Transcript REC 3045 Peridization Powerpoint

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* Primary Injury- acute or chronic resulting from
macro-traumatic or micro-traumatic forces
* Macro-traumatic- result from acute trauma=
immediate pain and disability
* Micro-traumatic- result from overloading or
incorrect mechanics associated with repeated
motion, also known as overuse injuries
* Secondary Injury- the inflammatory or hypoxia
response that occurs with the primary injury
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1. ↓ swelling, pain, inflammation
2. ↑ ROM
3. ↑ muscular strength, endurance, power
4. Maintain cardiovascular fitness
5. Re-establish neuromuscular control
6. Improve stability and balance
7. Address psychological reaction to injury/pain
8. Posture & core stability
9. Protect/prevent further injury
10.Kinetic Chain/ Jt above/below
11.Functional Progressions- sport specific
12.Return to Activity Criteria
13.Home Program
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* Overlap with each other
* Inflammatory Phase: 2-4 days, SHARP/D, Goals; 13,9
* Fibroblastic-Repair Phase: first few hours post
injury to 4-6 weeks, Goals; (1-3), 4-9, (10-11)
* Maturation- Remodeling Phase: 3 weeks to several
years, Goals; (1-9), 10-13
* **Critical- if this response does not accomplish
what it is supposed to, or if it does not subside,
normal healing cannot take place
* Leukocytes and phagocytic cells go to injured
tissue
* 2-4 days
* SHARP/D- Swelling, Heat , Redness, Altered
Function, Pain, Deformity
* Goals; 1-3,9
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* Scar formation and repair of the injured tissue
* Collagen- strong fibrous protein found in
connective tissue
* First few hours post injury to 4-6 weeks
* Some tenderness and pain if touched or
stressed with particular movements
* Goals; (1-3), 4-9, (10-11)
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* Long term process, 3 weeks to several years
* Increase stress and strain to realign fibers in a
position of max efficiency, parallel to lines of
tension
* Goals; (1-9), (10-13)
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* Extent of Injury
* Edema
* Hemorrhage
* Poor Vascular Supply
* Separation of Tissue
* Muscle Spasm
* Atrophy
* Corticosteroids
* Keloids and Hypertrophic Scars
* Infection
* Humidity, Climate, Oxygen Tension
* Health, Age, Nutrition
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* PRICE –Protect, Rest, Ice, Compression,
Elevation for the first 72 hours
* Rest- Active Rest or AAROM (active-assisted
ROM)
* Ice- Decreases pain, vasoconstriction of vessels
to control hemorrhage(bleeding) and edema
(swelling)
* Compression-decreases hemorrhage and
hematoma formation
* Elevation- reduces internal bleeding
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* Restoring normal ROM following injury is a
primary goal in rehab
* Must include exercise designed to restore
normal ROM to regain normal function
* Several factors can limit flexibility and ROM:
shape of jt, capsule, ligaments, mm, scars,
neural tissue
* Flexibility involves the ability of the
neuromuscular sys to allow for efficient
movement of a joint through ROM
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* Factors affecting flexibility:
* Muscle- most often responsible for limiting ROM
* Connective Tissue- lose elasticity and shorten
* Bony structure- restrict end point in the range
* Fat- limits full ROM
* Skin- inelastic scar tissue incapable of stretching with
jt movement
* Neural Tissue- tightness can create morphological
changes in neural tissues
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* Active ROM= dynamic flexibility- degree a joint
can can be moved by a muscle contraction
* Passive ROM= static flexibility- degree to which
a joint can be passively moved to the end
points of ROM
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* Reflex Autogenic Inhibition: Golgi Tendon
Organs = relaxation in antagonist mm
* Contraction of agonist causes a reflex
relaxation in the antagonist muscle
* Flexibility can be lost quickly
* Can be maintained with 1 session/week
* Need 3-5 sessions a week to improve!
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* Elasticity- ability to recover normal length
after elongation
* Viscoelasticity- slow return to normal length
and shape after deformation
* Plasticity- allows for permanent change or
deformation
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* Joint hypo-mobility most frequently treated
causes of pain
* Leads to compensations in the kinetic chain –
abnormal joint stress, soft tissue dysfunction,
neural compromise
* Can be traced to faulty posture, muscular
imbalances, and abnormal neuromuscular
control.
