injury that occurs as a result of a single event

tissue damage with traumatic injury is usually more extensive than other types of injuries

occurs at slow velocities <6.5 mph

tissue compression reaching 35%

usually require a large persistant force

occurs at velocityies between 1-46mph

produce tissue deformation between 5% (higher velocities) and 30% (slower velocities)

actual injury is due to redistribution of fluids at a rate greater than the tissue can accomadate

velocities >45mph

tissue explodes due to being unable to dissipate the energy of impact

tissue deformation due to fatigue and/or failure of the tissue

represents a state in which the accumulation of micro trauma creates the tissue injury

slowly developed injury as a result of viscous deformation of tissue

associated with chronically poor posture

1. transient reponse from the tissue

2. serve as a stimulus for an adaptive change

3. result in an injury/negative tissue deformation

1. alarm

2. resistance development

3. exhaustion

prolonged immobilization leads to the softening and eventual breakdown of articular cartilage

injury to the musculotendinous unit which can result from micro or macro trauma of an overstretch or overload variety

1 degree: few of the muscle fibers are torn

2 degree: 50% of muscle fibers are torn

3 degree: all the muscle fibers are torn (rupture)

injury to a ligament from an overload/overstretch

1 degree: few ligaments fibers are torn

2 degree: 50% of the ligament fibers are torn

3 degree: all of the ligament fibers are torn (rupture)

disruption of normal relationship ebtween joint surfaces taht is easily restored often by muscle contraction

causes: capsular laxity, neuromuscular insufficiency, degenerative changes

causes:

disruption of the normal relationship between joint surfaces that cannot be restored without the application of an outside force

cause: trauma, however chronic instability can do it

1. loss of GAGs in CT

2. inc. cross link formation of CT

3. ppor orientation of newly depositied collagen fibers

4. fatty fibrous infiltration od edematous areas

5. pannus formation ino joint (inflam. exudates over synovium)

6. atrophy of all tissue types

1-3days

vasodilation, edema, cell migration, debris removal

48hours-6 weeks

fibroplasia, wound closure, collagen content with random alignment regeneration of small vessels

3 weeks-12 months

reduction of wound size, increased wound strength, realignment of collagen, reduciton of abnormal cross links

6-8weeks

1. trauma: hematoma and necrosis of loose bone fragments (1-2days)

2. inflammation: last until necrotic tissue is removed (2-5days)

3. early repair: soft callus formation (begins at time pain and swlling go away). Increased vascularity, bony fragments are joind by fibrous tissue or cartilage (4-14days)

4. early callus: trabecular bone replaces soft callus and eastablish bony bridge between ends of fracture (17-40days)

5. maturation of callus: soft callus replaced by bone, bone becomes denser and begins to remodel (25-100days)

6. restoration to normal structure: cortical bone forms between ends of the fracture and shape of bone is restored to normal (50+days)

1. initial response: would fills with blood and ceullar deris, remaining stump attaches by the paratenon

fibroblasts invade

type I collagen syntheiss ocurs by day 3

collagen synthesis is 10-20x normal at day 10 (worry about adhesions)

2. 3/4 week: fibroblasts and collagen deposition continues

tissues align according to stresses

3. week 20: minimal differences between healed and adjacent tissues

1. ischemia: muscle fibers die after being disrupted or have blood supply disrupted (1 week)

2. fragmentation: macrophages clear away debris, blood vessels begin to invade the area (1-3 weeks)

3. myotube formation: satellite cells differentiate into myoblasts, which fuse to form myotubes (3-5weeks)

4. muscle fiber maturation: myotubes fuse to form muscle fibers, fibers grow and mature (5 week-6 months)

nerve injury: disruption of axon and myelin shealths but preservation of CT fragments (perineurium and epineurium)

regeneration is spontaneous and of good quality (1mm/day1inch/month)

severance of nerve

no spontaneous regeneratation

study of effects of forces on bodies/systems tissues

effect of force directed at a body, 3 outcomes:

