thermod notes
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| in informed consent person should be informed of: | diagnosis or findings of physical examination
recommendaed treatment procedures and rehab plan
prognosis if the recommended treatment is administered or rehab plan is complete
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| components of informed consent | risks and benefits of the recommended treatment and rehab
reasonable alternatives to proposed plan, with potential risks, benefits and prognosis
prognosis if not treatment is administered
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| Components of a comprehensive, progressive plan of care | 1. control pain and swelling, protect injury 2. restore ROM 3. restore neuromuscular control and muscular endurance 4. restore strength and power 5. resume sport specific training 6. return to physical activity
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| Tissue types | epithelial, connective, muscle, nervous
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| Epithelial tissue | coversl all internal and external structures, skin, outer layer of internal organs and inner lining of blood vessel
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| Types of injury to epithelial tissue | lacerations, abrasions, punctures and avulsions
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| Connective Tissue types | tendons, ligaments, cartilage, adipose, bone, blood and lymph
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| Connective Tissue | supports and protects the body
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| Injuries to connective tissue | sprains, strains, contusions, overuse syndromes and ruptures
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| Types of muscle tissue | skeletal, cardiac, smooth
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| Skeletal muscle | responsible for movement of boney levers
Made up of muscle fiber units that are grouped into bules called fascicli
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| Types of Skeletal muscle | slow twitch-type 1
intermediate fibers type II A
fast twitch type II B
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| Types of injuries to skeletal muscle | contusions, strains, myositis ossificans, infection
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| Nerve tissue | Provides communication between the CNS and muscles,
Basic cell is the neuron
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| Types of injury to nerve tissue | paraplegia, quadriplegia, compression
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| bone Tissue | Cancellous or spongy bone
Cortical or compact bone
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| Signs of inflammation | Redness, heat, swelling, pain, loss of function
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| Redness | blood vessels dialate (arteriole sphincters)
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| Chemical mediators | histamine, bradykinins, prostaglandins, seratonin
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| Histamine | causes vasodilation, heat and redness
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| Bradykinins | increase capillary permeability, increase sensitivity to pain receptors, pain and swelling
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| Prostoglandins | increase capillary menbrane permeability, increase sensitivity to pain, pain and swelling
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| Seritonin | increases capillary membrane permeability, swelling
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| Heat | increase blood flow to the injured area increases heat, chemical activity increases metabolic activity
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| Pain | GOAL is to releive athlete of noxious stimulous=physical, chemcial and cell anoxia
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| Physical pain | from the trauma to the area
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| Chemcial Pain | from the trauma to the tissue, bradykinin and prostoglandinds make pain receptors more sensitive to painful stimuli
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| Cell anoxia | death of cells interfereswith normal blood flow
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| Swelling | secondary to the increased blood flow to the area and broken blood vessels, exudate, tranudate
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| Exudate | an infection by product of an increase in the number of WBC
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| transudate | blood cells marginate and blood volume and capillary pressure increases
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| Causes of Swelling | torn blood vessels cell death-increases osmotic extracellular pressure(drives fluid from capillaries) increaded protien gravity chemical mediators-alters cell permeability to protien and fluid
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| Loss of Function | secondary to the pain and inflammation of the joint or tissue
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| Phases of Tissue Healing and duration of phase | inflammation(injury to 4 days), proliferation/fibroblastic(4 days to 3 weeks), remodelling(3 weeks to one year)
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| Goal of the inflammation phase | to clean wound and to minimize all factors tht can prolong inflammation
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| Inflammation Phase | Tissue injury Vasoconstiction-increase in sympathetic actiivity(shock lasts for 5 sec-10 min), decreases blood flow so clotting can occur release of chemical mediators by mast cells-increases bf, vasodilation, block lymph channels to prevnt systemic inf
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| Inflammation phase cells | PMNL-polymorpho nuclear luekocytes-leukocytes(macrophages and neutrophils)-chemotaxis occurs Diapedesis-movement of WBC and other substances through damaged cessels into the tissue phagocytosis
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| Chemotaxis | movement of an organism or cell along a chemical gradient
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| phagocytosis | Neutrophils-clean up dead cells-kill off other cells in the process Macrophages-form lysomes to destroy and increse phagocytosis
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| Treatment during inflammation phase | NSAIDS Antibiotics debridement RICE proper positioning
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| Goals of proliferation/fibroblastic phase | impart strength to wound increase epitheliazation increase collagen production increase healing
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| Proliferation/fibroblastic phase | New capillary system forms though endothelial cell regeneration cappilaries bring O2 & nutrients(AA, sugars, vitamins & enzymes) to the injured area fibroblast activity increase collagen production scar tissue formation
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| Modalities that effect proliferation phase | US-helps increase fibroblastic activity
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| Proliferation phase(collagen) | as collagen is being synthesized, the lytic process of the enzyme collagenase, which is produced by macrophages and granulocytes is also breaking it down. this occurs predominately in the 1st two weeks after tissue injury and results is tensile strength
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| Treatment for prolifertation phase | NSAIDs Antibiotics debridement RICE proper positioning early motion-make sure that collagen fibers do not line up in a shortened position, early movement allows collagen fibers to properly align
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| Remodelling phase Goal | final healing orientation and arragement of collagen fibers
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| Remodeling phase | regeneration of new cells Reduction in fibroblast, macrophages Type III collagen coverting to type I reduction of capillaries
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| Treatment of Remodelling phase | Controlled motion-motion of the injured tissue will influence thier strucures when they heal Modalities-STM, ultrasound, lazer Exercise
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