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* Intramuscular temperature should be increased
prior to stretching
* Positive effects on collagen and elastin
components within the musculotendinous unit
to deform
* Capability of GTO to reflexively relax is
enhanced when heated
* Low intensity warm up
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* Stretching Techniques:
* Dynamic and Static Stretching
* Proprioceptive Neuromuscular Facilitation
* Pilates
* Yoga
* Manual Therapy: Myofascial Release, Strain-
Counterstrain, Soft Tissue, Massage, Graston
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* First weeks of program is focused on training to
be efficient ex. Technique, target fiber and
contraction
* Strength directly related to efficiency of
neuromuscular sys; increase motor unit
recruitment, firing rate, enhancing
synchronization of motor unit firing
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* Resistance training plays a critical role in Rehab
* Muscle weakness/imbalance can result in abnormal
movement/gait and can impair normal functional
movement
* Muscular Strength- ability of a muscle to generate a force
against some resistance
* Muscular Endurance- the ability to perform repetitive
muscular contractions against some resistance for
extended period of time
* Muscular Power- ability to generate great amounts of
force against a certain resistance in a short period
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* ISOMETRIC- mm contracts, no change in mm length (static
strength, decrease atrophy)
* CONCENTRIC- mm contracts, mm shortens to move resistance
* ECCENTRIC- mm contracts, mm lengthens to move resistance
* ISOKINETIC- mm contraction in which the length of the m is
changing while the contraction is performed at a constant
velocity
* MUST use ALL 3 (ISOM,CONC,ECCEN) for program, watch out
for Rehabilitative Overload
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* Size of the muscle
* # of mm fibers
* Neuromuscular Efficiency
* Biomechanics
* Age
* Overtraining
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* Type 1- Slow Twitch, resistant to fatigue, time required
to generate force is greater
* Type 2- Fast Twitch, fatigue rapidly, produce quick,
forceful contractions
* Both types of fibers in muscle, varies between each
individual
* Muscles whose function is to maintain posture have a
higher percentage in slow twitch, and muscles whose
function is to produce powerful, rapid movements tend
to have more fast twitch
* Ratios are genetically determined
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* Hypertrophy: increase in size of the muscle
* Reversibility: if resistance training is discontinued or
interrupted, the muscle will atrophy, decreasing in
bone strength and mass.
* Adaptations can reverse in as little as 48 hours
* Physical Adaptations to Resistance Training:
* Strength of non-contractile tissue is increased
* Mineral content of bone is increased
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* For a muscle to improve in strength, it must be forced to work at a
higher level than it is accustomed to
* Without overload, the muscle will maintain strength as long as long
as training is continued against a resistance to which the muscle is
accustomed, but no additional gains
* To most effectively build muscular strength resistance training
requires a consistent increasing effort against progressively
increasing resistance
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* ISOMETRICS
* Progressive Resistive Exercise
* Surgical Tubing/ Theraband
* Repetitions- # of times movement is repeated
* Rep Max- max # of reps at a given weight
* Sets- # of reps
* Intensity- amount of weight lifted
* Recovery- rest interval between sets
* Frequency- # of times an exercise is done in week’s
period
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* Single Set
* Tri-sets
* Multiple Sets
* Supersets
* Pyramids
* Split Routine
* Circuit Training
* Plyometric
* Core Stabilization
* Open vs Closed Kinetic Chain
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* Critical and often most neglected,
improvements may be lost in as little as 12
days
* Regardless of training schedule/techniques;
Main goal is to increase ability of Cardioresp
sys. to supply a sufficient amt of oxygen to the
mm.
