UTHSC CLIN PRO Test 1 – Flashcards
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Thermal Agents
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Hot packs, paraffin, ice, and cold packs
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Mechanical agents
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traction, compression, hydrotherapy
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Why do we use mechanical agents?
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to decrease pain and promote tissue healing,
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electromagnetic agents
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electrotherapy, diathermy, laser, and light
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Why do we use electromagnetic agents?
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decrease pain, promote tissue healing, and muscle recruitment
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Why do we use thermal agents?
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decrease pain and promote tissue healing
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acoustic energy
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ultrasound
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why do we use ultrasound?
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decrease pain and promote tissue healing
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What would we use to treat swelling?
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cryotherapy, compression, elevation
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Manual Massage
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certain manipulations of the soft tissues of the body which are most effectively performed by the hands for the purpose of producing effects on the nervous, muscular, respiratory, and venous systems. (Beard 1952)
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Effleurage
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to skim over, stroke or glide. Has light, deep, and horizontal stroking. Also called knuckling, shingles, bilateral tree, and 3 count stroking
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Petrissage
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to knead. 2 hand, 1 hand or alternating 1 hand variations.
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Friction
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to rub one surface over another. There is no lubrication and it is in a small restricted area. Also called cyriax technique
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tapotement
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to strike or percussion. ex. hacking, cupping/clapping, slapping, beating/pounding, tapping, and pincement
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Vibration
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fine, tremulous movements made by hand or fingers. ex. shaking
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Identify the steps of a deep sedative manual massage
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Light effleurage, deep effleurage,petrissage, friction (modified), Petrissage, deep effleurage, and light effleurage
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describe direction in therapeutic massage
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main use is for venous return or edema
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describe pressure in a therapeutic massage
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begin light movements then move to pressured (based on RPE)
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Describe rate and rhythm in a therapeutic massage
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nice slow steady rate and rhythm. one movement into the next
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Describe duration in a therapeutic massage
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The amount of time treatment lasts (duration is for billing purposes)
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what is the frequency that a patient gets massages?
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it depends on the condition of the patient
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define medium
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a type of lubrication to reduce friction during massage
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Basic rules
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keep fingernails short do not use strong perfumes do not chew gum
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Describe mechanical effects of massage
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direct effect of touch, pressure, and stretching
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Physiological effects of massage on: skin and subcutaneous flow
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Stimulate sweat and oil glands improves texture and appearance of skin can soften scar tissue can toughen skin
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Physiological effects of massage on: blood and lymph flow
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inconsistent effects increased venous return increased lymph flow
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Physiological effects of massage on: muscle tissue
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does not increase strength doesn't increase muscle tone doesn't prevent muscle atrophy in denervated muscle muscle fatigue and inflammation may be relieved more quickly
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Physiological effects of massage on: other systems and tissues
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doesn't decrease adipose tissue no direct effect on bone no effect on nerve regeneration no proven effects on viscera may contribute to movement of lung secretions when used with postural drainage.
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Physiological effects of massage on: pain
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may control pain through "gate control" may induce a general relaxation may interrupt pain spasm cycle
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General indications of massage
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pain, edema, lymphedema, adhesions and scars
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general contraindications of massage
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open wounds, neoplasms, infections, hyperesthesia, severe blood disorders, severe skin conditions, acute inflammatory conditions, edema from CHF
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Types of internal massage
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Thiele's massage (coccyx massage) Mouth/ jaw (TMJ massage)
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What are mechanical massage typically used for?
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used by respiratory therapists for draining the lungs
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Types of massage
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acupressure, auriculotherapy, reflexology, rolfing, myofascial release, manual lymphatic frainage (MLD), therapeutic touch, trigger point therapy
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What is a trigger point?
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a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscles fascia, that is painful on compressions and that can give rise to characteristic referred pain, tenderness, and autonomic and phenomena
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who is Janet Travell?
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JFK's personal therapist
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what is the difference between latent and active trigger points?
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Latent TP will only cause pain when palpated
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what are Trigger Point characteristics?
