Chapter 3: Acute Injury and Pain: A Strategy, Management, and Rehabilitation Discussion for Physical Therapists 3 CCUs
By: H. L. B. Prasadinie Learning objectives
Summarize both the subjective and objective signs of acute injuries, including the five signs of inflammation. Compare and contrast muscle strain, sprains, contusions, fractures, dislocations and subluxation. Discuss the primary objectives when managing acute injuries to help further the stages of the soft tissue injury healing process. Identify the components of the “SPRICEMMM” and the “HARM” technique and protocol, respectively. Course overview Millions of Americans suffer with pain every year. Pain – both chronic and acute – is quickly becoming an increasingly dire public health issue that costs employers, patients and insurance companies billions of dollars each year. Pain directly affects quality of life and overall well-being of millions of Americans, both young and old. One of the fundamental aspects of practice for the physical therapist is to aid in the rehabilitation of injuries in order to
Define pain, discuss the scales used to measure pain and summarize the similarities and differences between acute pain management and chronic pain management. Describe four theories regarding pain perception and discuss both pharmacological and non-pharmacological strategies of pain management. Evaluate electrotherapy options, as well as techniques of manipulation and pain relief. Discuss alternative therapies and maintenance programs and methods, including Pilates, yoga, acupuncture and reflexology. promote the alleviation of pain; therefore, it is a good idea to occasionally review the basics of injury, pain and rehabilitation. This course is set up in two sections: The first section is a discussion about the management of acute injures. The second section discusses methods and management of pain. Physical therapists, upon completion of this course, will benefit from the information provided. 2. Chronic injuries : Injuries that have passed the expected time of healing, or a recurring injury. This course will focus on acute injuries. 2. Erythema : The skin over the affected area will be red due to hyperemia. 3. Pain : When an injury occurs, a certain chemical substance (Substance P) is been produced and released to the particular area of damage. Substance P is responsible for the occurrence of pain. This substance stimulates the free nerve endings to transmit pain to the brain. The pain may also be caused by the compression of the surrounding tissues by the fluid released out of the blood vessels following the injury. The pain depends on the severity/degree of the injury, number of pain receptors on the skin of the affected area, and texture of the tissue (loose tissue or confined space in the tissues). 4. Swelling : Swelling occurs from the increased exudation. The amount of fluid depends on the severity of inflammatory reaction and tissue type affected. 5. Loss of function : Functions of the affected tissue will be reduced due to the pain and swelling.
ACUTE INJURY MANAGEMENT INTRODUCTION TO INJURIES
An injury is an act that harms, damages, or hurts someone[1]. Injuries can be categorized as: 1. Acute injuries : Injuries that happened recently. Acute injuries Acute injuries occur suddenly and are often associated with some kind of physical trauma. They are categorized into three phases according to the timeframe: ● Acute. ● Subacute. ● Postacute phases. An injury is considered acute from the onset of the injury up to 4 days. The time from 5 to 14 days (post injury) is termed subacute ; whereas from 14 days on, it is called postacute [2] . The most common acute injuries are musculoskeletal injuries, especially soft tissue injuries. Examples of these acute musculoskeletal injuries include bruises, fractures, muscle strains, ligament sprains, joint dislocations, and lacerations. After an injury, the body undergoes several changes during the acute stage. The skin and/or the soft tissues may provoke an inflammatory process. There are five signs of inflammation. They are: 1. Increased temperature : The temperature of the affected area is increased due to active hyperemia (increased blood flow to the area).
TYPES OF MUSCULOSKELETAL INJURIES
There are numerous types of musculoskeletal injuries. Sprains, strains, contusions/bruises, dislocations, and fractures are the most common. Sprains Sprains are injuries of the ligaments caused by overstretching or tearing. These injuries can be categorized as acute and chronic sprains. Instantaneous pain after the injury, tenderness over
the injured area, localized swelling, and diminished or reduced movements in the affected joint are the prominent signs and symptoms of a ligament sprain [3] . Many with acute ligament sprains have felt or heard a popping/snapping sound at the onset of the injury. Sprains can be graded according to the severity of the damage. The categories are:
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