 

  • “low arch” 

  • Decreased efficiency 

  • Associated with excessive pronation 

  • Pes Cavus 

  • “High Arch” 

  • Tight Heel Cord 

  • Associated with excessive supination 

  • Decreased shock absorption 

  • Kinetic chain is the direct effect on distal and prostomial segments 

  • Everything in your body is connected 

  • Algia – injury to nerve 

  • Metatarsalgia 

  • Orthotics – can help correct biomechanical problem 

  • Using things to help fix the arch of your foot 

  • Plantar fascia is a super think band of tissue that goes from your heel to your toes 

  • Assists in maintaining stability 

  • Lbracing long. Arch 

  • Good for shock absorption 

  • Flat feet and high arches can causeplantar fasciitis 

  • Increased tension 

  • Tight heel cord 

  • Pain at medial heel 

  • Sharp pain wt-bearing in morning or after rest 

  • Pain with dorsiflexion 

  • Lasts around 8-12 weeks 

  • Orthodics and arch tape can help heal 

  • Stress fracture 

  • Running, jumping, marching 

  • If they’re not treated tehy can lead to full fractures 

  • Usually at the 2nd metatarsal 

  • Point tender, throbbing, aching 

  • Relives with rest 

  • Underlying casuses are high arch/low arch 

  • 2-4 weeks complete rest 

  • Gradual introduction back into activity 

  • Bunions: hallux valgus 

  • You can heal bunions by changnig your shoe selection 

  • Surgery is more of a “last resort” for bunions 

  • Tibia – medial malleolus – big bone in lower leg – inside of leg 

  • Fibula – lateral malleolus – small bone in lower leg – outside of leg 

  • Talus – what goes in and out: allowing dorsi/plantarflexion 

  • Calcaneus – heel 

  • Your distal tibiofiblar is between tibia and fibula 

  • Talocrural is your “ankle joint” 

  • 3 main lateral ligaments 

  • Anterior talofibular ligament (ATFL) 

  • Calcaneofibular ligament (CFL) 

  • Posterior talofibular ligament (PTFL) 

  • Limits inversion 

  • Lateral ankle sprains 

  • 5 cardinal Sx – redness, ecchymosis(redness), pain, swelling, loss of range of motion 

  • POLICE/RICE crutches 

  • Same cardinal symptoms and process as lateral sprains for medial sprains 

 

Knee 

  • 4 ligaments in the knee 

  • MCL (Medial Collateral Ligament - INSIDE) 

  • Prevents anterior movement of tibia on femur 

  • ACL - Anterior crucial ligament 

  • PCL (posterior cruciate ligament) 

  • LCL (lateral collateral ligament) 

  • Valgus stress/force 

  • Direct blow to lateral knee 

  • Taking a blow from the outside of the knee pushing inwards 

  • Grade one tear is less than 50% tear on a ligament 

  • Grade two tear is more than 50% tear on a ligament, but not a complete tear 

  • Grade three is a complete tear on a ligament 

  • Ways to tear ACL 

  • Foot planted and pivot in a different direction 

  • Deceleration/landing 

  • Rotary force 

  • Hyperextenxion of knee 

  • More than 50% of ACL tears are non-contact 

  • Females are at higher risk of tearing their ACL 

  • More likely to tear ACL if a family member has 

  • Sx of sprain 

  • A pop or a snap 

  • Often pain immediately, then it subsides 

  • + Lachmans test 

  • Athlete senses that “something is wrong” 

  • PCL sprain 

  • Mx – posterior translation of the tibia 

  • Hyperflexion in the knee and plantarflexion in the foot 

  • Rx – rarely operative 

  • IT band (iliotibial band ITB) - lateral thigh muscle and tendon 

  • Outside of leg 

  • Patellar tendon 

  • Patella is a sesmoid bone 

  • More than 15 bursas in the knee 

  • IT band 

  • Helps with ABduction 

  • Can get tight 

  • Repition and overuse can cause injury 

  • Sx – pain at the lateral femoral epicondyle 

  • Rx – foam rolling, hip strengthening 

  • Patella Tendon 

  • Excessive jumping, kicking, or repitition can cause injury or strain 

  • Sx – pain at the patella tendon 

  • Rx – no sudden explosive movements 

Thigh, Hip and Pelvis 

  • Femur 

  • Femoral Head – large top of bone 

  • Femoral neck – part connecting  

  • Pelvis is made up of three parts 

  • Ilium – Right/left side 

  • Pubis – Bottom part 

  • Sacrum – middle at the base of the spine 

  • Femoral head is sunk into the pelvis to help with weight bearing 

  • Sacrum is formed of 5 different bones fused together 

  • 6 degrees of freedom in the hip 

  • Abduction and Adduction 

  • Flexion extension 

  • Internal & external rotation 

  • Flexibility 

  • Hip flexors 

  • Hamstrings 

  • Groin 

  • IT band 

  • Stability 

  • Gluteus medius 

  • “core” muscles 

  • Biomechanics 

  • Leg length discrepancy 

  • Muscular imbalances 

  • Maintain strength 

  • Squats, lunges 

  • Leg Injuries 

  • Quad contusions 

  • Sx – discoloration, Loss of ROM, M. Weakness 

  • Rx – Early is key:  

