PHTY206 Lecture 7: Principles of management of acute injuries
Principles of management of acute injuries
• Understand the aetiology of acute injuries
• Understand what and how risk factors may contribute to the development of acute injuries
• Discuss principles of physiotherapy management for acute conditions as they relate to stages
of healing or classification
• Discuss common modalities used in physiotherapy management of acute conditions
• Treatment planning
o Will depend on
• Findings from patient interview and physical exam
• Identification of
▪ Impairments
▪ Functional limitations
▪ Participation restrictions
• Stage of injury/tissue remodelling and repair
o Healing times
• Tensile strengthening over time
• Active tension can occur prior to tissue maturation and collagen strengthening
▪ Implications for rehab?
o Interventions
• Phase 1: Acute management
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o Acute phase 0 - 72 hours
• Inflammation
▪ Rupture and necrosis of tissue/fibres
▪ Formation of haematoma
▪ Inflammatory cell reaction
o First 24hrs critical period
• When soft tissues injured, blood vessels damaged also -> accumulation blood ->
compressing adjacent tissues -> secondary hypoxic injury and further tissue
damage
• Important to reduce/control bleeding at injury site
o 0-72 hours
• Treatment aims to:
▪ Minimise extent of initial damage
▪ Reduce associated pain and inflammation
▪ Promote healing of damaged tissue
▪ Maintain or restore flexibility, strength, proprioception, overall fitness
▪ Functionally rehabilitate
▪ Assess and correct any predisposing factors to reduce recurrence
• POLICE
▪ "Rest should be of limited duration and restricted to immediately after
trauma. Longer periods of unloading are harmful and produce adverse
changes to tissue biomechanics and morphology"
▪ Protection
• Brief immobilisation to prevent excessive distention at injury site ->
reduce size of haematoma -> minimise size of scar
• Orthopaedic braces
• Designed to increase passive support/restraint
• Limit ROM
• Reduce loading
• Knee extension brace
• Patella dislocation
• Limited ROM brace
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• Can set range
• Prevent medial and lateral movement
• MCL injury
• Cam boot
• e.g. Achilles tendon ruptures
• Foot fractures
• Ankle braces
• Injury prevention
• Reduction of ankle sprain by 69% among those with
previous ankle injury
• Similar in effect of taping (71% reduction)
• Increase passive stability
• Reduces plantarflexion excursion during walking
• Deload tissues
• Anti-proatio rae/tapig i.e. ↓Ti post & Ti At
activity
• Tape
• Pain reduction
• Plantar fasciitis
• Patellofemoral pain
• Patella fat pad
• Lateral ankle sprains
• Injury or re-injury prevention
• Protective effect greatest with previous ankle sprain
history
• Taping is effective at reducing likelihood of ankle sprain
• Reduction of strain on injured tissue
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