Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

ATTR 362: Injury Response Process

Before examining therapeutic modalities, students must understand the basic physiology and pathophysiology underlying the selection and appropriate use of therapeutic interventions.
by

Kenneth Games

on 22 August 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of ATTR 362: Injury Response Process

The Injury Response Process
Stresses Placed on Tissues
Stress
-Any mechanical, chemical, thermal, or emotional force placed on the body
Are stresses always negative?
What do you think?
NO!!! Many stresses in life are positive!
No stress = No LIFE
Physical Stress Theory
None to low

Low

Normal

Moderate
(Positive Overload)

High

Extreme
-Cell Death

-Decreased tolerance
(e.g., atrophy)
-Maintenance

-Increased tolerance
(e.g., hypertrophy)

-Injury

-Cell death
Physical Stress Level
Tissue Response
General Adaptation Syndrome
(GAS)
1.
Alarm Stage
2.
Resistance Stage
3.
Exhaustion Stage
Physical Stress' Relationship to Trauma
Macrotrauma (acute)
Force
/
Time
Microtrauma (chronic)
Force
Time
/
Wolff's Law
Bones adapt to stresses place on them
What are some examples?
Physical Stress' Relationship to Treatment
Your Turn to Think
1. THINK
2. PAIR (write)
3. SHARE
Types of Soft Tissue in the Body
A Quick Review
Types of Cells Found in the Body
Type
Tissues Where
Found
Ability to Regenerate
Labile cells
Stabile cells
Permanent cells
Skin, GI, Blood
Good
Bone
Some
Muscle
PNS
CNS
Some
Some
None
(very little)
Epithelial Tissues
Characteristics
-Ability to absorb & secrete
-Devoid of blood vessels
-Regenerates easily
-Most commonly injured tissue
-Excellent barrier
Importance to therapeutic modalities
-All forms of energy from TM must pass though epithelial tissue FIRST

-Thermal Agents: Heat is transferred across epithelial

-Ultrasonic Agents: Pass easily through skin

-Electrical Agents: Cells of stratum corneum are dead/dry = poor conduction

-Transdermal Agents: Must travel past stratum corneum via hair follicles and sweat glands.
Adipose Tissues
Characteristics
-Protects, Pads
-High H2O content
-Insulator
-Important metabolic and endocrine functions
Importance to therapeutic modalities
-Thermal Agents: Retains heat
-Thermal Agents: Insulates underlying tissues
-Ultrasonic Agents: Not significantly affected by adipose thickness
Muscle
Characteristics
You Tell Me
Considerations for Therapeutic Modalities
-Often the target for intervention
-Thermal Agents: Can be heated or cooled
-Ultrasonic Agents: Absorbs US energy
-Electrical Agents: Excitable,
BUT
clinically induced contractions typically caused by depolarization of motor nerves
PADLET CHALLENGE!
In 140 characters or less...
Explain what the Arndt(h)-Schultz Principle has to do with therapeutic interventions
Nervous Tissue
-Afferent and Efferent
-Action Potentials
-Communicate via synapses
-Electrical (Gap Junction)
-Chemical
Do you remember
action potentials?
Application of therapeutic modalities
-Most agents affect nervous tissue in some way
-Thermal Agents: Alter Na-K pump
-US Agents: Alter Na-K pump
Electrical Agents: Stimulate nervous system in an orderly, predictable manner
NCV
Connective Tissue
-Most abundant
-Strength
-Structure,
-Nutrition
-Defense against trauma
Tissue Effects of Therapeutic Modalities
Thermal Agents: or elasticity of collagen fibers
US Energy: elasticity of collagen fibers
Diathermy: elasticity of collagen fibers
Evidence-Based Practice
Although superficial and deep heating will increase collagen elasticity, mechanical stress is required to permanently elongate fibers*
*Sawyer PC, Uhl TL, Mattacola CG, et al. Effects of moist heat on hamstring flexibility and muscle temperature. J Strength Cond Res. 14:285, 2003
The Injury Process
2 Stages
Primary
Injury