  • POLICE/RICE 48-72 hours 

  • Position/wrap knee in fully flexed position 

  • NO heat or deep massage for minimum 72 hours 

  • Hip point 

  • Contusion to Iliac crest 

  • Site of numerous m. attachments 

  • No protection 

  • Mx – direct blow 

  • Sx – very dibilitating, painful, ROM decreased, difficulty walking 

  • Rx – protective padding for RTP 

  •  

 

 

Spine 

  • Bones in the spine are called vertebrae 

  • 7 cervical  

  • 12 thoracic – where your ribs are 

  • 5 lumbar 

  • Sacrum and coccyx make up tailbone 

  • Displacement in spine allows certain movements to not put strain on your spine 

  • Axial load 

  • In between the vertebrae there are intervertebral discs 

  • Made of fibrocartilage 

  • Nucleus pulposus – middle of disc 

  • Annulus fibrosus – outside of disc 

  • Spine anatomy - Made of nerve roots and a spinal cord 

  • Change in spincal cord can result in poor posture 

  • Kyphosis  

  • Forward head 

  • Swayback 

  • Flatback 

  • Lordosis 

  • Scoliosis 

  • Strength & flexibility weakness or imbalances 

  • Tight hamstrings 

  • Tight hip flexors 

  • Weak abdominals 

  • Burners are when you stretch out the region between your neck and shoulders 

  • Stingers are neural injuries to your neck area 

  • Stretch or compression of the brachial plexus 

  • Sx – burning, tingling, numbenss down arm. Transient and unilateral 

  • Before RTP, the athlete needs to have full muslce strength 

  • Sx Free 

  • Acute Cervical injuries 

  • Mx – axial load, All other neck movements 

  • Sx – paresthesia or no sensation, weak AROM or Paralysis, is the injury unilateral or bilateral 

  • Rx – Spinal motion restriction(manual), ABCs, Call EMS. 

  • Chronic lower back pain 

  • Mx 

  • Poor mechanics – lifting 

  • Malalignments 

  • Muscle imbalance/weakness 

  • Poor posture 

  • Obesity 

  • Congenital abnormalities 

  • Rx 

  • Read chapter 20, it explains it 

  • Disk Herniation 

  • Etiology 

  • Trauma or degeneration 

  • Ususally L4-L5 

  • Mx 

  • Forward bending and twisting 

  • Sx 

  • Radiation neuro sx 

  • Pain with flexion 

  • Manage with rest 

  • Stabilization ex!, surgery possibly 

  • “spondy” - spondylolisthesis 

  • Degeneration, defect or stress fx fo the vertebrae 

  • Common with repeated extension (L5-S1) 

  • Most of the trunk flexion occurs in the lumbar region of the spine 

  • 75% between L5-S1 

Review – Soft Tissue Response to Injury 

  • 3 stages of healing 

  • Continuum, overlap, no definitive beginning or ending 

  • Clinican goals 

  • Recognize what physiological events are taking place 

  • Dont interfere 

  • Create an environment conducive to healing 

  • “pain is good” - letting you know your injuried 

  • Phase 1 – inflammatory response 

  • Phase 2 – repair 

  • Phase 3 – maturation-remodeling 

  • 5 signs of inflammation 

  • Pain 

  • Ecchymosis (swelling) 

  • Redness 

  • Loss or ROM 

  • Increase in temperature 

  • Amount of edema/swelling is directly related to extent of vessel damage 

  • Secondary injury due to hypoxia 

  • Hypoxia is cell death due to low oxygen 

  • Phagocytosis is histamines trying to heal damaged tissues 

  • Fibroplasia: scar tissue formation 

  • Scar tissue is almost never as strong as the original tissue 

  • Broken bones – heal by a spongy-bone covering the broken area 

  • Wolffs law is adaptations to stress & strain 

  • POLICE is the process of decreasing swelling 

  • RICE is the same – rest, ice, compression, elevation 

  • Cryotherapy is the theraputic use of cold 

  • Decrease pain 

  • Decrease muscle spasms 

  • CBAN – Cold, Burn, Ache, Numb 

  • Heat does the opposite 

  • Thermotherapy is the theraputic use of heat 

  • Basic goals of rehab 

  • First aid and control swelling 

  • Decrease pain 

  • Restore ROM 

  • Talus – 4th bone in foot ot know 

  • Outside of ankle is lateral maleolis 

  • Muscles going on the outside of the malleoli correspond to eversion 

  • In front of the malleoli corresponds to dorsiflexion 

  • Behind of malleoli corresponds to plantarflexion 

  • Pes planus is low arch 

  • Pes cavus is high arch 

  • Over-pronation is when your feet lean into the midline causing your ankles to cave inwards 

  • Over-supination is the exact opposite 

  • Stance phase is 60% of total gait 

  • Orthodics helps correct biomechanical issues in the foot 

  • Medial malleolus is on the tibia? 

  • Lateral malleolus is on the fibula? 

  • 70-80% of all ankle sprains are lateral movements 

  • Functional testing is “return to play” stuff 

  • Muscle in the front by the tibia is the tibialis anterior 

  • Decelerates your foot 

  • Patella is a sesamoid bone 

  • Sesamoid means floating 

  • MCL has a blood supply so it can heal on its own 

  •