How is the severity of tissue injury measured?
What are the characteristics of a Grade I tissue injury?
- mild pain at time of injury or within 24 hours
- mild swelling, local tenderness, and pain when tissue is stressed
What are the characteristics of Grade II tissue injuries?
- moderate pain that requires stopping of activity
- stress and palpation increases pain
- for ligaments, some fibers torn with increased joint mobility
What are the characteristics of Grade III tissue injuries?
- near complete or complete tear or avulsion with severe pain
- stress to tissue is painless
- if ligament then instable
What are the three stages of healing?
What are characteristics of the acute stage of healing?
- vascular changes
- exudation of cells and chemicals
- clot formation
- early fibroblastic activity
What is a clinical sign of the acute stage of healing?
What are the goals during the acute stage of healing?
- control inflammation and pain
- decrease muscle guarding
- maintain function of uninvolved areas
What are common treatment tactics during the acute stage of healing?
- intermittent muscle setting
- PROM within pain free ROM and outside plane of injury
- massage with caution
- modalities to decrease pain and swelling
- gentle joint play
What is a precaution and contraindication during the acute stage of healing?
- precaution: no movement should increase pain or inflammation
- contraindication: active movements at point of pathology
What are characteristics of the subacute stage of healing?
- removal of noxious stimuli
- growth of capillary beds into area
- collagen formation
- granulation tissue
- very fragile so easy to injure
What are clinical signs of the subacute stage of healing?
- decreasing inflammation
- pain synchronus with tissue resistance
What are the goals of treatment for the subacute stage of healing?
- decrease pain and guarding
- increase ROM and strength
- muscle re-education
- promote a functional, mobile scar
What are the treatment methods in the subacute stage of healing?
- decrease support from assistive devices
- progress from low intensity --> sub-max isometrics at one angle --> sub max isometrics at multiple angles --> max isometrics at 1 angle --> max isometrics at multiple angles
- progress from no motion -->short arc --> full ROM (then add mild resistance)
- progressively lengthen injured tissue
- joint mobilization with pain limits
- deep friction massage
What are precautions during the subacute stage of healing?
- forceful manipulations
- agressive stretching
What are signs and symptoms of over activity?
- increase pain
- decreased motion
- excessive fatigue
- muscle spasm
- loss of strength
- increased swelling or inflammation
What are characteristics of the chronic stage of healing?
- maturation of connective tissue
- contracture of scar tissue
- remodeling of scar
- collagens aligns to stress
WHat are clinical signs of the chronic stage of healing?
- absence of inflammation
- pain after tissue resistance
- function limited by muscle weakness, poor endurance or poor neuromuscular control
- can last 6-12 months
What are the goals of the chronic stage of healing?
- increase strength and motion
- normal muscle balance
- pain frree
- return to full function
What are the treatment methods for the chronic stage of healing?
- mobilize any adhesions
- aggresive stretching and mobilizations
- continue strength training
What are indications for musculoskeletal surgery?
- acutre traumatic rupture of muscle, tendon, ligament, cartilage
- severe chronic joint destruction from RA, OA, or arthritis
- correction of congenital or idiopathic defect
What are some adverse effects of surgery?
- intubation and anesthesia
- risk for pulmonary infection
- post-op infection or vascular disorders (DVT, PE)
- delayed healing of soft tissue and bone
- adhesions and contractures of soft tissue and joints
What are some post-op problems?
- increased risk for pulmonary or circulatory problems
- increased risk for joint stiffness or loss of motion
- increased risk of muscle atrophy
- loss of strength and mobility
What are some general guidelines for the healing process?
- respect healing process
- go from submax to max
- no motion --> mid range --> full ROM
- want to overload, NOT overwhelm