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Early Inflammation: INTERVENTION
- Goal: limt/curtail inflammatory response, treat pain, effusion, immobilization.
- 1. control pain and swelling
- 2. Injury protection
- 3. modalities and meds
- 4. gentle soft tissue mobz, to reduce pain, guarding, edema
- 5. Gentle passive movements
- 6. CMP w/in pain fre raing; no stretching
- 7. posssible Grade 1 oscillatory techniques
- 8. muscle setting
- 9. no pain or inflammation
Intermediat stage of Inflammation: Characteristics
- Sub Acute: 4-14 days Repair & Healing
- 1. removal of noxious stimuli
- 2. growth of capillary beds into area
- 3. collagen proliferation
- 4. muscle strenght is decreased 2nd to immobilization, inhibited by pain & joint effusion leading to atrophy.
Intermediate stage of Inflammation: Clinical Signs
- 1. Decrease inflammation
- 2. Pain- intermittent, felt during movement, synchornous w/ motion barrier, porximal -> distal w/ repeated movements.
- 3. Motion Barrier: Muscular (fast-slow garding)
Intermediate stage of Inflammation: Intervention
- 1. Pain contorl: meds as needed
- 2. gentle movement (low grade mobz 1-2)
- 3. AROM/PROM in pain free range
Intermediate stages of Inflammation: Inert Tissues
no stretching of joint capsule if effusion is present.
can begin gnetle capsular stretching and joint mobz.
Intermediate stages of Inflammation: Contractile Tissue
- 1. begin isometric resistance exercises
- 2. begin gentle stretching techniques
- 3. gentle transverse friction massage
- 4. Muscle Tears: develope mobile scar and parallel alignment of CT
- 5. Tendon Lesions: promote parallel alignment of collagen fibers.
Intermediate stages of Inflammation: Precautions
some discomfot will occur w/ exercise during this stage, but it should not alst longer than couple hours
Intermediate stages of Inflammation: Signs and Symptoms of Excessive Activivty
- 1. prolonged pain
- 2. pain with rest
- 3. increse in swelling, heat, stiffness, or weakness
- 4. muscle guarding
- *Activitiy levle must be decreased if these signs occur.
Late stages of Inflammation: Characteristics
- Chornic: 14-21 days until there is pain free functional use; Maturation and Remodeling.
- 1. maturation of CT
- 2. contracture of scar tissue
- 3. appropriate stressin of collagen = parallel fibe alingment and improved proliferation of elastin.
Late stages of Inflammation: Clinical Signs
1. absense of inflammatory signs & symptoms
Late stages of Inflammation: Pain
- 1. not severe
- 2. proximal location
- 3. only felt w/ forceful movements
- 4. felt after motoin barrier (overpressure)
Late stages of Inflammation: Motion Barrier
Late stages of Inflammation: Intervention
- 1. vigorous soft tissue, joint mobz (grades 3-4), stretcheing
- 2. decreased ROM: isometirc exercises at various ranges to maintain/imporve strength
- 3. adequate ROM: progressive strengthening, endurance, and functional exercises
Late stages of Inflammation: Inert Tissue
vigorous capsular stretching and joint mobz if joint play is restricted and no effusion
Late stages of Inflammation: Contractile Tissues
Dynamic Resistance exercisese (eccentric): Parallel scar tissue increase tensile strength, and increases PSCA which results in decreased stress on injury site.
Maitland describes the irritability of a disorder as:
- 1. its susceptibility to becom painful
- 2. how painful it becomes
- 3. the lenght of time this pain takes to recover
PROM: High Irritability/Reactivity
- 1. Pain b4 motin barrier.
- 2. empty or muscular end feel (fast guarding)
PROM: Moderate Irritability / Reactivity
- 1. pain synchronous with motion barrier
- 2. muscualr end feel ( fast-slow guarding)
PROM: Low Irritability/Reactivity
- 1. pain felt after motion barrier (overpressure)
- 2. capsular (firm) end feel
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