KNES 315 Exam 2

What are the physiological effects of appropriate movement? (4)

1. Encourages venous return 2. Encourages edema resorption 3. Encourages phagocytosis 4. Prevents contractures and loss of ROM

What do leukocytes do initially?

Margination/Pavementing: line up around damaged area

What are the 4 steps when dealing with open wounds?

-Follow universal precautions & infection control standards 1. Control bleeding : direct pressure & elevation, if not effective use indirect pressure and target the arteries 2. Clean 3. Determine whether emergency care is required 4. Dress the wound

Describe Repair phase by 2-4 weeks

-Increase in tensile strength combined with decrease in vascularity -recession of capillaries and fibroblasts

Describe maturation phase (4 things)

-continued recession of fibroblasts and capillaries -initial haphazard formation goes through modification -slow realignment of collagen fibers -oriented to lines of stress

What is vasoconstriction and how long does it last?

-few seconds- 10 minutes - marks the beginning of coagulation and initiates clotting -broken blood vessels to seal off - primary injury zone- are injured tissue prior to vasodilation

Describe Repair phase by 6-8 weeks

-relatively less tensile strength (30% less) than normal healthy tissue and less functional -shortening of tissue yielding a decrease in flexibility

Forms of cold application (3)

1. Bag 2. Bath 3. Massage

What does compression do? (2)

1. Controls edema formation 2. Decreases swelling by promoting fluid resorption

What does elevation do? (2)

1. Decreases capillary pressure (decreases bleeding) 2. Decreases swelling

What are the 5 expectations of the Coach in regards to soft tissue wound management?

1. Evaluate 2. Assess severity 3. Recognize life-threatening conditions 4. Provide immediate care 5. Initiate procedures for on-going management

How long is each phase?

1. Inflammatory - 0-6 days 2. Repair- occurs 3 days following injury and can last 6-8 weeks 3. Maturation- up to 1+ years

What are the 3 phases of the healing process?

1. Inflammatory Phase 2. Repair/Proliferative 3. Maturation

What are the stages of cold sensation?

1. Initial cold sensation (0-3 min) 2. Burning and aching (2-7 min) 3. Numbing sensation (5-12 min)

What are the 4 options available to the coach when findings have been determined?

1. No physician referral 2. Physician referral 3. Immediate physician referral 4. Summon EMS

When developing the Emergency Plan where are the 4 inputs you should get?

1. Personnel at the facility 2. Higher authorities 3. Medical personnel 4. Legal personnel

What are the areas to address? (7)

1. Population being served 2. potential injuries/conditions 3. personnel 4. availability of medical/first aid equipment 5. Facility access 6. Communication 7. Documentation

What is vasodilation?

1. Slows blood flow and increases blood viscosity(thickness) 2. Releases chemicals to increase swelling and increase capillary permeability

What are the physiological effects of cold (7)

1. Vasoconstriction 2. Decreased tissue temperature 3. Decreased metabolism 4. Decreased edema 5. Decreased muscle spasms 6. Analgesic(reduces pain; Anasthetic (numbs area) 7. Increases collagen viscosity

What are the 5 things that happen during the inflammatory phase?

1. Vasoconstriction 2. Vasodilation 3. Edema... swelling 4. Fibrin 5. Phagocytosis

What are the physiological effects of heat? (9)

1. Vasodilation 2. Increased tissue temperature 3. Increased metabolism 4. Increased capillary permeability 5. Increased inflammation 6. Increased blood flow 7. increased joint stiffness 8. Decreased muscle spasm 9. Analgesic 10. Increased collagen extensibility

3. An individual sustains an open wound that results in bleeding. Explain the management of this condition.

1.) Control bleeding -Application of direct pressure using gauze pads to promote clotting -elevate wound to position above heart to slow blood flow 2.) clean wound with saline rinse or water to ensure removal of debris

12. You are a fitness specialist. A 35 year old client comes to a training session having sustained a grade II hamstring strain one week earlier. He is very inquisitive and asks you to explain what is taking place at the injured site. How would you explain the healing process to your client in a manner that makes sense to him?

