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49 Cards in this Set
- Front
- Back
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Components of a stress-strain curve
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Toe Region
Elastic Range Elastic Limit Plastic Range Complete Failure (rupture) Resting length Length of Stretch New Resting Length After Stretch Hysteresis Loop Fiber "Necking" |
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In a stress-strain curve of musculotendinous tissue, what does the toe region represent?
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straightening of collagen fibers
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In a stress-strain curve of musculotendinous tissue, what does the elastic range represent?
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fibers require substantial tension to deform and will return to original shape after stretch
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Where is the index of tissue stiffness represented? What is considered to represent "stiffer" tissue?
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slope of the curve in the elastic region is an index of tissue stiffness
The steeper the curve the stiffer the tissue |
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In a stress-strain curve of musculotendinous tissue, what does the plastic range represent?
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stretched fibers will not return to normal length (partial tearing of fibers)
Fiber necking occurs in this region |
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In a stress-strain curve of musculotendinous tissue, what does the complete failure present?
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rupture of the tendon
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What is fiber necking?
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When a set of parallel tendon fibers is stretched into the plastic range, there is a time where the fibers become thinner in the middle as they are tearing then at the ends of the fibers, creating a horizontal hour glass shape, or "fiber necking"
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Hysteresis loop represents what?
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heat loss during the stretch of the tendon
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What does the x-axis of a stress strain curve represent?
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Represents the amount of strain (% deformation)
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What does the y-axis of a stress strain curve represent?
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The amount of stress (load)
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Does deformation cause damage?
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deformation in the elastic range DOES NOT cause damage
but, deformation in the plastic range and beyond WILL cause damage |
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What is microtrauma sometimes identified as?
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Overuse syndromes
Cumulative cell-matrix adaptive response |
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Define microtrauma
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Tissue level tearing
Micro does not necessarily mean small, it just indicates that the tearing/damage is at the tissue level |
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Repetitive maximal or submaximal stress (or movement in the elastic range) causes what?
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It causes microscopic tears or lesions which creates inflammation and tissue malformation
Overwhelming of cell metabolism means that the cell can't maintain structural integrity, which causes an increase in tissue synthesis |
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What is different about tissues formed in response to an overload stimulus?
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tissues that are formed in response to overload stimulus are of inferior quality (scar tissue)
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What percentage of sports injuries are microtrauma responsible for? Why?
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responsible for 30%-50% of sports injuries
so common because sports are the most common method to overuse your body |
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These types of injuries are characterized as what from person to person?
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These types of injuries are very "individualistic" in nature
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What are the structures most commonly affected in microtraumatic syndromes?
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Bursa: synovial fluid sacs that decrease friction between skin-bone, tendon-bone, muscle-muscle
Tendon Sheaths: paratenon - fat & areolar tissue - "extended bursa" surrounding tendon Tendons - tendonopathies Bones - stress fractures Muscle - delayed onset muscle soreness |
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Symptomology progression of microtraumatic overuse syndromes?
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Phase 1: pain AFTER activity (immediate to 12 hours) which is palpable at injury site
Phase 2: pain DURING & AFTER activity - no significant impairment - eventually resolves Phase 3: pain DURING & AFTER activity - significant impairment - eventually resolves Phase 4: pain all the time accompanied by significant impairment - no resolution |
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What are the currently accepted theories as to the causes of DOMS?
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Eccentric Contractions
Prostaglandin & Histamine Increased Phospholipase and Protease Activity Phagocytes & Macrophages Cell Adaptations |
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How are eccentric contractions thought to cause DOMS?
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eccentric contractions cause sarcomere inhomogeneities and sarcolemma (membrane) disruption
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How are prostaglandin & histamine thought to cause DOMS?
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prostaglandin and histamine cause edema and inflammation which cause the stimulation of free nerve endings
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How are increased phospholipase and protease activity thought to cause DOMS?
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increased phospholipase and protease activity begin to degrade the myofibril (by the protease) and associated membrane (by the phospholipase)
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How are phagocytes and macrophages thought to cause DOMS?
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Phagocytes and Macrophages invade cell 2-6 hours after the injury and continues for 2 to 3 days
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How are cell adaptations thought to cause DOMS?
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the cell adapts to cause future bouts of the same exercise cause less injury
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Tendinitis
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inflammation of tendon or tendon sheath
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how common is tendinitis?
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rarely occurs (for the tendon sheath)
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what are the correct terms for inflammation of the sheath
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tenosynovitis
paratenonitis |
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Tendinosis
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degeneration and deleterious changes in tendon without inflammation
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What most clinicians in the past have termed as "tendonitis" is actually what?
