Interventions based off of Acute Phase of healing
- Acute/Protective phase 7-10days
- Intervention goals are to :
- control inflammation
- avoid painful positions
- Minimize pain and edema
- restore full passive ROM
- Maintain soft tissue joint integrity
- Reduce muscle atrophy through gentle isometric muscle setting
- maintain aerobic fitness
Interventions based off of Subacute Phase of Healing
- Subacute/controlled motion 10 days - 6 weeks
- Progressively stressing the healing tissue structures
- Modify faulty joint mechanics
- protect forming collagen
- direct orientation parallel to the lines of force it must withstand
- prevent crosslinking and scar contracture
Interventions based off of Chronic phase of healing
Chronic/return to function phase 6weeks-months
- Gradual return to full pain free ROM
- progressively increasing movement speed
- Developing neuromuscular control
- By end of the phase the full and unrestricted ROM should be present
- More aggressive work related and sport specific movements and activities should be incorporated as appropriate
Low to high potential for healing tissues
- cartilage
- meniscus
- ligament
- Tendon
- bone
- muscle
Acute/Protective phase timeline
7-10days
Subacute/Controlled Motion phase timeline
10 days to 6 weeks
Chronic/ Return to Function
6 weeks to months
Strain grades
- Grade 1 = pain only limited swelling, few tears, no loss of function
- Grade 2= Increased pain, some loss of strength/function, disruption of moderate amount of fibers
- Grade 3= complete rupture of musculotendinous units, loss of function
What is a strain?
- Distractive strain is excess pull/overstretch
- Risk factors include= inadequate flexibility/ strength/rehab from previous injury, muscle imbalances, insufficent warm up, fatigue
Tendinitis
- Swelling, pain, dysfunction of the tendon
- Has no PG mediated inflammation
Tendinosis
- Degeneration of tendon structures
- Pain isn’t always present
4 main Histological Changes
1. Angioblast hyperplasia
2. Disorganized immature collagen
3. Vascular hyperplasia and neovascularization
4. Hypercellularity
NSAIDs
- Nonsteroidal anti-inflammatory drug
- Acute/Chronic MSK disorders its used for
- Decreases inflammation/blocks vasodilation and inflammatory response
-Nonselective
Osteoporosis
A chronic progressive disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to decreased bone strength enhanced bone fragility and increase in fracture incidence
- High bone turnover rate leads to weakening due to weaker trabecular/cancellous bone
- New bone formation falls behind resorption due to declining osteoblast function
What are the treatments and preventions of Osteoporosis
- Nutrition= calcium/vitamin D
- Vitamin K can help bone metabolism
- Magnesium may increase BMD in the elderly
- Exercising, gait training, pain management
- Weightbearing exercises, flexibility exercises, postural/balance
What exercises are contraindicated for osteoporosis
- Flexion exercises because it can lead to vertebral fracture by placing compressive forces on the anterior part of the vertebrae
Major Risk factors of osteoporosis
- Body weight < 70kg or <21 BMI
- Corticosteroids
- personal history of fractures as an adult
- First degree relative with osteoporosis
- Currently smoking
Where does articular cartilage get its nutrition from ?
diffusion from the synovial fluid
How do ligaments get their blood supply?
Epiligament layer
Intraarticular Ligament
Inside the joint capsule
- Encased in synovium
- Blood dissipates into the synovium
Hematoma prevented
- Limited arrival of growth factors and cytokines needed to mediate inflammation and healing
- Doesn’t follow typical tri-phasic healing timeframes
Extraarticular Ligament
Outside of the joint capsule
- Epiligament layer= highly vascular/cellular/ sensory and proprioceptive nerves
- greater likelihood of healing without surgery
- Follows typical triphasic healing timeframes
Neural Zone
Little to no resistance to movement
Plastic zone
permanent deformation and may lead to injury
Elastic zone
First barrier to motion encountered
Hypermobile
- generalized multi-joint
- Localized hypermobility
- Instability
- Laxity + symptoms associated with inability to control joint during movement
