Stages of the healing process: BIP-R

BLEEDING

INFLAMMATION

PROLIFERATION

REMODELLING

These stages are NOT mutually exclusive (they don't just happen one at a time individually) they overlap!

Soft Tissue Wound Healing

"Wound healing refers to the body's replacement of destroyed tissue by living tissue"

2 essential components (REG & REP)

• Specialised tissue is replaced by proliferation of surrounding undamaged specialised cells

• L.T replaced by G.T which matures to form S.T


• Lost tissue is replaced by granulation tissue which matures to form scar tissue
  
  

Factors known to delay healing

GENERAL

Steroids & NSAIDS

Temperature (lower rate when colder)

Protein Deficiency


Age

LOCAL

• Poor blood supply / ischaemia
• Adhesion to bone or other underlying tissue
• Continued inflammation
• Drying of wound
• Excessive movement (restarts inflammation)

"Tissue healing is a complex and dynamic system which enables effective repair of damaged tissue."

Connective Tissue

Most abundant tissue in the body (ABUNDANCE)

Derived from the mesoderm of embryonic tissue (MESODERM)

Help to bind and support other tissues (BIND & SUPPORT)

Relatively few cells (NOT MANY CELLS)

Several types (BBLDC) Bone, Blood, Loose, Dense, Cartilage

Leukocytes - Soldiers of the body

NEUTROPHIL

• Most common type of leukocyte



• Involved with degradation of foreign material through phagocytosis



• Contain multiobed nucleus



• Cytoplasm grainy in appearance due to high number of lysosomes (digestive enzymes)



• Grows around foreign matter, lysosomes help digest foreign body and then it's removed



• Duty to defend using lysosomes to digest



• On a constant patrol, destroying harmful things in the body

MACROPHAGE (monocytes)

• Destroy bacteria through phagocytosis


• Larger in size than neutrophils


• Found in LUNGS and LYMPH NODES (first line of defence)


• Creates hostile environment for bacteria so that it si harder to get ill (causes sore throat etc)

LYMPHOCYTES (B & T)

• B lymphocytes secrete antibodies which destroy bacteria


• T lymphocytes are involved in cell destruction


• Some specialised lymphocytes go into cell to destroy it, others send antibodies out

BLOOD

BLOOD - A liquid connective tissue used for:

1. TRANSPORT: respiratory gases (oxygen/carbon dioxide, nitrogen), nutrients, waste products

2. DEFENCE: provides cells for clotting and antibodies to fight infection

3. TEMPERATURE REGULATION (distributes heat)

4. PRESSURE (provides pressure)

Hematoma

Hematoma in acute stage - 6 days after injury

HEMATOMA - Internal bleeding (a collection of blood outside the blood vessels)

Usually the result of a hemorrhage (loss or escape of blood from the circulatory system - bleeding!)

Phagocytosis

Products of PHAGOCYTOSIS along with plasma and blood cells form EXUDATES*

(any fluid that filters from circulatory system into lesions or areas of inflammation*)

Exudates accumulate causing SWELLING (tumor) and PAIN (dolor)

Exudates are composed of serous fluid, red blood cells, fibrinogen OR tissue debris and white blood cell breakdown products

APOPTOSIS

Programmed cell death

(as opposed to necrosis = uncontrolled cell death)

Normal Ranges of Movement

Hip Flexion: 120 degrees
Hip Extension: 15 degrees
Hip Abduction: 50 degrees

Inversion: 45 degrees
Eversion: 20 degrees

Knee Flexion: 130 degrees

Cross Fit WOD 13/12/09

Buy in

500m row
10 pull ups x 2
10 push ups x 2
10 sit ups x 2
10 squats x 2

Skill

Weighted pull ups

3-3-3-3 (12kg)

Weighted muscle up

1 (12kg)

'Helen'

3 rounds: 400m run, 21 kb OHS (24kg), 12 pull ups

Proprioceptive exercises

Good proprioception (awareness of limb position in space and time) is essential for all tasks, whether complex or simple. Picking up the remote to watch TV or doing a single leg squat on a BOSU all require varying degrees of proprioception or neuromuscular control. Essentially proprioception is this relationship between the neurological system and the muscular system and any injuries that occur e.g. trauma can cause a disruption between the the communication of these two systems. Sensory (afferent) feedback is interupted (like your Mum asking you to do the washing up when you're on the phone) and this has reprecussions on motor control (you drop the phone!)

5 ways to progress proprioceptive exercises!

1. REMOVING VISUAL STIMULI

2. ALTERING BASE OF SUPPORT

3. INCREASING WEIGHT BEARING

4. INCREASING SPEED

5. MAKING AN EXERCISE MORE COMPLEX (e.g. adding pertubation)

Proprioceptors

Ruffini end Organs

(slowly adapting)

Monitor position of limb in space

Pacinian Corpuscles

(slowly adapting)

Detection of acceleration/deceleration or sudden mechanoreceptor deformation

Mechanoreceptors !

MECHANORECEPTORS: Any sensory nerve ending that responds to mechanical stimuli e.g touch, pressure, displacement, sound ...

Sag Sign

Sag sign looks at the contour of the tibial tubercles. A rupture of the PCL will cause tibia to sag back (from the force of gravity alone). Sag sign is good to do before a PA drawer test because this can produce false positive results (the excessive anterior translation would just be pulling the tibia to neutral)

Lachman's Test (modified PA drawer)

Lachman's Test is a modified PA drawer test looking for a rupture in the anterior cruciate ligament (ACL). The modification in position stops the patient's hamstrings from resisting the movement.