* Upper vs Lower body injury
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* Cardiorespiratory Endurance- ability to perform
whole-body activities for extended periods of
time without undue fatigue
* Training Effects:
* Heart, blood vessels, blood, lungs
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* Continuous- technique that uses exercises
performed at the same level of intensity for
long periods of time
* Interval- alternating periods of relativity
intense work followed by active recovery
* Detraining- Changes of the effects from
training can reverse, improvements may be lost
in as little as 12 days – several months
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* After injury, the CNS “forgets” how to put
together information from mm and jt receptors
* Stimulus from cutaneous (skin), visual, and
vestibular input as well
* Neuromuscular control is the mind’s attempt to
teach the body conscious control of a specific
movement
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* How it works:
Successful repetition of a patterned movement makes its
performance progressively less difficult and thus requires less
concentration- eventually becoming automatic
* Requires many repetitions, from simple to complex
movements
* Strengthening exercises- specifically those that are more
functional= essential for NMC
* MOST critical during the early stages of rehab to avoid reinjury
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* Regaining NMC means regaining the ability to
follow a previously established sensory pattern
* CNS will compare the intent and production of
a specific movement with stored information
and adjust until any discrepancy in movement
is corrected
* Relearning normal functional movement and
timing after injury to a joint may require
several months
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* 4 components:
* Proprioception (position of jt in space) & Kinesthesia (ability to
detect movement)
* Dynamic Stability
* Preparatory and reactive mm characteristics
* Conscious and unconscious functional motor patterns
* Relies on the CNS to interpret and integrate proprioceptive and
kinesthetic info and then control the mm and jts to produce
coordinated movements
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* Multiplanar Lunges
* Single Leg Squat
* Proprioceptive Neuromuscular Facilitation
Techniques
* An unstable platform promotes reactive muscle
activity- attempting to balance on a platformmanually perturb
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* Process of maintaining the COG within the body’s base
of support
* Involves integration of muscular forces, neurological
sensory information, and biomechanical information
* The ability to maintain postural stability and balance is
essential in acquiring or reacquiring complex motor
skills
* Decreased sense of balance or a lack of postural
stability following injury might lack sufficient
proprioceptive and kinesthetic information and/or
might have muscular weakness
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* Single most important element dictating movement
strategies within the close kinetic chain
* Highly integrative dynamic process involving multiple
neurological pathways
* Postural Equilibrium- Alignment of joint segments in
an effort to maintain COG within an optimal range of
the max limits of stability
* Re-establishing neuromuscular control is one part of
balance
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* Somatosensory inputs provide information concerning
the orientation of body parts to one another and to the
support surface
* Injury can cause a disruption at some point between the
body’s COG and base of support
* This can cause compensatory weight shifts and gait
changes along the kinetic chain that have resulted in
balance deficits
* BESS- Balance Error Scoring system
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* Static: COG is maintained over a fixed base of supporton a stable surface- double, single leg, or tandem
stance
* Semidynamic- maintain COG on a moving surface, or
unstable surface- foam, trampoline, mini squats
* Dynamic (functional)- base of support is changing,
forcing COG to adjust- balance beam, bounding
* BAPS board, BOSU, Dynadisc
* 2-3 sets of 15 reps progress to 30 reps
* 10 sets of 15 second period, progress to 30 seconds
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* Psychological and sociological consequences of
injury are just as debilitating as the injury
itself
* Can have an adverse impact on RTP
* Barriers to rehabilitation
* Focus on prevention: Listen, Educate on injury
and rehab, Goal setting,
Meditation/Progressive Relaxation, Imagery,
REFERRAL
* Maintain confidentiality!
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* Athletes may have problems adjusting socially
and may feel alienated from the rest of the
team
* Common feelings:
* Coaches cease to care
* Teammates have no time to spend with them
* Friends are no longer around
* Little support from coaches and teammates
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* Stress: positive and negative forces that can disrupt the body’s
equilibrium
* Negative stress tends to decrease the athlete’s attentional focus and
create mm tension- can lead to a reduction in in flexibility, problems
in coordination, and an overall decrease in movement efficiency, can
cause athlete to miss important cues
* Physical Response to Stress: hormonal increases- cortisol, produce
fear/anxiety = fight or flight response, epinephrine and
norepinephrine, blood corticoids
* Emotional Response- personality change, if athlete enters a contest
angry, frustrated or discouraged they are more prone to injury
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* Overtraining: imbalance between a physical load placed on an
athlete and their coping capacity. Can lead to staleness and
burnout.
* Staleness: often attributed to emotional problems stemming
from daily worries, fears, and anxieties.
* Anxiety: feeling of uncertainty or apprehension. The most
common mental and emotional stress producer. Athlete can
feel inadequate, have heart palpitations, shortness of breath,
sweaty palms, etc.
* Symptoms of Staleness: chronic fatigue, deterioration in
performance, apathy, loss of appetite, indigestion, weight loss,
inability to sleep
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* Burnout: syndrome related to physical and emotional
exhaustion that leads to a negative self-concept, negative
job or sport attitudes, and loss of concern for the feelings
of others.