1st inflammation takes place, blood flows to site of injury. Edema (swelling) and pooling of blood take place 0-6 days, blood starts to clot. WBC move to area and begin removing cellular debris. Repair phase begins 3 days after injury and lasts 3-8 weeks. fibroblasts start laying down collagen after hematoma reduces size to allow for tissue growth. Increase of blood flow to area, and initial scar formation

How long should cold be applied?

20 minutes on/ 1 hour off

The tensile strength of a wound 6-8 weeks post-injury is approximately ___ % of normal.

30%

What temperature should cold be?

55-60 degrees

18. In developing an emergency plan, several areas must be addressed, including I. Population being served II. Potential injuries/ conditions III. Personnel IV. Availability of medical/ first aid equipment V. Communication VI. Documentation A. All of the above B. II, III and IV C. I, II, and III D. III, IV, V, and VI

A. All of the above

12. An individual sustained a grade 2 ankle sprain during a 6:00am workout. Which of the following movements would be appropriate for the individual to perform that evening? A. Wiggling the toes and gently flexing/ extending the ankle B. Walking in a straight line C. Light resistance activities involving the foot and ankle D. Movement should not be permitted until 72 hours after the injury

A. Wiggling the toes and gently flexing/ extending the ankle

6. The repair phase of healing includes which of the following processes? I) phagocytosis II) angiogenisis III) fibrous tissue formation IV) wound contraction V) decreased fibroblast activity A. All of the above B. I, II, and III C. II, III, and IV D. II, IV, and V

A. all of the above

5. Phagocytosis refers to A. the ingestion of cellular debris and waste products B. the development of the secondary injury zone C. onset of vasodilation D. the release of mast cells

A. the ingestion of cellular debris and waste products

When can movement be initiated in the Inflammatory phase?

As soon as bleeding stops

5. Which of the following statements is true? A. A compression wrap should be applied in a proximal to distal direction. B. A compression wrap should be applied in a distal to proximal direction. C. A patient should not feel any firmness from a compression wrap. D. A wet compression wrap is contraindicated in managing an acute injury.

B. A compression wrap should be applied in a distal to proximal direction.

15. Following an acute soft tissue injury, the application of superficial heat during the inflammatory phase of healing can be beneficial as a means for increasing blood to the area. A. True B. False

B. False

16. In managing an acute injury, the options available to the coach should include I. Standard acute care with no physician referral, but providing the individual with a written instruction sheet II. Standard acute care with physician referral prior to return to activity III. Standard acute care with immediate physician referral IV. Summon EMS A. All of the above B. II, III and IV C. I, II, and III D. III and IV

B. II, III and IV

14. An individual sustains a grade 2 contusion to the quadriceps. Two days after the injury, which of the following would be most advantageous? A. Ice bag B. Ice cup (massage) C. Moist heat

B. Ice cup (massage)

19. The best method for controlling bleeding of an open wound is A. indirect pressure B. direct pressure C. application of cold D. application of heat

B. direct pressure

4. The application of a compression following an acute soft tissue injury can A. decrease tissue metabolism B. reduce the space available for fluid seepage C. encourage phagocytosis D. prevent pooling of blood in the extremities

B. reduce the space available for fluid seepage

3. In the immediate management of a muscle strain, cold should be applied A. for 60 minutes, followed by repeated applications of 20 minutes on and 1 hour off B. repeatedly for 20 minutes on and 1 hour off C. repeatedly for 15 minutes on and 15 minutes off D. repeatedly for 1 hour on and 20 minutes off

B. repeatedly for 20 minutes on and 1 hour off

rest\restricted activity? what's the key?

Balance between safe and protection Key to rest/restricted activity is MOVEMENT

What is a hematoma?

