Transcript REHAB-4-

Rehabilitation
exercise
Lecture 4
Essential Considerations in Designing a Rehabilitation
Program for the Injured Athlete
FDSc FISM year 1
Janis Leach
Session Outcomes
► At
the end of this session you should be
able to:
► Recognise the phases/stages of
rehabilitation.
► Recognise the criteria for progression
through the stages.
► Design a rehabilitation program.
The Rehabilitation Team
►
Group effort
 Sports Therapist
 Athlete
 Physician
 Coaches
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Sports Therapist
Responsibilities
 Injury prevention
 Recognition, evaluation
and assessment
 Immediate care
 Treatment and
rehabilitation of injuries
 Rehabilitation program
design
Philosophy of Sports Medicine
Rehabilitation
► Communication
is critical on all levels
► Trust and confidence involved in the
working relationship must evolve
 Goal directed approach
 Involving multiple individuals
► All parties must be involved in the
rehabilitation process and must
communicate effectively at every level of
athletic participation
The Healing Process
► Progression
through rehabilitation should be based
on injury healing
► Sports
Therapists must possess an understanding
of time sequences and physiological events
associated with healing process
► The
Sports Therapist must create an environment
conducive to the healing process
SAID principle
► Exercise
Intensity
 SAID principle – Specific Adaptations to
Imposed Demands
►Ability
of the body to adapt to stress and overload
imposed on it
►Critical to consider during rehabilitation
►Indications of having applied too much stress:
 Pain, swelling, loss or plateau in strength or range of
motion, increased laxity in healing ligaments
►As
healing progresses exercise intensity should
increase
Understanding Mechanics of
Injury
► Due
to injury normal joint and anatomic function is
compromised
► Adaptive changes occur resulting in alterations in
biomechanics
► A background in anatomy and biomechanics is
critical in defining a rehabilitation program
► Must have the ability to identify adaptive or
compensatory actions resulting from injury and
correct the mechanism of movement
Understanding the Psychological
Aspect of Rehabilitation
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Critical factor that is often neglected and overlooked
Injury/illness produce a variety of emotional responses
Athlete’s vary on:
pain threshold
cooperation
anger
fear
►
competitiveness
compliance
depression
guilt
The psychological aspect can also play an important role in
performance enhancement
Development of Athletic Injury
Rehabilitation Programs
►
A well-designed injury rehabilitation
program should include three basic
components
1. Identifiable, sequential phases
individualised progression
2. Specific therapeutic objectives
3. Measurable and objective criteria for
progression to the next phase
4. Knowledge of ROM at each joint
ROM examples
► Ankle
dorsi flexion – up to 20 degrees
► Knee
– 150 degrees - flexion
► Shoulder
► Wrist
– 180 degrees – flexion
extension – 70 degrees
Phases of Rehabilitation
► Immediate
post injury (Phase 1)
► Acute stage (Phase 2)
► Sub-acute (Phase 3)
► Active rehabilitation (Phase 4)
► Functional rehabilitation (Phase 5)
Phase 1 - Immediate
► Aims
of treatment
 Initial first aid
 SALTAPS
 Possible referral
Phase 2 (Acute)
► 0-48
hours post injury
 PRICE regime
 Signs and symptoms
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Pain
Swelling
Redness
Heat
Lack of function
Importance of Controlling Swelling
► Initial
injury management an swelling control is
critical
► Swelling can result in increased pressure to the
injured area, causing pain and altered
neuromuscular function
► Swelling slows the healing process and normal
function is not regained until swelling is eliminated
► To limit swelling the PRICE principle should be
applied
Phase 3 (Sub-acute)
► Therapeutic
Objectives
 Limit inflammatory response and minimise effects of
immobilisation
 Teach correct walking techniques
 Assist in the healing process using therapeutic
modalities
 Maintain muscular strength and minimise muscular
atrophy
 Minimise adhesions to the injured area
 Maintain overall fitness level
Phase 3
► Therapeutic
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Objectives
Promote the healing process
Early NWB mobilisations of the joint
Increase flexibility
Early NWB strengthening of muscles
Recommendations for home care
Phase 3
► Completing
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aims of phase 3
Continue with cryotherapy
NWB exercises
Walking aids
Compression bandaging
Stretching and mobilising
Phase 3
► Before
progression to phase 4, these aims should
be addressed;
Increase in ROM
Increase in strength
Increase in extensibility
Scar tissue laid down to ensure that new fibres lay
along lines of muscle stress
 Awareness of dietary requirements
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Phase 4 (Active Rehabilitation
Stage)
► Aims
of this phase of treatment
 Progression from NWB – PWB
 Taping techniques
 Maintenance of rest of body fitness
Phase 4
► Criteria
for Progression to Phase 5
 Sufficient reduction in local symptoms (pain, swelling,
etc) and wound healing to allow for a safe return to
competition
 Sufficient restoration of joint ROM, muscle strength,
muscle endurance, gait mechanics, and fitness level to
return to competition level
 Sufficient protection from re-injury by taping and/or
bracing, safety of playing environment, and modification
of practice activities
 Satisfactory motivation and confidence of the athlete
Phase 5 (Functional
Rehabilitation Phase)
► Definition
 The time period in the injury process when
return to play/functional activities resume
► Therapeutic
Objectives
 Continue to restore full ROM, strength,
endurance, and flexibility necessary for full
participation in the sport
 Continue development of overall fitness level
Phase 5
► Therapeutic
Objectives
 Re-establish normal motor patterns specific to sports
participation
 Restore athlete’s confidence in their ability to return to
their sport
 Restore cardiovascular fitness to pre-injury levels
► Criteria
for Progression
 Restore all components of normal physiologic function
(strength, ROM, etc.) to optimal levels
 Resumption of unrestricted activity
Re-establishing Neuromuscular
Control
Joint position sense is involved via
mechanoreceptors
► Neuromuscular control relies on the CNS to interpret
and integrate proprioceptive and kinesthetic
information, translating it into coordinated motion
► Injuries alter this ability
► Early stages of rehabilitation involves regaining
previously established sensory patterns
► Practice is required until the patterns become
automatic
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Restoring Range of Motion
► Loss
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of range of motion is associated with
Resistance of musculotendinous units
Connective tissue stretch contractures
Muscle/postural imbalances
Neural tension
Joint dysfunction
► Physiological
movement constraints must
be determined and treated accordingly
 Stretching
 Joint mobilisation & traction
Maintenance
► Definition
 The time period after rehabilitation is complete
and full activity is resumed, but during which
specific conditioning and maintenance exercises
may be performed to ensure continued safe
participation
Maintenance
► Therapeutic
Objectives
 Maintain muscular strength in the affected area
to levels equaling the unaffected side
 Maintain flexibility in the affected area to levels
equaling the unaffected side
 Maintain muscular endurance in the affected
area to a level consistent with the demands of
the sport
 Maintain neuromuscular pathways
Establishing Goals
► Rehabilitation
should be goal directed
► Short term goals
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Provide immediate first aid and care
Reduce/minimise pain
Restore full range of motion
Restore increase strength, endurance and power
Improve postural stability and balance
Maintain cardiovascular fitness
Follow a functional progression
► Long
term goal = return to play
Practical session
►In
groups of 3 research exercises for
the ankle and access a journal on ankle
rehab to help with this (Or find a
suitable text book)
►Work
on a 20 minute exercise routine
for the foot and ankle in the NWB
phase (Phase 2). This will be presented
to the rest of the group.