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it is actually "tendinosis" or more generally "tendinopathy"
Both tendinitis and tenidnopathy can occur together |
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What types of tendon injuries can occur together?
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Tendonopathy and tendinitis can occur together
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What are observations common among most if not all tendonopathy patients?
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The problem is most often accompanied by:
tissue degeneration (necrosis) and vascular abnormalities (disorganized vascularization) collagen disorganization and fiber separation by mucoid or lipoid (inferior) ground substance |
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Tendonopathy may contribute to what other problem that is much worse?
How does it contribute? |
The problem may lead or contribute to complete or partial tendon rupture
Chronic tendonopathy causes fibrinous adhesions which causes diminished tissue strength & function which leads to complete or partial tendon rupture |
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Although cause & etiology are debatable, recent opinions purport causes of tendonopathy to be related to:
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The sliding of tendon over other structures (compressive forces)
Subjecting the tendon to loads close to tensile strength & exceeding anabolic capabilities Eccentric Contractions -negative direction on force velocity curve Chronic anabolic steroid use causes a decrease in tissue quality and tensile strength which causes the increase in incidence of tendon rupture malnutrition influence: decreases in vitamin A Vitamin C and copper causes a decrease in collagen synthesis and crosslinking Menopause causes a decrease in the concentration of E2 which causes a decrease in connective tissue elasticity which causes an increase in tendinitis & other overuse injuries Collagen production is impaired in smokers and causes tendinopathies heal slower |
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What are the general steps in the healing of microtrauma pathology including time frames for each stage?
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INFLAMMATION: day 0-6 (if present), Some authors say day 1 or 2 only
FIBROPLASTIC PROLIFERATION: days 5-21 REMODELING/MATURATION: 20 days - 6 months |
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What are the pathology, healing, and objectives of the healing stage for microtrauma including inflammation?
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INCREASE GAG & COLLAGEN SYNTHESIS
Prevent prolonged course of inflammation (if present) Prevent injury to developing collagen |
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What are the pathology, healing, and objectives of the healing stage for microtrauma including fibroplastic proliferation?
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Increase rate of collagen synthesis by fibroblasts
SYNTHESIZED COLLAGEN FIBERS NEED TO BE ALIGNED |
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What are the pathology, healing, and objectives of the healing stage for microtrauma including remodeling/maturation?
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increase rate of crosslinkage formation and fibril size
replacement of initial and/or inferior tissues |
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What are the treatment implications of the healing stage for microtrauma including inflammation?
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REST
nsaid's, oral corticosteroids low level ROM exercises cryogenic therapy? load reducing devices (casting, bracing, heel lifts, etc.) |
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What are the treatment implications of the healing stage for microtrauma including fibroplastic proliferation?
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low level/low duration exercise
STRETCHING ALIGNS THE COLLAGEN Cryogenic-thermogenic therapy? Ultrasonography? Laser? Electricity causes increase in fibroblast electricity? |
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What are the treatment implications of the healing stage for microtrauma including remodeling/maturation?
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strengthening exercises
increase in intensity and duration eccentric exercises to further stimulate collagen alignment |
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Not about the general steps of healing of tendon microtrauma pathology was?
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Almost all body tissues follow this paradigm of healing only with a different time frame
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Effects of immobilization on injured tendinous tissue
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Protein degradation exceeds protein synthesis causing a net decrease in collagen quantity
Reduction in the number of collagen crosslink bonds Atrophy of tissues at myotendinous (muscle-tendon) junction -2% loss of total collagen mass at 9 weeks, 27% loss at 12 weeks |
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Benefits of mobilization (movement) on injured tendinous tissue
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Greater cross-sectional area of the healed tendon
Improvement in collagen fiber type and fiber arrangement in the replacement Greater number of crosslink bonds Better quality of ground substance in the tendon |
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Collagen Type I
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most abundant type for humans
has the highest tensile strength of the 3 types, and is in tendons, muscle endomysium, fibrocartilage, bone, "final" scars |
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Collagen Type II
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found in hyaline cartilage
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Collagen Type III
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found in granulation tissue, reticular tissue, and basement membranes
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Common Therapies for Tendon Microtrauma
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NSAID drugs
Corticosteroids Surgery |
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How are NSAID drugs used as a therapy for tendon microtrauma?
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Previous reviews conclude approximately 73% of studies show NSAID's to be effective
They decrease healing time and decrease inflammation Other, more recent studies show NO MEASURABLE BENEFIT OF NSAIDs Note: approx. half of those using NSAIDs will have adverse side effects |