Blood from broken blood vessels and damaged tissues

7. The tensile strength of a wound 6-8 weeks post-injury is approximately ___ % of normal. A. 30 B. 40 C. 50 D. 60

C. 50%

1. Which of the following is the appropriate temperature for a cold bath? A. 45-50 degrees B. 50-55 degrees C. 55-60 degrees D. 60-65 degrees

C. 55-60 degrees

13. Which of the following is a potentially "good" or advantageous physiological effect of heat? A. Analgesic B. Decrease in collagen viscosity C. Increase in blood flow D. Vasoconstriction

C. Increase in blood flow

2. The beginning of the acute inflammatory phase of healing involves processes which A. Produce scar tissue at the wound site B. Act to stop blood loss from the wound C. Increase the flow of blood to the wound area D. Promote vasodilation

C. Increase the flow of blood to the wound area

10. Which of the following are physiological effects of application of heat? A. Vasodilation; increased blood flow/ increased muscle spasm B. Vasoconstriction; increased capillary permeability; increased collagen extensibility C. Increased blood flow; decreased joint stiffness; increased collagen extensibility D. Vasodilation; anesthetic; increased tissue temperature

C. Increased blood flow; decreased joint stiffness; increased collagen extensibility

11. During the inflammatory phase of healing, which of the following is an advantage of movement? A. It establishes the lines of stress B. It directs the placement of collagen C. It encourages venous return D. It decreases the space available for fluid seepage.

C. It encourages venous return

17. Which of the following statements is true? A. In developing the emergency plan, the plan should be limited to emergency conditions. It does not need to address injuries that are mild or moderate. B. One single emergency plan should be able to satisfy the needs of every institution. C. The emergency plan should be a written document that is comprehensive, yet flexible enough to adapt to any emergency situation at any activity venue. D. An emergency plan is a well-developed process that defines the policies and procedures to be used in the management of an acute injury to a participant. The plan does not need to be put into writing.

C. The emergency plan should be a written document that is comprehensive, yet flexible enough to adapt to any emergency situation at any activity venue.

7. In the management of an acute injury, a compression wrap should be worn A. 20 minutes on and 1 hour off throughout the time that the individual is awake B. constantly throughout the time that the individual is awake C. constantly throughout the time that the individual is awake and asleep D. 1 hour on and 20 minutes off throughout the time that the individual is awake

C. constantly throughout the time that the individual is awake and asleep

2. The stage of cold sensation that includes a burning and aching feeling occurs A. from the onset of the application of the cold and lasts for approximately 3 minutes B. from the onset of the application of the cold and lasts for approximately 5 minutes C. from approximately 2 minutes after the application of the cold and lasts for approximately 7 minutes D. from approximately 10 minutes after the application of the cold and lasts for approximately 10 minutes

C. from approximately 2 minutes after the application of the cold and lasts for approximately 7 minutes

1. Hypoxia refers to the A. the death of living cells B. the destruction of tissue C. the disruption of oxygen supply D. inflammation

C. the disruption of oxygen supply

What is the role of the fibrin network?

Contain area, form blood clot

8. Elevation of an injured site can A. reduce the space available for fluid seepage B. encourage fluid absorption C. decrease tissue metabolism D. decrease capillary pressure

D. decrease capillary pressure

Why is movement important to fibroblasts?

Essential to normal wound healing and pathological matrix deposition in fibrosis

Effects of movement during the repair phase?

Establishes lines of stress; directs optimal placement of collagen rather than haphazard or unorganized

6. In the management of an acute soft tissue injury, protected rest means cessation (stopping) of all physical activity involving the injured area. A. True B. False

False

9. True or False? Local factors at the site of a wound can delay the healing process in comparison, systemic factors are not cause for concern as they cannot impede the healing process.

False

9. The application of cold is more important than the application a compression wrap in the management of an acute soft tissue injury. A. True B. False

False: both equally important

4. True or False? Ecchymosis is a fluid with high protein content and cellular debris that forms in the area of injury.

False: that is exudate

3. True or False? Neutrophils and macrophages are immature connective tissue cells released into the injured area by the exudate.

False; those are fibroblasts

Why is it important to understand the healing process?

For proper injury management

What type of movements should take place?