Rectus Femoris (Has 2 heads)

Rectus Femoris has 2 heads: straight (originating from the AIIS) & reflected (originating from ilium just superior to acetabulum)

The tendons of origin combine to form a FUSIFORM muscle belly!

Cross Fit 9/12/09

GOALS

- 30 kettlebell swings (32kg)
- 3 consecutive muscle ups (DONE! 4 ring muscle ups in a row)
- 30 muscle ups for time in 12 minutes
- Back squat 3 rep max above 100kg (DONE! 102.5 kg)
- 2 consecutive bar muscle ups

Today worked on acrobatics, muscle ups, kettlebell swings, handstand push ups, K2E, and back squats.

Was happy with everything but back squat needs work, tech for muscle ups in a row needs some practice to make it efficient. Good sesh!

Contraindications to ICE

• The elderly
• Circulatory Problems
• Radiotherapy/chemotherapy
• Raynaud's Disease
• Diabetes
• Hypersensitivity
• Cardiac Problems

*Raynaud's disease is a vascular disorder which effects blood flow to the extremities (toes,nose,fingers,ears) when exposed to cold temperatures or psychological stress.

*The elderly: skin is thin and risk of ice burns

*Diabetes: blood becomes viscous, ice will force thick blood though a small vein

MOVE THE ICE TO THE LIMB NOT THE LIMB TO THE ICE!

USE A BARRIER BETWEEN ICE AND SKIN TO PREVENT BURNS!

REGULARLY MONITOR BODY FOR EXCESSIVE CIRCULATION LOSS!

DURATION OF TREATMENT SHOULD MATCH SIZE OF AREA BEING TREATED!

Should be 10-20 minutes every 2 waking hours over the acute and sub-actute stages until demand no longer necessary

Mobilisation

What is mobilisation?

Slow, controlled, preferably unloaded movement of a joint through a full ROM (pain free) in all available planes of motion.

Mobilisation will improve/maintain mobility of a joint

Remember: Psychologically people might refrain from certain movements because it has hurt them in the past. Passive movements can promote confidence and encourage them to start moving the joint again :)

Contraindications to joint mobility work:

• Pain
• Heat/inflammation (swelling)
• Recent unstable fractures
• Neurological symptoms (spasms, numbness, pins & needles, dead shoulder = nerve impingment)
• Mechanical blocks (e.g. bursas trapped under acromion head)

Energy Expenditure

10% exercise
20% lifestyle (or physical activity)
70% RMR (resting metabolic rate)

Cross Fit WOD 03/12/09 Muscle Ups

WOD: 30 ring muscle ups for time

Jay - 13.49

My target for next time is 12 mins or under. I found with this that muscle fatigue and rate of recovery plays such a big role. To begin with I was getting out 5 reps at a time quite quickly but then it got to a point where after one rep my arms would just not get me up! The dip and the lock out where the most demanding parts. Keeping good form and technique helped A LOT! I was glad I'd watched a vid on tech before I headed down to the gym. Aside from that for a first stab at it I don't think I did too bad at all. The dip is the part that needs work :)

Gluteus Maximus

ORIGIN - Iliac crest, sacrum and coccyx

INSERTION - Upper Posterior femur and ITB

ACTION - Extension of the hip and lateral rotation of the hip

75% inserts into ITB

25% inserts into posterior femur

Function of the Patella

"The patella is a BIOMECHANICAL PULLEY THAT IMPROVES THE EFFICIENCY OF THE QUADRICEPS TENDON"

CROSS Fit WOD 2/12/09

CROSS FIT TOTAL!

3 rep max training:

Power Clean - 70kg
Shoulder Press 50kg (2.5 reps 55kg)
Deadlift - 155kg PB

Bones of the Foot

7 tarsal bones (only talus articulates with the leg bones)

5 metatarsals which articulate proximally with the tarsals and distally with the phalanges.

The hallux (big toe) has only 2 phalanges (the rest have 3) = 14 phalanges in total

The trochlea of the talus articulates with the tibia and fibula

The head of the talus articulates with the navicular bone

The calcaneus articulates with the talus superiorly and the cuboid anteriorly

Talus is like a snail!

Grades of sPrains

SPRAIN

"If it's got a 'P' it's a ligament injury"

Grade 1 - Some tenderness and minor pain at the point of injury. This indicates small tears in the ligament

Grade 2 - Noticeable laxity in the knee, major pain and tenderness on the inside of knee as well as swelling. Indicates larger tears in the ligament but not a complete rupture

Grade 3 - Considerable pain/tenderness, some swelling, marked laxity/instability of the joint. Ligament is completely torn/ruptured

LCL what you know about lateral collateral ligament?

Originates from - Lateral epicondyle of the femur

Inserts into - Head of fibula

Length - 5cm

Shape - Cord like structure and more circular in diameter (due to the pointy shape of head of fib it's necessary)

Limits - Varus stress on the knee

ELITE

ENVIRONMENT

LOAD

INDIVIDUAL

TASK

EQUIPMENT

Myostatitc Contracture

'True Muscle Shortening' - Number of sarcomeres in a row will reduce due to inactivity

End Feels

Soft End feel = Related to soft tissue approximation (e.g. muscles)

Elastic End feel = Related to stretching of joint capsule and ligamentous structures

Hard = Related to bony block

Empty = No end feel detected because the patient does not allow movement to end of range