physiotherapy: midterm review part I

here are questions and answers from the first 60 pages of material from the physiotherapy textbook, covering introduction to tissue repair, thermotherapy, and cryotherapy.

questions
tissue injury and repair part I (p. 4)...
1. what are the three phases of tissue injury and repair?
2. how long does the acute inflammatory phase usually last?
3. what are the hallmarks of the acute inflammatory phase?
4. what is the end of the first phase of tissue injury and repair signaled by and what does it do?
5. what are the clinical objectives of the first phase?

phase 2, repair phase (p.7)...
6. how long after injury does the repair phase start and how long does it typically last?
7. what are the hallmarks of this phase?
8. describe the quality and orientation of the collagen that is deposited in this phase.
9. what is fibroplasia?
10. what are the clinical objectives while treating a patient in this phase?
11. how long after injury does contraction of the scar start and how long may it take?

phase 3, remodeling phase (p. 9)...
12. what is the timeframe of this phase?
13. what are the hallmarks of this phase?
14. what are the clinical objectives of this phase?

ligament injury (p.13)...
15. what is a "first degree" ligament injury?
16. what is a "second degree" ligament injury?
17. what is a "third degree" ligament injury?
18. what are the times for recovery for first, second, third degree muscle strains?
19. tendonitis grade I.
20. tendonitis grade II.
21. tendonitis grade III.
22. tendonitis grade IV.
23. tendonitis grade V.

thermotherapy (p.16)...
24. what is the therapeutic temperature range?
24b. what is normal skin temperature range?
25. what are the mechanisms for heat transmission in thermotherapy?
26. what are examples of radiation and conversion?
27. what is the distinction between superficial and deep heat?
28. which methods of heat transmission are better suited to heating tissue deeply?
29. what are thermotherapy's effects on metabolism?
30. what are thermotherapy's effects hemodynamically?
31. what is erythema ab igne?
32. what is the effect of thermotherapy on the muscles?
33. how much does the heart rate rise in response to every 1 degree rise in body temperature?
34. what is the temperature law of van't-hoff?
35. what are some systemic conditions for which thermotherapy would be appropriate for?
36. what are some contraindications for thermotherapy?
37. what is the temperature range for hot packs?
38. what is the temperature range for home heat wraps?
39. what is the temperature range for paraffin baths?
40. what are some conditions which are particularly indicated for paraffin baths?

cryotherapy (p. 38)...
41. what are the two mechanisms of cryotherapy?
42. what are cryotherapy's effects on hemodynamics?
43. what are the vascular effects of cryotherapy?
44. what are the metabolic effects of cryotherapy?
45. what are the muscular effects of cryotherapy?
46. what is the hunting response?
47. what are some contraindications for cryotherapy?
48. what is the duration and frequency of cold application in cryotherapy?
49. how soon after injury should cryotherapy ideally be applied?
50. what is the temperature range of an ice pack?
51. what are the four stages of reaction from ice massage?
52. what is the "cryokinetics" technique?
53. what is a potential argument against the merits of contrast hot/cold cryotherapy?
54. what are some indications for passive contrast hot/cold therapy?
55. what are some indications for active contrast hot/cold therapy?
56. what is the generally accepted ratio for time of application of hot / cold in contrast hot/cold therapy?

answers
1. acute inflammatory, repair, remodeling.
2. anywhere from 2-72 hours.
3. changes in vascular flow, permeability, edema, cellular changes.
4. fibrinolysin signals the end, opens the lymph channels to begin wound healing.
5. pain relief
vasoconstriction
increase circulation
maintain muscle tone and range of motion
[pain, circulation, movement]
[constrain the pain of bloody muscles]

6. 24 hours after, lasts 2 days to 6 weeks.
7. collagen deposition, removal of cell debris, fibroplasia.
8. not fully oriented in direction of tensile strength, inferior to original in terms of integrity.
9. the contracting of a wound by the action of myofibroblasts.
10. prevent adhesions
orient repair tissue
pain relief
muscle tone and movement.
[orient collagen, prevent adhesions]
11. 4 days, 6 months.

12. 3 weeks to a year.
13. reorientation of collagen for more effective resistance of tensile forces.
14. proper alignment
elasticity
break down adhesions
relieve spasms
increase strength and ROM

15. an injury that has little noticeable signs, minimal functional loss, recovery within 2 weeks.
16. an injury that results with significant structural weakening, tends to recur, may need immobilization, and may take 2-3 months to recover fully.
17. a severe injury that causes a loss of structural integrity, needs prolonged protection or surgery, and will only recover to 50-80% in 1-6 months.
18. 2-20, 20-90, 50-180.
19. pain only with activity, does not interfere.
20. same, but localized instead of generalized tenderness.
21. interferes with activity, but disappears after.
22. same, but doesn't disappear and more severe.
23. interferes with ADL's, chronic/recurrent, altered tissue/muscle.

24. 104-113F.
24b. 82-90F.
25. conduction, convection, radiation, conversion.
26. radiation: infrared light. conversion: ultrasound, diathermy.
27. less than or greater than 1cm into the tissues.
28. diathermy or ultrasound.
29. increased enzymatic activity, O2 consumption, phagocytosis, metabolite clearing.
30. increased capillary pressure and permeability increases fluid, nutrient exchange.
31. mottled pigmentation of skin that may result from excess application of superficial heat- might be from destroyed RBC's or permanently dilated arterioles.
32. no change in muscular blood flow, but marked relaxation via inhibition of muscle spindles.
33. 10bpm.
34. for every 18F increase in body temperature, metabolism increases 2-3 times.
35. polio, GBS, polyneuropathy, collagen vascular disease.
36. malignancies, thrombophlebitis, hemorrhage, over gonads.
37. 165-170F.
38. 104-154F.
39. 124-129F.
40. non-acute RA, osteoarthritis, raynaud's, dupuytren's.

41. conduction, evaporation.
42. decreased temperature, increased viscosity leads to decreased blood flow, decreased histamine release.
43. a sympathetic mediated reflex vasoconstriction leading to decreased capillary pressure and edema.
44. decreased metabolic rate: decreased oxygen requirement, tissue damage, edema.
45. decreased spasm, viscosity, tensile strength, increased connective tissue strength and isometric muscle strength.
46. bursts of alternating vasoconstriction and vasodilation after 10-15 minutes of extreme cooling of tissues.
47. cold hives, raynaud's, cryoblobulinemia, paroxysmal cold hemoglobinuria.
48. 20 minutes on, 2 hours off.
49. within 5 minutes.
50. 23-32F.
51. CBAN: intense Cold, Burning pain, Aching, Numbness.
52. repeated cold application to the point of numbness followed by voluntary activity/stretching in order to enhance rehabilitation and shorten recovery time.
53. some studies suggest that contrast hydrotherapy is only effective in superficial tissues.
54. chronic inflammatory conditions, sinus/congestive headaches.
55. arthritis, sprains, strains, venous congestion.
56. 4:2 hot:cold.