1. reaction force equal and opposite

2. change in motion

3. deformation of body

1. torsion: combo compression, shear, and tension, common in long bones

2. compression: secondary to gravity or result of muscular contraction. muscular loads (NWB) are actually weight bearing loads

3. tension: ligaments and tendons along the fibers

4. bending: combo of compression and tension, common in spine

5. shear: load at right angles to long axis of structure (Knee)

viscoelastic materials

constant progressive strain of material when exposed to a constant load over time

occurs when fluid separates the surfaces such that they will never come in contact with each other. 2 principles:

1. greater velocity of movement means more effective lubrication

2. fluid pressure in a synovial fluid causes a deformation of artciular cartilage which results in increased load bearing surface area

this same deformation is not possible with bone on bone contact

the center is calculated by taking x-rays in 2 positions that are a small arc of motion from one another.

The xrays are then overlaid and lines are drawn that connects analogous points on each image

the perpendicular bisector of these 2 lines is the instant center of rotation

study of relative motions that take place between articular surfaces and associated joint structures within a joint (roll, glide, spin)

valuable info. on freedom of motion, quality of motion, and joint tolerance to outside sources

1. component motions: non-voluntary movements that take place at joint surface to faciliate an active motion

classical movements can't occur in a normal manner without their respoective compoenent motions

2. joint play: non-voluntary movements that occur in response to an outside force

1. convex is moving on fixed concave, the direction of joint glide is in the opposite direction as physiologic motion

2. concave moving on fixed convex surface, direction of joint glide is in smae direction a physiologic motion

thoracic and lumbar spine

if segments are in neutral (facets unlocked) and movement is in cardinal plane, side bending and rotation will occur in opposite directions (side bending and rotation opposite)

thoracic and lumbar spine, segments are not in nutral (facets locked) then side bending and rotation occur in the same direction

In the lower cervical spine (C2-C7) this is true for all facets (locked or unlocked)

cervical, thoracic, lumbar

as motion is introduced in a given segment in one plane, motion in other plans is reduced

AA: left rotation

AO: r SB/slight flexion

AA: r rotation

AO: L SB/slight flexion

OA: anterior roll and posterior slide of occipital condyles

AA: anterior pivot of atlas on axis

OA: posterior roll and anterior slide of occipital condyles

AA: posterior pivot of atlas on axis

OA: slide of occipital condyles

AA: posterior slide of ipsilateral inferfior facet of atlas and anterior slide of contral lateral inferior facet of atlas

OA: contralateral slide of occipital condyles

AA: posterior slide of contralateral inferior facet of atlas and anterior slide of ipsilateral inferior facet of atlas

describe flexion and extension for lower cervical spine

flexion: superoanterior glide of both facets of superior vertebrae

extension: inferoposterior glide of both facets of the superior vertebrae

superoanterior glide of contralateral facet of superior vertebrae

posteroinferior glide of ipsilateral facet of the superior vertebrae

superoanteroglide of contral lateral facet of superior vertebrae

posterioinferior glide of ipsilateral facet of superior vertebrae

flexion: superoanterior glide of both facets of the superior vertebrae

extension: inferoposterior glide of both facets of sueprior vertebrae

superoanterior glide of contralateral facet of superior vertebrae

posteriorinferior glide of the ipsilateral facet of the superior vertebrae

classical: form the more traditional description, include active and passive

active: motion about the joint as a result of voluntary muscle action

passive: motions in which a joint is passively moved through a range of classical motion

describe the 3 types of manipulation movements (passive movement of a joint)

1. distraction

2. non-thrust

3. thrust

1. distraction: separationg of 2 articular surfaces perpendicular to the plane of articulation

2. non-thrust: when joint is oscillated within the limits of an accessory motion or taken to end of accessory range and then oscillated or stretched

THRUST: sudden, high velocity, short amplitude motion is delived at the pathological limit of an accessory motion

