PT504 E1

• Goal: limt/curtail inflammatory response, treat pain, effusion, immobilization.
• 1. control pain and swelling
• 2. Injury protection
• 3. modalities and meds
• 4. gentle soft tissue mobz, to reduce pain, guarding, edema
• 5. Gentle passive movements
• 6. CMP w/in pain fre raing; no stretching
• 7. posssible Grade 1 oscillatory techniques
• 8. muscle setting
• 9. no pain or inflammation

• Sub Acute: 4-14 days Repair & Healing
• 1. removal of noxious stimuli
• 2. growth of capillary beds into area
• 3. collagen proliferation
• 4. muscle strenght is decreased 2nd to immobilization, inhibited by pain & joint effusion leading to atrophy. 

• 1. Decrease inflammation
• 2. Pain- intermittent, felt during movement, synchornous w/ motion barrier, porximal -> distal w/ repeated movements. 
• 3. Motion Barrier: Muscular (fast-slow garding)

• 1. Pain contorl: meds as needed
• 2. gentle movement (low grade mobz 1-2)
• 3. AROM/PROM in pain free range

no stretching of joint capsule if effusion is present. 

can begin gnetle capsular stretching and joint mobz. 

• 1. begin isometric resistance exercises
• 2. begin gentle stretching techniques
• 3. gentle transverse friction massage
• 4. Muscle Tears: develope mobile scar and parallel alignment of CT
• 5. Tendon Lesions: promote parallel alignment of collagen fibers. 

some discomfot will occur w/ exercise during this stage, but it should not alst longer than couple hours

• 1. prolonged pain
• 2. pain with rest
• 3. increse in swelling, heat, stiffness, or weakness
• 4. muscle guarding
• *Activitiy levle must be decreased if these signs occur. 

• Chornic: 14-21 days until there is pain free functional use; Maturation and Remodeling.
• 1. maturation of CT
• 2. contracture of scar tissue
• 3. appropriate stressin of collagen = parallel fibe alingment and improved proliferation of elastin. 

1. absense of inflammatory signs & symptoms

• 1. not severe
• 2. proximal location
• 3. only felt w/ forceful movements
• 4. felt after motoin barrier (overpressure)

Capsular

• 1. vigorous soft tissue, joint mobz (grades 3-4), stretcheing 
• 2. decreased ROM: isometirc exercises at various ranges to maintain/imporve strength
• 3. adequate ROM: progressive strengthening, endurance, and functional exercises

vigorous capsular stretching and joint mobz if joint play is restricted and no effusion

Dynamic Resistance exercisese (eccentric): Parallel scar tissue increase tensile strength, and increases PSCA which results in decreased stress on injury site. 

Functional Retraining 

• 1. its susceptibility to becom painful
• 2. how painful it becomes
• 3. the lenght of time this pain takes to recover

• 1. Pain b4 motin barrier. 
• 2. empty or muscular end feel (fast guarding)

• 1. pain synchronous with motion barrier
• 2. muscualr end feel ( fast-slow guarding) 

• 1. pain felt after motion barrier (overpressure)
• 2. capsular (firm) end feel