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18 Cards in this Set

  • Front
  • Back

Pain and Pain Transmission

Pain: an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage


Pain transmission occurs through receptors called nociceptors which are sensitive to mechanical, thermal, and chemical


Afferent nerve fibers carry info from nociciptors towards spinal cord, then up to brain

Types of Pain Signals - A-delta

Myelinated


FAST pain


Larger in diameter


Touch, pressure, and temperature stimulus


Located in the skin


Touching a hot burner - fast so you get the hand off quickly

Types of Pain Signals - C-fibers

Unmyelinated


SLOW pain


Small diameter


Spraining ankle - pain the day after; tells you injury is still there


As a therapist, this is is what treatment is for

Gait Control - Step-by-Step

W/o stimulation (no pain), both A+C fibers are quiet and SG+inhibitory interneuron block signal in T cell that connects to brain - "gate is closed" therefore NO PAIN


W/ pain stimulation, C fibers become active. They BLOCK inhibitory SG+activate Tcells. B/C activity of inhibitory interneuron is blocked, it CANNOT block output of Tcell that connects w/brain. "Gate is open", there fore PAIN (C-fibers fire)


W/non-painful stimulation, large nerve fibers (A) activated primarily. This activates SG, which then activates inhibitory interneuron, which then BLOCKS signal in Tcell that connects to brain. "Gate is closed",therefore NO PAIN - goal of treatment

Types of A-beta Input

Pressure - massage; rubbing a child where they bumped themselves


Vibration - 4Hz (4x/sec) taps on ankle x 10 min = released opiates and gate closed - non painful stimulation


Position Sense - shaking a finger after jamming it (changes motion/range, body picks up on position sense and blocks slow pain c-fibers); AROM/PROM

Cautions - Caveat Emptor (Buyer Beware)

Accommodation = rise in threshold


If a nerve is submitted to passage of a constant strength of current, the site of nerve under stimulation shows decrease of excitability


Constant input = no sensation to body


A fibers WILL accommodate


C fibers WILL NOT


Change up the stimulus - increase intensity or add new stimulus

Ice (Cryotherapy)

Body's response to cold depends on:


Cold media being applied (ice, cold water immersion, sprays, chemical packs) differences in temp and area covered


Conductivity of area being cooled (high water tissue means greater cooling; muscle better than fat, joints better than muscle)


Length of time of exposure - best is 10 on, 10 off, 10 on (less pain in first week)

Ice and Injuries

Tissue injury at primary and 2ndary sites - cell death from hypoxia


Increased bleeding to area


Pain


Ice will decrease metabolism of cells, decreasing their need for 02 - lessens damage from hypoxia


Ice will vasocontrict surrounding vessels slowing bleeding to area

Physiological Responses to Cryotherapy

Muscle Guarding - decreases, breaks pain/spasm cycle


Blood flow - decreases


Capillary Permeability - decreases


Metabolic Rate - decreases (reduced o2 requirments)


Collagen elasticity - decreases - more stiff (bad)


Joint stiffness - increases - lower ROM (bad)


Edema - controversial (will not reduce swelling present, but prevents swelling tomorrow)


Pain perception - deceases; 2nd degree to a-fiber input and c-fiber conduction rate

Heat (Thermotherapy)

Body's response to heat depends on:


Type of heat applied - moist heat(better for deep tissue), dry heat (better tolerated), ultrasound (mechanical)


Intensity of heat - sensitivity of person


Duration of application - increase blood flow unitl heat source removed; will peak after 5min - body protects from getting too hot; only when heat source removed will tissue temp drop


Physiological Responses to Thermotherapy

Blood Flow - increases


Capillary Permeability - increases


Metabolic Rate - increases


Collagen Elasticity - increases


Joint stiffness - decreases


Muscle Spasm (ischemic) - decrease; makes muscle more pilable and increases blood flow


Edema - depends on timing of heat - don't give during inflammatory stage


Pain - decrease - 2nd degree to A-fiber input

POLICE - Protection

Brace/tape/crutches


Protection and rest after injury are supported by interventions that stress shield, unload, and/or prevent joint movement for various periods


Short periods of unloading may be required after acute soft tissue injury and that aggressive ambulation or exercise should be avoided


Goal: decrease blood supply and prevent further injuyr

POLICE - Optimal Loading

Maintaining ROM and fitness while building support


Optimal loading=replacing rest w/balanced incremental rehab program where early activity encourages early recovery


Individualized to each person


Superior to immobilization for sprained ankles

POLICE - Compression

Most essential component when limiting hematoma


An elastic bandage pulled tight can limit blood flow by up to 95% w/in a few seconds


Reduced blood low increases linearly w/pressure, so a lossely fit bandage will only decrease flor 60%


Applying a pad or icebag underneath will also increase pressure

POLICE - Elevation

No reduction of blood flow until the injured area is at least 30cm above heart


At 50cm flow is to 80% of normal


At 70cm flow is 65%


People w/sprained ankles place foot on chair while sitting - this does nothing/doesn't meet elevation requirments

Icing Information

Quick application minimizes 2nd degree injury


Put ice on people not people on ice - tissue damage (freeze) from blood pushed away


Best cooling effect from ice mixed w/water in bag directly on skin


Compression over top is best - wet/dry towel


Never apply gel packs directly to skin - often too cold and can freeze surrounding tissue

Fibroblastic/Repair Phase Goals

Tissue Level: phase starts day 5/6; individual should be feeling better; pain and swelling down; job as healer/trainer is to hold them back and prevent further injury to delicate formed scar


Goals: decrease remaining pain; increase blood flow and ROM


Heat is a good treatment

Heat in Fibroblastic/Repair Phase

Increases blood flow to promote healing; Decreases spasms; Increases collagen elasticity; Decreases stiffness


Heat 10-15min depending on tissue depth (deeper may take longer; remember tolerance)


Idealize ROM - scar is healing, this way it won't be too short


Start at low level strength/proprioception exercises


Increase as ability does


Gentle and pain free process - don't want to re-injure and rip out scar