Injury that results from a single event.

*Tissue damage due to traumatic injury is usually more extensive.

1) Crush injury

2) viscous injury

3) blast injury

Tissue deformation due to fatigue or failure of the tissues.

*microtrauma creates the tissue injury

Slowly developing injury as a result of viscous deformation of the tissue.

*Caused by chronically poor posture.

3 days

30%

1) Strain

2) Sprain

3) Subluxation

4) Dislocation

Strain

1 degree = few of the tissue fibers (tendon or ligament) are torn.

2 degree = ~50% of fibers are torn.

3 degree = All fibers are torn (rupture)

A disruption in the joint surfaces that spontanously return come back into contact with eachother.

Causes of a Subluxation

(3)

1) Capsular laxity

2) neuromuscular insufficiency

3) degenerative changes

The disruption of the joint surfaces that cannot be restored without the help of outside sorces.

1) Reaction Phase

2) repair Phase

3) remodling phase

1) BV vasoconstrict [lasts 5-10 mins]

2) BV vasodialate bringing blood the the injury site.

3) Tissue permeability increases allowing plasma to enter the tissue causing swelling.

4) Leukocytes enter the area and "clean up" the area

1) Fibroblasts appear and begin to lay down collegen, and starts to close down the wound.

*large amt. of collegen is present 4-5 days after and continues to build for 6 wks.

2) During this time the wound has very little strength resulting in immobilization if neccassary. 

1) Lots of collegen is present but in random arrangement.

2) Gentle mobilization will help rearrange the fibers to a more functional state. It will also break down and cross links to abnormal arrangement.

1) A transient change in tissue.

2) Stimulate an adaptive change.

3) result in an injury/ negative change in tissue.

1) alarm Reaction

2) resistance Development

3) Exhaustion

5 days

40 %

How long does it take for bone to heal?

What are the 6 phases that it must go through and how long does each stage last?

6-8wks

1)Trauma [1-2 days]

2) Inflammation [2-5 days]

3) Early repair [4-14 days]

4)early callus [17-40 days]

5) Maturation of callus [25-100 days]

6) restoration to normal structure [50+ days]

1)Trauma - Hematoma forms & necrosis of broken off bone fragments

Inflammation- lasts until necrotic tissue has been removed

Early repair - Soft callus forms. Increase in vasculature. Bony fragments are jointed via cartilage.

early callus- Trabecular bone begins to form & replace the soft callus creating a bony bridge between the ends of the fracture.

How long does it take for a ligament to heal?

Children

* Their ligaments are stronger than the bone

1) the ligament that is injured

2) the grade of injury

3) vascularity of the ligament

Initial response

Wound fills with bloods and cellular debris

Remaining stump attaches by the paratenon

Fibroblasts invadecollagen synthesis is 10-10x normal

Fibroblasts and collagen deposition continues.

*tissues align depending on stresses

Joint effusion

Define?

Concequences?

Swelling with in the joint.

The swelling with in the joint may passively stretch and weaken the capsule and ligaments.

Hemeathrosis

Define?

Concequences?

Bleeding within the joint capsule.

The bloody inflammatory soup destroys the articular cartilage with in the joint.

What are the stages of muscle healing?

(4)

Describe each stage and roughly how long they last.

1) ischemia - muscle fibers die and or have thier blood supply blocked [1 wk]

2) Fragmentation - macrophages clear away debris, BV invade the area. [1-3 wk]

3) Myotube formation-satellite cells differentiate into myoblasts which fuse to form myotubes [3-5 wks]

4) Muslce fiber maturation - myotubes fuse to form muscle fiber, fibers grow adn mature [5 wks - 6 mo.]

1) neuropraxia

2) axonotmesis

3) neurotmesis

disruption of the axon and myelin sheaths but preservation of the connective tissue fragments. Regeneration is spontaneous and of good quality.

[epineurum and perineureum stay intact and guide the nerves healing]

What are the outcomes are possible when a force is applied to a body?

(3)

1) a reaction force equal and opposite

2) A change of motion

3) a deformation of the body

True or False

Muscular loads (NWB) are > than weight bearing loads

Twisting forces

[common on long bones]

Load at right angle to the long axis of the structure.

[common at the knee joint]

Combination of compression and tension stresses 

[common in the spine]

Stress

Define?

How is interanal resistance generated.

The reaction that occurs in the response to a load.

The internal resestance is generated as a tissue resists deformation, this internal resistance is divided by the tissues cross-sectional area.

