Pain is produced by the ______ when it perceives that danger to the body tissue exists and that action is required
brain
Cell physiology
- AP elicits NT signaling to cascade along the axon of dendrites
- Afferent info ascends through spinal thalamic tract to the brain
Interpretation of NT elicits _____ OUTPUT
PAIN
What are 3 pain mechanisms?
- nociceptive
- neuropathic
- central sensitization
Nociceptive pain is increased sensitivity of _______ nerves
peripheral afferent nerves
What occurs in nociceptive pain
- inflammatory mediators contribute to increased sensitivity to other stimuli
- upregulation of existing and new ion channels
Neuropathic pain is sensitivty at the _____
nerve
Neuropathic pain can spread due to:
- changes in axoplasmic flow
- immune cell activation
- intraneural edema
- progressive demyelination
- upregulation of ion channel
Central sensitization is defined by:
- augmentation of sensory processing in the CNS
- impaired descending inhibitory pain pathways
- over-activation of facilitatory pain pathways
- temporal summation of second pain
- long term potentiation of pain synapses
Central sensitization occurs in what patients?
Chronic pain patients
In central sensitization, pain that has outlived its usefulness and has made changes in your ______ to make it easier to understand the pain
brain
What happens in somatosensory cortex smudging
- avoid, protect and heal
- inhibition, weakness, aberrant movement patterns
- homuncular changes of somatosensory cortex
Smudging and changes in _________ awareness, sensorimotor reorganization
kinesthetic
Muscle Guarding is defined as increased _______ activity in the muscle
resting
Muscle guarding possible causes:
- protective response to painful stimuli
- neuro dysfunction
- emotional stress, anxiety, fear
What are trigger points?
hyper-irritable area of tissue chemo- and mechanonociceptors located within the muscle
What is the difference between Active and Latent trigger points?
Active is symptomatic and refers pain at rest or during motion
Latent does not cause patient pain unless they are activated by palpation
What trigger points do we as PTs treat?
Active
Travell’s energy deficit hypothesis
- After injury, trauma (micro or macro) of the muscle inflammatory cascade initiated
- Interleukin factors, cytokines, CGRP, lactic acid build up
- Metabolites increase acidity (lowering pH) = increasing muscle spindle excitability via alpha motor neuron, gamma gain
- Tonic, low-grade muscle contraction, can lead to the trigger point
_________ are constantly stimulated which leads to low level tension and can cause a trigger point (knot)
Muscle spindles
Manual therapy is traditionally used to produce a number of therapeutic effects:
- pain reduction
- increase soft tissue extensibility
- improve quality of motion in a restricted area
Caution of manual therapy for physical therapists
do not become over reliant on manual techniques to improve patients because we want to promote independence
Much of much of Manual therapy use is based off of…
clinical outcomes rather than evidence-based proof
Indications for manual therapy
MSK pain/mechanical pain
- pain reported with activity and that is relieved by rest
- pain that is relieved or provoked by particular motions/positions
- pain altered by changes related to sitting or standing posture