Gentle, controlled movements leading up to activities of daily living

Describe Repair phase 3 days after injury

Granulation tissue Fibroblasts- immature connective tissue cells; lay down collagen; initial scar formation Capillary Budding - ↑capillaries in area; ↑blood supply for healing

6. Explain the significance of granulation tissue in the repair phase of healing?

Granulation tissue: fibroblasts that come into the area and lay down collagen

5. Why should universal precautions be followed in the management of an open wound?

In the event that an individual is infected with a blood-born pathogen or an infectious disease

What is the purpose of capillary budding?

Increase blood supply to area

Beneficial effects of heat? When? How?

Increase in Blood Flow Decrease joint stiffness Decreases muscle spasm Analgesic: reduces pain Increase in collagen extensibility After bleeding stops/ after 72 hours. Deep extensive heat

3. One of your clients sustains an ankle sprain. You explain that an ice bag should be applied to the area. The individual has never had an (cold) treatment. What would you tell the individual to expect to feel (senastions) while the ice bag is applied?

Initial cold sensation for 0-3 minutes, burning aching sensation 2-7 minutes, numbing sensation for 5-12 minutes

Describe the healing tissue at the beginning and the end of the repair phase of the healing process.

Initial scar formation at beginning

What is the Emergency/Accident Plan?

It is a written document that defines policies and procedures to be used in the management of an acute injury. It shouldn't be limited to emergency conditions, comprehensive yet flexible, and no single plan works for everybody.

What happens after macrophages have done their job?

Leukocytes re-enter the blood stream

5. What is phagocytosis?

Leukocytes: surrounding wound, entering wound, ingesting cellular debris Neutrophils: eat bacteria Macrophages: eat neutrophils and cellular debris

4. In the process of cleansing an open wound, what conditions would require the coach to recommend immediate physician referral?

Life-threatening wounds uncontrolled bleeding inability to clean wound entirely requirement of stitches penetrating wound

What is diapedesis?

Movement of leukocytes into the injured area

What type of movement should take place in the repair phase?

Movement that increases in intensity and complexity

1. In developing an emergency plan for a fitness facility, what individuals should be involved in the process? Why?

Personnel at facility, higher authorities, medical personnel, rep. from EMS services, and legal personnel

2. In developing an emergency plan, what general areas should be addressed? Why?

Population served, location, potential injuries, facility access, availability of first aid, communication and documentation

How to apply elevation?

Raise the body part above the level of the heart

8. Describe scar tissue. What is the significance of movement in the remodeling phase?

Scar tissue is fibrous, inelastic, and nonvascular. Overall it is less strong and less functionable than original tissue

10. Identify five local factors (not systemic) that can delay the healing of a soft tissue injury.

Size of injury Extent of edema and hemorrhaging muscle spasm infection poor blood supply

7. Describe the strength of the healing tissue at 3-4 weeks post-injury and 3-4 months post-injury?

Strength of tissue 3-4 weeks: 25% of normal Strength 3-4 months post: 70%

What are the implication for that statement on dynamic vs static structures?

Stretch scar tissue if it involves a muscle but not a ligament. dynamic(muscle) Static( tissue)

Describe Repair phase day 4-5

There is weak, vascular connective tissue and low tensile strength.

8. True or False? The repair phase begins when the hematoma's size decreases enough to permit room for growth of new tissue.

True

How to apply a compression?

Use an elastic bandage that is snug but doesn't constrict. Also apply in the distal to proximal direction. Keep it on constant. Equally important as cold in the initial management of a soft tissue injury.

Physiological effects of cold

Vasoconstriction Decrease in Tissue Temperature Decreases metabolism Decreases edema Decreases muscle spasm Analgesic: reduces pain Anesthetic: causes numbness Increase collagen viscosity(or thickness)

What takes place during the acute inflammatory phase?

