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pain and healing - Coggle Diagram

- - - - Adelta and c fibres synapse at the same location as Abeta fibres in the spinal column
        
        descending pathways close the "gate" and diminish pain perception
      - stimulate A beta
        
        touch and pressure
        
        massage
        
        heat
        
        mobilisations
    - - endorphin pain control
        
        released when there is pain
        
        act on C fibres
        
        A delta suppress C system via descending efferent inhibition
        
        TENs
        shockwave
        dry needeling
  - - - spinal cord
        
        neurons at, above and below the segment they enter at
        
        spinothalamic tract
        
        cerebrum
  - - - mechnothermal (A delta)
        
        heat
      - polymodal (C fibres)
        
        pain and discomfort
        
        slow
        longer lasting
        dull
        diffuse
        throbbing
      - mechanisesitive (A delta)
        
        pain, touch, pressure
        
        sharp
        localised
        perceived at time of injury
- - - - time frame
        
        usually 6-8hours up to 48hours
      - subjective
        
        pain
        discolouration
      - objective
        
        discoloration and pain
      - treatment/goals
        
        reduce pain
      - process
        
        inflow of blood by damaged vasculature
        
        degree dependent on
        
        1) nature of tissue - consider vasculature
        
        2) nature of injury e.g strain vs strain
      - initiated next phase via mediators (mast cells, platelets basophils etc.)
    - - time
        
        1-3 day and last weeks
      - process
        
        2 responses
        
        vascular
        
        cellular
        
        mediators
        
        increase :
        
        vasodilation/vasopermeability
        
        blood flow and exudate
        
        oedema
        
        attract phagocytes--> debris clearance
        
        lactic acid production
        
        1 more item...
      - subjective
        
        pain at rest with activity
        stiffness post rest
        irritable
      - treatment
        
        manage swelling
        
        allow 24-72hours of response to initiate healing prior to NSAIDS
        
        reduce aggravation of inflam response
        
        reduce pain
        
        no friction
        
        compression
        tape
        elevation
        massage
        rest
        gentle massage
      - objective
        
        heat
        swelling
        bruising
        altered ROM
        pain or soft end feel
    - - time
        
        commences at 2-3 days of injury - 2-3 weeks to reach peak. lasts up to a month
        
        depends on
        
        co-morbidities
        injury
        management of recovering tissue
      - process
        
        fibroplasia
        
        fibrin network
        
        collagen 3 laid down
        
        myofibroblast
        
        wound contracture
        
        angiogenesis
        
        capillary infil
        
        increase 02
        
        assist with collagen production
        
        increase blood supply
      - subjective
        
        decreasing
        
        symtoms
        
        stiffness
        
        irritability
      - objective
        
        reduced oedema
        notmal temp on palpation
        pain with stretch/contract or palpation
        no stiffness through range
        end-feel- increasing
      - treatment
        
        reduce pain
        stimulate fibroplasia
        stimulate angiogenesis
        reduce secondary problems
        
        EPA
        exercise
        manual therapy
        increase bloody flow
    - - time
        
        weeks up to a year
      - process
        
        reorganisation of collagen fibres
        
        reabsorption of type 3 collagen collagen fibres laid down
        
        replacement with collagen 1
        
        increased crosslinks and tensile strength
      - subjective
        
        nil resting pain
        nil irritability
        pain with activity or posture
        loss of function rather than stiffness
      - objective
        
        full ROM
        no swelling
        may have reduced proprioception and strength
        firm palpation
        pain with stretch/contract or plapation
      - treatment
        
        functional return
        
        consistent loading
        
        HEP:
        
        flexibility
        
        strength
        
        endurance
        
        neuromuscular control
        
        proprioception
        
        stimulate replacement fo type 3 with type 1 collogen