Secondary
Injury

-Ischemic
-Enzymatic
Injury Response Cycle
The Healing Process
Three Distinct Phases
1. Acute Inflammatory
2. Proliferation Phase
3. Maturation Phase
Time Course of Healing Process
Overlapping Stages!!!
Acute Inflammatory Response
Overview
-Trigger by trauma or infection
-Inflammation is
GOOD
-Contains, dilutes, destroys injurious agents
-The body has more firepower than need
-Starts almost immediately
-Lasts a few seconds to months
-Occurs at 2 levels
1. Hemodynamic changes
2. Cellular function changes
Cellular Response
Neutrophils released first
1st line of defense
Very aggressive
Leukocytes & other mediators follow
-Heprin
-Histamine
-Kinins
-Protaglandins
How do the mediators get from the blood to the injured tissue?
Normal
Margination &
Pavementing
Pavementing
Hemorrhage
In order to occur, one of two prerequisites must be met:
1. Loss of continuity (rupture)
2. Increase permeability (be more leaky)
The vessel must:
OR
For hemorrhage to stop:
1. Restore continuity
2. Pressure gradient must be restore
OR
Coagulation
Check Your Knowledge
Write the important concepts that ATs need to know about the Acute Inflammatory Phase
Think, Pair, Share
Evidence-Based Practice
Instead of
RICE
or
PRICE
, should we be calling the
POLICE
(protection, optimal loading, ice, compression, & elevation)? The POLICE method suggests that prolonged immobilization is detrimental to healing. Optimal loading is the early implementation of "balanced and incremental loading." The mechanical stress stimulates the cellular response, encouraging healing.*
*Bleakley CM, Glasgow P, MaxAuley DC: PRICE needs updating, should we call the POLICE? Br J Sports Med. 46:220, 2012.
Evidence-Based Practice
Cold application has little effect on hemorrhage. The effects of cold are time- and depth-dependpent, meaning it would take at least 10 minutes to cool an injured area. External compression may quickly reduce hemorrhaging by equalizing pressure gradients.*, **
*Kraemer WJ, French DN, Spiering BA: Compression in the treatment of acute muscle injuries in sport. Intl SportMed J. 5: 200, 2004.
**Knobloch K, et al: Midportion Achilles tendon microcirculation after intermittent combined cryotherapy and compression compare with cryotherapy alone. A randomized trial. Am J Sports Med. 36: 20128, 2008.
CLINICAL PEARL
Cardinal Signs of Inflammation
1. Redness (Rubor)
2. Heat (Calor)
3. Swelling (Tumor)
4. Pain (Dolar)
5. Loss of function (Functio laesa)
Proliferation Phase
Overview
-Removal of debris from Phase I
-Development of new, permanent tissue
-Development of temporary vascular framework
-Typically begins about 72 hours after injury, may last 3 weeks
Possible Outcomes of Injury Response Process
Outcome
Description
Resolution
Regeneration
Repair
Dead cells and cellular debris are removed by phagocytosis. The tissue is left with its original structure and function intact.
The damaged tissue is replaced by cells of the same type. The structure retains some or all of its original structure and function
The original tissue is replaced with scar tissue. The original structure and function is lost.
*Most often a combo of repair and regeneration
Revascularization
-1st step in repair
-Macrophages and granulocytes form granulation tissue and new capillary beds
-Fibroblasts migrate to area and lay Type III collagen
-Creates an extracellular matrix
Contraction/Remodeling
-Myofibroblasts lay down Type III collagen
-Moves from edges to center
-Nerves & vessels begin to develop
-In late phases (5-11 days), type I replaces type III collagen
Maturation Phase
-End of proliferation phase
-Injured area is returned to pre-injury status
-Chemical mediators and fibroblasts return to baseline levels
-Reduction of capillaries to baseline
-Increases in tensile strength
Other Consequences of Injury
Secondary Injury
-Consequence of primary injury
-Reduced BF and increased B. viscosity result in ischemia
-Damaged cells lyse, releasing ICF into extracellular space
damaging more cells
-Creates an ATP shortage
cell death
-Seen within 30 minute primary injury
Evidence-Based Practice
Applying cold packs within 30 minutes of musculoskeletal trauma can decrease amount of secondary injury.*
*Merrick MA, McBrier NM: Profression of secondary injury after musculoskeletal trauma - a window of opportunity? J Sport Rehabil. 19: 380, 2010.
Swelling & Edema
Swelling
-increase in limb volume due to fluid buildup
Edema
-buildup of fluids & protein in the interstitial space due to pressure imbalances
Edema accumulation is proportional to:
-Severity of injury
-Vascular permeability
-Amount of hemorrhage
-High-pressure gradients
-Presence of chemical mediators
Venous/Lymphatic Return
-Swelling/edema are transported via venous/lymphatic systems
-Passive systems!!
-Must use respiration, muscle contractions, & gravity to return blood/fluid centrally
Muscle Pump
Effect of Gravity
PADLET CHALLENGE!
In two sentences...
Describe Starling's law as it relates to swelling and give an example of how it is used in AT practice
Muscle Spasm
-Involuntary contraction of muscle fibers
-Intrinsic "splint", provides protection
-Can result from trauma, decreased O2, or neuro dysfunction
-Self-perpetuating cycle
Muscle Weakness and Atrophy
-When muscles are not used, actin and myosin become smaller
Disuse Atrohpy
-results from immobilization or lack of use
Denervation Atrophy
-results from lack of nerve supply to muscle
Effusion at joint can lead to atrophy of prime movers via
arthogenic muscle inhibition
Quick Review of Injury Process
Phase
Events
Inflammatory
Proliferation
Maturation
Platelet accumulation, coagulation, leukocyte migration
Growth of new tissue, angiogenisis, fibroplasia, wound contraction, formation of collagen matrix
Resolution of matrix, deposition of permanent tissues, return to function
"The Crawl" Ironman 1997
Full transcript