1. unweight joint surface

2. relieve pressure on intra-articular structures

3. stretch joint capsule

4. assist in reduction of a dislocation

1. mechanicaly enlongate CT, including adhesions

2. neurophysiologically-fire cutaneous, muscle, and/or joint receptor mechanisms

1. alter positional relationship

2. release adhesions/scar tissue

3. produce neurophysiological effects

direction of translatoric bone movement is perpendicular to and away from the treatment plane

results in separation of joint surfaces

direction of translatoric bone movement is parallel to treatment

this joint play movement is performed either as a test of passive joint mobility (joint play) or a joint mobilization technique (glide mobilization)

Grade 1 traction is often performed simultaneously with this movement

grade 1: joint surfaces are unweighted (LOOSENED)

grade 2: slack of capsule is take up (TIGHTENED)

grade 3: capsule and ligaments are (STRETCHED)

manipulation technique, series of 2-5 medium amplitude oscillations (distraction or gliding)that progress to end of available range, reaching end range only with the final oscillations

oscillations are started at apprixmately the middle of the available range, with each oscillation havin gthe same amplitude

technique that is commonly used in thoracic spine while utilizing breathing as an adjunct

used iwth joint glide or distraction and involves continuous and sustained force applied to create the glide or distraction

long duration technique that can work well for tissues that have adaptively shortened

1. soft tissue approximation: knee flexion

2. muscle: SLR

3. ligament-valgus stress

4. carilage: elbow exn

5. capsule: hyperexn of elbow

what are the 10 kinds of abnormal endfeels?

1. capsule

2. adhesions/scaring

3. bony block

4. bony grate

5. springy rebound

6. pannus: soft crunch equelnch

7. loose: ligamentous laxity

8. empty: boggy, soft, not limited mechanically, synovities, hemarthrosis

9. painful: considerable pain before end range is reached, end feel is lacing in resistance other than patient's protective or evoked muscle guarding

10. muscle: abnormal elastic resistance

in case of hypomoile joint, application of a force at end of range will produce plastic elongation.

Grade 3 & 4 mobilizations are necessary to do so, as the reacfh edge of resistance

sustained and progressive loading are often effective in producing mechanical effects.

examples of where mechanical effects are desired are:

1. stretch tight capsules

2. stretch out adhesions

3. snap adhesions

oscillations in beginning range decreases pain and soft tissue relaxation

type III mechanoreceptors (inhibitory) fired as a result of strong stretch but my responsd to a steady stretch to a joint or swelling in a joint

laying on of hands has powerful effect on pateints

make close contact: success in treatment 30-50% of time

joint hypermobility

muscle holding

hemarthrosis

joint replacement

presence of systemic disease

osteoporosis

fracture

specific techniques that are graded based on level at which restriction is found to occur in the skin, underlying fascia, and associated CT

friction massage and incisional mobilization

incorporates wolf's law into treatment where tendon, ligaments and other CT have become pathological due to stresses that are not sufficient enough to cause degeneration, but are too exfcessive to allow time for normal tissue modeling

lubricant not used and amplitude of movement is minimal, with a rate of approximately 2-3 cycles/second in a rhythmic fashion

pressure is increased every 1-2 minutes for between 5-15 minutes

most sutures and/or staples are removed at 7-10days post op

early intervention to assist in normal tissue movement is recommended

bone are held in place by inherent tension within muscles and CT

deep manual pressure and stretching are applied to tissues with end goal of bringing order to soft tissues

first may be used to apply pressure required to achieve depth needed for techqniue

series of 10-12 treatments at a frequency of 1x/week

point specific massage that may be used to create analgesia

pressure applied to circular, transverse or deep constant manner

duration of tehcnique is 30-90 seconds, but one point may be treated up to 3-4 minutes

based on neuroreflexive responses that reduce tissue tension

clinician determined a point of entry into musculoskeletal system from which a suitable stress was placed and modified accordingly until tissue tension was relaxed