Vasoconstriction Vasodilation Phagocytosis

Physiological effects of heat

Vasodilation Increase tissue temperature Increase metabolism Increases capillary permeability Increases inflammation Increase in Blood Flow Decrease joint stiffness Decreases muscle spasm Analgesic: reduces pain Increase in collagen extensibility

Describe Edema

When large amounts of fluid and exudate go in the interstitial spaces. It increases capillary permeability and increases the osmotic pressure becoming a continuous cycle of increased swelling.

13. Can the actions of the coach, physical educator, and fitness specialist as the first responder to an acute soft tissue injury influence the primary or secondary injury zone? Why?

Yes it can, you can adjust local factors

cold application following an acute injury? physiological effects? how to apply? how long? what temperature?

analgesic, reduction in secondary hypoxia, capillary pressure decreased, inflammatory mediators inhibited First 72 hours after exercise 50-60 degrees

What is the primary injury zone?

area of injured tissue prior to vasodilation (unchangable)

concerns with immobilization (3)

atrophy, loss of strength, and decreased rate of healing if healing tissue is kept immobile, resultant repair is weak

What causes the repair phase to begin?

begins when the hematoma's size decreases enough to permit room for growth of new tissue

What are neutrophils and macrophages?

both are white blood cells neutrophils- destroy bacteria only. No value in a closed wound because there is no bacteria. macrophages- tolerate low oxygen conditions and ingest dead neutrophils and cellular debris

1. Why is the application of cold the appropriate course of action in the immediate management of an acute musculoskeletal injury (i.e., what are the physiological effects of cold)?

capillary permeability,

What is exudate?

cellular debris and protein

4. What is exudate?

cellular debris and proteins

compression application following an acute injury? physiological effects? how to apply? how long?

decreases hemorrhage, , reduces space available for seepage, and encourages fluid absorption distal to proximal application Worn through night and day

Muscle fibers during maturation/ remodeling phase

do not reproduce in response to injury but can regenerate some of the fibers .... As such, adhesions develop within the muscles ...inhibits muscle fiber regeneration....severe cases, may only regain 50% of pre-injury strength

4. Explain (in detail) the role of movement in the inflammatory phase of the healing process. (Make reference to the nature of the movement with regard to time and physiological responses.)

encourages venous return, encourages fluid resorption, encourages phagocytosis, and prevents contracture and loss of range of motion

What is the significance of movement in the remodeling phase?

fibroblasts need to know where to lay down the collagen --- movement provides natural tensions in the healing tissue, increasing strength

What is meant by hypoxic injury? What is necrosis?

hypoxic injury- disruption of oxygen supply Necrosis- cell death

11. You are a high school physical education teacher. A sophomore student comes to class on Monday using crutches, having sustained a 2nd degree ankle sprain. The inquisitive student asks you why she needs to be on crutches. Based on your understanding of the healing process, how would you respond to the student?

limiting the movement of injured area to control bleeding but also allows for movement for collagen fibers to be set AKA remodeling

ligaments and tendons during maturation/ remodeling phase

minimal repair cells .... As such, healing can take more than a year ..... significant tensile force can cause elongation of fibers .... In case of ligaments, this can be problematic --- lead to joint instability

elevation following an acute injury: physiological effects? how?

reduction in bleeding in area, encourages venous return, and prevention in blood pooling in extremities.

2. Why is the application of compression equally as important as the application of cold in the immediate management of a majority of acute soft tissue injuries?

reduction in subcutaneous temperatures

What are macrophages? What are neutrophils?

• Neutrophils: eat bacteria • Macrophages: eat cellular debris and neutrophils

What occurs as a result of vasodilation?

• Swelling (edema), hematoma (pooling of blood) • Release of chemicals ex: Heparin • Increase in capillary permeability • Increase in blood viscosity • Bleeding approximately 36 hours

What take place during the remodeling phase of the healing process?

• continued recession of fibroblasts • initial haphazard formation goes through modification o slow realignment of collagen fibers o oriented to lines of stress

What is the function of the fibroblasts?

lay down collagen, stabilization of wound site

Length of time for compression?

leave it on 24/7

What is necrosis?

Cell death

What is granulation tissue made out of?

Fibroblasts