Professional Documents
Culture Documents
Fibroblastic-repair phase
Maturation-remodeling phase
Viscoelasticity
Allows slow return to normal length and shape after
deformation
Plasticity
Allows permanent change and deformation
Maturation-Remodeling Phase
Long term process that involves realignment of
collagen fibers that make up scar
Increased stress and strain causes collagen fibers to
realign to position of maximum efficiency
Parallel to lines of tension
Gradually assumes normal appearance and function
Usually after 3 weeks a firm, contracted, nonvascular scar exist
Total maturation phase may take years to be totally
complete
Maturation-Remodeling Phase
Wolfs law/Davies Law
Bone and soft tissue will respond to physical demands
placed on them
Remodel or realign along lines of tensile force
Critical that injured structures are exposed to progressively
increasing loads throughout rehab process
As remodeling phase begins aggressive active range of motion
and strengthening
Use pain and tissue response as a guide to progression
Maturation-Remodeling Phase
Controlled mobilization vs. immobilization
Animal studies show Controlled mob. Superior to
Immobilization for scar formation
However, some injuries may require brief period of immob.
During inflammatory phase to facilitate healing process
Factors that impede healing
Extent of injury Hemorrhage
Microtears vs. Bleeding causes same neg.
effect as edema
macrotears
Poor vascular supply
Edema
Tissues with poor vascular
Increased pressure supply heal at a slower rate
causes separation of Failure to deliver phagocytic
tissue, inhibits neuro- cells and fibroblasts for scar
muscular control, formation
impedes nutrition,
neurological changes
Factors that impede healing
Separation of tissue Corticosteroids
How tissue is torn will In early stages shown to
effect healing inhibit healing
Smooth vs. jagged
Keloids or hypertrophic
Traction on torn tissue,
separating 2 ends scars
Ischemia from spasm Infection
spasm Health, Age and
Atrophy nutrition
Healing Process-Ligament Sprains
Tough, relatively inelastic band of tissue that connects
bone to bone
Stability to joint
Provide control of one articulating bone to another
during movement
Provide proprioceptive input or sense of joint position
through mechanoreceptors
3 Grades of lig. tears
Healing Process-Ligament Sprains
Physiology
Inflammatory phase-loss of blood from damaged vessels
and attraction of inflammatory cells
During next 6 weeks-vascular proliferation with new
capillary growth and fibroblastic activity
Immediately to 72 hours
If extraarticular bleeding in subcutaneous space
51
Left Lymph duct, Thracic duct
& Cysterna chyli
52
Vena Subklavia kanan & kiri
53
54
55
Evidence Based Practice
What the research DOES support about
kinesiotaping:
Decreased inflammation / edema
Tsai, 2009
Bialoszzewski, 2009
Osterhues, 2004
56
Gradual Exercise
(Using PNF Concept)
Inflamatory Phase
Maintain muscle physiology (contractility, length-tension rel.)
Use philosophy Positive Approach
Use Basic principle Irradiation & Reinforcement
Pattern
Use PNF Technique Rythmic Initiation
Combination of Isotonic
Proliferation Phase
Increase strength, ROM and propriocetion
Use philosophy Positive Approach
Use Basic principle Irradiation & Reinforcement
Pattern
Use PNF Technique Rythmic Initiation
Combination of Isotonic
Dynamic Reversals
PNF Philosophy (5)
1. Positive approach: no pain, achievable tasks, set up for success,
direct and indirect treatment, strong start.
2. Functional Approach : Highest functional level, ICF, include
treatment on body structure level and activity level.
3. Mobilize Reserves: Mobilize potential by intensive training:
active participation, motor learning, self training.
4. Consider the total whole person: Total human being with
his/her environmental, personal, physical, and emotional
factors.
5. Use of motor control and motor learning principles: repetition
in a different context; respect stages of motor control, variability
of practice.
PNF in practice 2007
BASIC PRINCIPLES (10)
Exteroceptor stimuli
Tactile Stimulation
Visual Stimulation
Auditory Stimulation
Proprioceptor stimuli
Resistance
Traction & Approximation
Stretch
Body Position & Mechanics
Timing
Pattern
Irradiation & Reinforcement
TECHNIQUE (10)
Agonist Technique
Rythmic Initiation
Combination of Isotonics/ Agonist Reversal
Repeated Stretch from begining of range
Repeated Stretch through range
Replication
Relaxation and/ or Stretching techniques
Contract Relax
Hold Relax
Antagonist Technique
Dynamic Reversals
Stabilizing Reversals
Rythmic Stabilization
Taken from Prentice, Rehabilitation Techniques in Sports Medicine, 3rd ed
Inflammation is the first physiological process to the repair and remodeling of
tissue. You cannot have tissue repair or remodeling without inflammation. Ice
constricts blood flow and impedes the inflammatory cells from reaching
injured tissue. The blood vessels do not open again for many hours after ice is
applied.
Inflammatory cells are designed to release a hormone known as Insulin-like
Growth Factor (IGF-1). IGF-1 is a primary mediator of the effects of growth
hormone and a stimulator of cell growth and proliferation, and a potent
inhibitor of programmed cell death. The application of ice inhibits the release
of IGF-1.
Swellinga byproduct of the inflammatory processmust be removed from
the injured area. Swelling does not accumulate at an injured part because there
is excessive swelling, rather it accumulates because lymphatic drainage is
slowed. The lymphatic system does this through muscle contraction and
compression. Ice has been shown to reverse lymphatic flow.
Gabe Mirkin, MDthe physician who coined the term RICEhas since said he
was wrong. Coaches have used my RICE guideline for decades, but now it
appears that both Ice and complete Rest may delay healing, instead of helping.
Gabe Mirkin, MD, March 2014
In a National Athletic Trainers Association position statement (the review of
many scientific papers) on the management of ankle sprains (2013) found that
ice therapies had a C level of evidence, meaning little or poor evidence exists. In
an interview, the author of that article said: I wish I could say that what we
found is what is really being done in a clinical setting. Maybe our European
colleagues know something we dontthere is very little icing over there.
Ice does not facilitate proper collagen alignment. Diagnostic imaging of chronic
tendon injuries like Achilles tendinopathy, jumpers knee, runners knee, and
plantar fasciitis show poor collagen arrangement of connective tissue. Study
shows that exercise (especially eccentric loading) helps align collagen.
Ice impedes cellular signaling and inhibits the proper development of new cells.
The processes of mechanobiology and cellular signaling take progenitor cells
infant cells who do not know what they are going to beand makes them into
rebuilding cells like myocytes, osteocytes, tenocytes, chondrocytes, etc.
Ice slows nerve firing and interferes with the strength, speed, and coordination
of muscle. A search of the medical literature found 35 studies on the effects of
cooling and most reported that immediately after cooling, there was a decrease
in strength, speed, power and agility-based running.
Ice does control pain, but that pain relief lasts only 20-30 minutes and as
evidenced above, has detrimental side effects to healing.