[force/unit area]

Strain

Deffinition?

*not related to tendion tear

non-linear region of low tension.

[represents the slack coming out of the tissue]

Plastic zone

Define?

Can energy be recovered?

Only marginal increases in tension as it continues to elongate resulting in microscopic failure.

Tissues remains permantly deformed. Energy is not recoverable

Zone D stress/strain curve

Increases

Elastic range

increases

1) greater velocity of movement means more effective lubrication.

2) Fluid pressure in a synovial fluid causes deformation of articular carilage which results in increased load bearing surface area.

[not possible with bone on bone]

prevention of injury

improved health/repair of articular cartilage.

Are measured from the point of application of the force to the axis of rotation. 

[Systems with longer moment arms increase Mechanical Advantage]

How are limb movements described?

How are spinal movements determined?

The study of relative motions that take place between articular surfaces and associated joint structures with in a joint.

[roll,glide and spin]

1) component motions

2) joint-play

Convex/concave Rule.

What happens when concave is moving on convex and vice versa?

Convex moving on concave: The direction of joint glide is opposite to the direction as the physiologic motion.

Concave moving on convex: The joint glide is in the same direction as the physiologic motion.

Fryette's Laws of coupled vertebral motions.

Define each law (3)

1) For thoracic and lumbar spine only, if the facets are unlocked and the movement is in the cardinal plane than side bending and rotation occur in opposite directions.

2) Thoracic and lumbar spine, if facets are locked then side bending and rotation occur in the same directions. Cervical spine [C2-C7] always moves in the same direction.

3) In the whole spine, movement in one plane restricts movement in other planes. 

Movement couples in the O,C1 and C2 joints.

L rotation at the A-A joint cause what to happen at the A-O joint?

R rotation at the A-A joint causes what to happen at the A-O joint?

1) R side bending and slight flexion

2) L side bending and slight flexion

1) distraction

2) non-thrust

3) thrust

Define distraction.

What are the 4 reasons distraction is used for?

The separation of two articular surfaces perpendicular to the plane of the articulation surface.

1)unweight the joint surfaces

2)Relieve pressure in the joint

3)stretch the joint capsule

4) assist in the reduction of distraction location

Define Non-thrust

Used for what purpose?

(2)

When the joint is either oscillated within the limits of an accessory motion or taken to the end of accessory motion then oscillated and stretched.

1)mechanically-elongate connective tissue

2) Neurophysiologically - fire cutaneous, muscle and or joint receptors mechanisms. 

Define Thrust

Name 3 reasons why it is used?

A sudden, high velocity, short amplitude motion is delivered at the pathological limit of an accessory motion.

1) alter position relationships

2)release adhesions/scar tissue

3) produce neurophysiologic effects

Concave

Concave

Distraction can by performed by translatoric bone movement is ______ and ______ from the treatment plane.

Grading of accessory Joint Motion.

Name the grade, joint status and if the joint should be mobilized or not.

0- ankylosed - no mobilization, surgery

1 - considerable hypomobility - mobilize

2-slight hypomobility - mobilize

3- normal - not mobilization

4 - slight hypermobility - no mob, sablization instead

5 - considerable hypermobility - no mob, sablization instead

6 - unstable - no mob, surgery

*sablization can be done through bracing/exercise or educ.

Grade 1 - joint surfaces unweighted

Grade 2 - slack of capsule taken up

Grade 3 - sapsule and ligaments are stretched

Grade 1 - small amplitude @ the beginning range

Grade 2- large amplitude movement from the beginning to middle.

Grade 3 - large amplitued middle to end

Grade 4 - small amplitude performed at the end range

Grade 5 - High velocity, low amplitude performed up and to through the end range "thrust"

Direct hand or finger placement at the involved site with the minipulating force applied at the points of contact.

joint injury

chronic posture

health habits

disease

True or false

In a healthy joint AROM > PROM

False 

PROM > AROM

Cyriax and kaltenborn have how many ways to describe normal end feel and abnormal?

Describe each category.

3 normal descriptors 4 abnormal descriptors

Normal: Soft, firm and hard

Abnormal: Soft, firm hard and empty

Paris has how many descriptors for normal end feel and abnormal end feel.

1) soft tissue approximation - knee flexion

2) muslce - SLR

3) ligament - valgus stress

4) carilage -extension of elbow

5) capsule - hyperextension of elbow

Considerable pain before end range is reached. End feel is lacing in resistance other than the patient's protective or evoked muscle guarding.