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exquisite local tenderness referred pain palpable band with restricted stretch range local twitch response metabolic distress weakness and fatigue favorable response to stretch
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Trigger Point Evaluation
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ROM: painful, restricted Strength: weakness in affected muscles palpation: taut band, jump sign, local twitch response pain: hypersensitivity symptoms: can reproduce with palpation
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What is the goal of Trigger point Treatment
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deactivate trigger point
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Techniques of treating trigger points
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stretch and spray relaxation injections or dry needling massage(ischemic compression) ultrasound Electrical Stimulation Cryotherapy
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Other treatment for trigger point may include
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knobble, theracane, dry needling, and algometer
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What is the first stage of clot formation?
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Blood escapes into surrounding tissue also called hemorrhage
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What is the second stage of clot formation?
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platelets aggregate at site and form a platelet plug to stop bleeding (hemostasis)
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what is the third stage of clot formation?
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fibrinogen converted into fibrin plug
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What are vascular changes
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brief vasoconstriction blood flows slowly Vessel wall becomes sticky WBC marginate to vessel wall Vessels become leaky
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when WBC marginate to vessel wall what does it help with?
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inhale debris and helps clean the wound
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what does trunsudate mean
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initally plasma serum passes into tissue/ interstitial spaces
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what does exundate mean?
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as vessel becomes more permeable leukocytes pass into tissue/ interstitial spaces
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what WBC is responsible for early phagocytosis?
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polymorphonuclear leukocytes; cleaning tissue debris
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What WBC is responsible prolonged phagocytosis?
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mononuclear leukocytes (macrophages)
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what are macrophages and what are their roles?
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larger single nucleated WBC; continue phagocytic process and trigger the fibroblastic phase of tissue healing
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what does serotonin cause during the inflammatory phase?
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vasoconstriction
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what does histamine cause during the inflammatory phase?
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vasodilation
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what does prostglandins cause during the inflammatory phase?
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vascular changes and pain
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what is redness caused from during the inflammatory phase?
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increased blood flow
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what is heat (hot) caused from during inflammatory phase?
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increased blood flow
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what is swelling caused from during inflammatory phase
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increased interstitial fluids
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what is pain caused from during inflammatory phase?
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pressure and release of certain chemical mediators
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what does PRICE stand for?
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Protection, rest, ice, compression, and elevation
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why is cryotherapy used for during inflammatory phase?
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to reduce pain, limit edema, and limit second hypoxic injury
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how do you promote early healing?
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cautious, gentle passive movement, massage and muscle setting
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what happens in the proliferative fibroblastic stage?
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growth of capillary beds collagen formation granulation tissue
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What happens during the growth of capillary beds?
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neovascularization, endothelial buds develop from intact capillaries -> grow into damaged area and establish new vascular network
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what happens during collagen formation?
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fibroblasts from dermis migrate into the wounded area along strands of fibrin -> fibroblasts secrete collagen to replace damaged tissue
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what happens after collagen formation?
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early scar tissue with new vascular supply is referred to as granulation tissue. it is very fragile and easily injured
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what are the clinical signs in the proliferative stage?
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decreased redness, heat, edema, and pain with tissue resistance
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what are physical therapy suggestions for the inflammatory process?
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promote healing; mobile scar
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what physical agents do you use with this type of injury?
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mild heat and mild cold
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what does mild heat do?
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may facilitate the healing process by causing increase in blood flow / could also cause more inflammation
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what does mild cold do?
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may decrease pain and inflammation / may increase stiffness
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what type of exercise would you recommend?
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nondestructive - very minimal resistive very minimal endurance and progress carefully in intensity and range
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what are the characteristics in maturation?
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maturation of connective tissues, contraction of scar tissue, remodeling of scar
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what happens during the maturation of connective tissues?
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as scar matures it becomes stronger but is never as strong as the original tissue that it replaced
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what happens during the contraction of scar tissue?
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myofibroblasts pull collagen fibers closer together
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what happens during the remodeling of the scar?
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collagen fibers become more aligned and organized and Type III is replaced by type I
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why does collagen aligns to stress??
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to keep them moving - get collagen to lengthen
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Does the tissue become more or less vascular during maturation?
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less vascular
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what is a hypertrophic scar?
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scarring in the area
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what is a keloid scar?
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outside boundaries of injury
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what are the signs for abnormal scarring?
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absence of inflammation - pain after tissue resistance
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what is the treatment for abnormal scarring?
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increase strength and alignment of scar - improve function
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what are the cells responsible for clot formation?
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platelets and fibrin
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what happens after clot formation?
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transient vasoconstriction and margination of leukocytes
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what happens during vasodilation?
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histamine causes vesicles to leak
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what happens after vasodilation?
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increased vascular permeability, leukocyte infiltration, and phagocytosis
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what is the imflammatory phase called?
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clean out phase
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what is the proliferative phase called?
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the healing phase
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what happens during proliferative phase?
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neovascularization, fribroplasia, and granulation tissue
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what happens in fibroplasia?
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secrete collagen
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what is the maturation phase called?
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remodeling phase
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what happens during the remodeling phase?
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remodeling and maturation of the scar tissue and balance of collagen synthesis and lysis.
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for the inflammation phase what thermal agents do we use?
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cryotherapy, elevation, and compression
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for the proliferative phase what thermal agents do we use
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mild heat or cold
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for the maturation phase what thermal agents do we use?
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vigorous heat or cryotherapy and stretch - could also use ESTEM.
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CHRONIC INFLAMMATION
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the inflammatory reaction continues for months or years
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how do you get chronic inflammation?
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autoimmune reaction or repeated trauma
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what happens with chronic inflammation?
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excessive collagen is produced and adhesions may develop, granulomas may develop, and the pt might be stuck in the inflammatory face
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what is edema?
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abnormal collection of fluid in the tissue spaces
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hydrostatic pressure
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pressure in and outside of the vessels
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what does CHP stand for?
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capillary hydrostatis pressure
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what does TOP stand for
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tissue osmotic pressure
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what does THP stand for
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tissue hydrostatic pressure
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what does COP stand for
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capillary osmotic pressure
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what does EFP stand for?
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external force pressure
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what is the equation for capillary filtration pressure (CFP)?
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CHP+TOP/THP+COP+EFP
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What are the causes of edema?
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increased permeability of capillaries and lymphatic obstruction
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examples of increased permeability of capillaries are
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burns, allergic reactions, inflammations, and increase tissue TOP AND THP
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examples of lymphatic obstruction
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filariasis and lymph node resection
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types of timulus
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injury to skin, musculoskeletal injury, and acute inflammation
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what are pain receptors?
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nociceptors that are designed to pick up pain signals and can be free nerve endings are primary receptor
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where does pain signal travel after the nociceptor?
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peripheral nerve - afferent pain fiber
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what fibers are slower conducting fibers?
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C and A delta fibers
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after the peripheral nerve where does the pain signal go?
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peripheral nerve conduction - cablelike and slow conductors
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after the peripheral nerve conduction where does the pain signal go?
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synapse - dorsal horn and lateral spinothalmic tract
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after the synapse where does the pain signal go?
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reticular formation - pons and medulla
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after the reticular formation where does the pain signal go?
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thalamus - sensory relay center
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after the thalamus wher does the pain signal go?
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hypothalamus- stress response
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after the hypothalamus where does the pain signal go?
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limbic system - emotional response
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after the limbic system where does the pain signal go
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somatosensory cortex - parietal lobe to locate pain
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what is peripheral nocioceptive pain?
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injury to musculoskeletal or skin - acute inflammation due to tissue damage
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what is the nature of peripheral nocioceptive pain?
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sharp, well localized - subsides as healing occurs
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what is peripheral neurogenic pain?
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radicular pain from spinal dysfunction; entrapment neuropathy
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what is the nature peripheral neurogenic pain?
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paresthesia and pain, localized to sensory distribution, sharp shooting
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what is central pain?
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central nervous system lesion
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what is the nature of central pain?
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inconsistent, often little correlation between stimulus and response
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what is pain related to sympathetic nervous system/
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sympathetic nervous system
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what is the nature of pain related to the SNS?
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intense burning, pit of proportion to expectations following injury, vasomotor instability
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what is affective pain?
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limbic system pain
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what is the nature of affective pain?
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pain behaviors linked to pain tolerance
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what is the suggested intervention for peripheral nocioceptive pain?
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rest, modalities, and ther ex
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what is the suggested intervention for peripheral neurogenic pain?
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rest, modalities and ther ex
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what is the suggested intervention for central pain?
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pharmacological agents, behavior modifications, modalities are not very helpful
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what is the suggested intervention for pain related to SNS
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Modalities, drugs, ther ex, and functional activites
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what is the suggested intervention for affective pain?
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pt education, modalities not likely helpful