*bursitis, abscess or disease

Manipulation precautions

(7)

1) joint hypermobility

2)muscle holding

3) hemarthrosis

4) joint replacement

5) presences of a systemic disease

6) osteoporosis

7) fracture

Improve the ability  os soft and connective tussue to fold up on itself [hip flexors]

Expand 3-d

Expand its ability to bend around bony promenances

enhance splaying of a muscle during movement.

Define Therapeutic muscle stretching.

Goal?

lengthening of soft tissues in the cardinal plances along joint axis.

Lengthen muscles to increase ROM.

Contract

protective

muscle spindle

Connective tissue massage

define.

Define the 2 sub categories that fall under CTM

Special techniques used depending on the amount of tightness found at the different levels.

Friction massage - Provide sufficient stress to stimulate tissue modeling  while other excessive stresses are diminished.

Incisional mobilization - mobilization of the tissues allows for the scar to heal properly

Rolfing

Define?

How often is it done?

Deep manual pressure and stretching are applied to the tissues with the end goal of bring about order to the tissues.

10-12 treatments at 1x/wk

Acupressure

Define?

Treatment pattern/length?

Point specific massage that may be used to creat analgesia. Pressure may be applied in a circular, transverse, or deep constant manner.

30-90 seconds but one point may be done for 3-4 mins.

Trigger point therapy

Define?

Myofascial Release

Define

Muscular relaxation

soft tissue mobilization

joint manipulation

therapeutic muscle strengthening

neuromuscular re-education

strengthening

home exercise program

Palpitory grips

(5)

Describe them.

1) Back of hand - to notice condition

2)Thumb buttress - used to protect IP joints during deep palp.

3)Finger buttress

4) Golfers grip-uses intrinsic grip

5)sawmiller's grip-thenar eminences touching

Palpate for condition

palpation for position

palpation for mobility

4 layers of tissue

define?

Angle of application?

first layer - skin - 0-10 degrees

Second layer - superficial fascia - 25-45 degrees

3rd layer - deep fascia, muscle and connective tissue - 45-60 degrees

4th layer - periosteal - 75 -90 degrees

0- absent [areflexia]

1 - diminished [hyporeflexia]

2 - average [normal]

3 - exaggerated [brisk]

4 - clonus [hyperreflexia]

Biceps tendon reflex level?

Brachioradials reflex level?

Triceps reflex level?

patella reflex level?

Tibialis posterior?

medial hamstring?

lateral hamstring?

achilles?

C5-C6

C5-C6

C7-C8

L3-L4

L4-L5

L5-S1

S1-S2

Lumber and cervical regions lose their lordadic curve.

Thoracic becomes more kyphotic

Reversal of the thoracic kyphosis.

Normal lumbar and cervical lordosis

Sacrococcygeal curvature changes to spine motion much like the rest of the spine.

True or false

False

Sacrococcygeal segments do not change when it comes to movement.

At the apex of each region

C4-C5

T6

L3

T1-T3 - points posteriorly

T4-T6 - Downward sligtly

T7- T9 - point downward

T10 - is below the transverse of the vertebrae below

T11 - midway between there own transverse process and and the transverse process below

T12 - Spinous process is = with its transverse process.

Abnormalities of the T1 vertebrae?

full costal facet superiorly which articulates entirely with the head of the first rib.

Partial costal fascet inferiorly which articulates with a portion of the head of the second rib.

T11- complete costal fascet on its body for articulation with 11th rib.

T12 - complete costal fascet for articulation with 12th rib.

T11 and T12 - Transverse processes do not articulate with the neck of ribs 11 and 12.

Runs from occipital bone to the anterior aspect of the sacrum.

Narrow at the cranium and thicker at the sacrum.

Posterior aspect of the vertebral bodies.

C1 to sacrum

Start wide at the cranium and gets thinner at the sacrum.

Goes from Lamina to lamina

Thickest in the lumbar region

Resits flexion

Aka "yellow ligament"

Goes from spinous process to spinous process

C7 to the sacrum

Limits flexion

Goes from spinous process to spinous process of C7 to the skull.

Limits flexion

Spans the space between adjacent transverse process

Limits contralateral lateral flexion

Runs posterior to the transverse ligament and runs from C1 to the basilar part of the occipital bone.

Helps connect the axis with the cranium limits the extreames of cervical flexion and extension.

Transverse ligament

Goes from either side of the Dens to the occipital condyles

Limits axial rotation.

top of the dens to the occiput

prevents head removal