* Stems from overwork- affects both athlete and trainer,
Detrimental to health
* Symptoms: headaches, gastrointestinal disturbances,
sleeplessness, chronic fatigue
* Athletes can feel depersonalization, increased emotional
exhaustion, a reduced sense of accomplishment, cynicism,
and a depressed mood
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* Must include:
* Rapport: relationship or a mutual trust and
understanding
* Education: need to explain and educate on the
rehab process, explaining the exercises to be
performed correctly at home
* Cooperation: need cooperation between
athlete, trainer, doctor
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* Many return to full participation physically ready but are
psychologically ill prepared
* Progress in small increments: complete necessary skills
away from team, engage in a small practice group, then
attempt participation in full team non-contact
* Complete rehab exercises on the sideline- bike, core,
functional, progressive exercises
* Use relaxation methods
* Goal Set
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* Establishing progressive, attainable goals is essential in
rehab
* Injured athlete has to take responsibility for the progress
of the injury and be responsible for doing the necessary
rehab
* 9 Factors for goal setting: specific and measurable,
positive language, challenging but realistic, reasonable
timeline, short/ medium/ long goals, link outcome to
process, internalize goals, monitor and evaluate goals,
link sport goals to life goals.
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* Reducing tensions/ anxiety: Meditation and
Progressive Relaxation
* Cognitive Restructuring: Refuting Irrational
thoughts and Thought stopping
* Imagery
* Coping with Pain: Reducing Muscle Tension,
Diverting Attention, Altering the Pain Sensation
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* Must be able to recognize and make a referral
to the appropriate medical team
* Keys to referral:
* Recognize the need
* Know your limits
* Discuss referral with other members of the
sports medicine team
* Maintain Confidentiality
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* Depression: disease in which an individual experiences
helplessness and misery, loss of energy, excessive guilt,
diminished ability to think, changes in eating and sleeping
habits.
* 1/5 suffer from depression
* SAD: Seasonal Affective Disorder characterized by mental
depression related to a certain season of the year
* Most likely to occur due to a decrease in sunlight
* Symptoms: fatigue, diminished concentration, day-time
drowsiness
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* Contribute to 20% of all medical conditions
* Physiological responses: sweating, increased heart rate and
blood pressure, irritability, sleep disturbances
* Panic Attacks: unexpected and unprovoked emotionally
intense experience of terror and fear. Occur in 30% of young
adults and at night
* Phobias: persistent and irrational fear of a specific situation,
activity, or object (heights, flying, closed spaces)
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* A pathological disturbance in cognition, affect interpersonal
functioning, or impulse control
* Paranoia: having unrealistic and unfounded suspicions about
specific people or things.
* OCD: Obsessive Compulsive Disorder combination of
emotional and behavioral symptoms. Engages in
unreasonable acts (washing hands, counting)
* PTSD: Posttraumatic Stress Disorder affects individuals who
have suffered a psychologically traumatic event. Numbing
of general responsiveness, insomnia, increased aggression
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* Core= Lumbo-pelvic-hip complex, location of COG and where
all movements begin
* Posture- involves positioning the body’s center of gravity
within the base of support
* Weak core= fundamental problem of many inefficient
movements that lead to injury
* If one sys is out of alignment= patterns of dysfunction=
Mechanical imbalance= bad posture (kyphosis, lordosis, sway
back)
* MUST emphasize stable positions to maintain the structural
integrity of the entire kinetic chain
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* 29 muscles have an attachment to the lumbo-pelvic-hip
complex
* Referred to as “Butt and Gut”
* Inner (pelvic floor mm, TA, multifidus, diaphragm) and
Outer unit (posterior oblique, deep longitudinal, anterior
oblique, lateral)
* Lumbopelvic like a cylinder- inferior- pelvic floor,
superior- diaphragm, posterior- multifidus, anterior/
lateral- transverse abdominus
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* NEED ALL 5 ( including scapular stability)
* POST OB: glute max, contralateral lat
* Deep longitudinal- ES, biceps femoris, ligaments – Glute
hamstring ES
* Anterior Oblique- internal and external obliques and
contralateral adductors
* Lateral- glute med and min and contralateral adductors
* Simple exercises first then complex, need proper
activation with any activity
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* Can create predictable patterns of dysfunction
throughout the entire kinetic chain
* Crossed Pelvis Syndrome
* Upper Crossed Syndrome
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* Postural faults that persist can give rise to
discomfort, pain, or disability
* Lack of mobility closely associated with faulty
alignment
* Main goal- strengthen weak, stretch tight
* Pain in relation to Faulty posture- cumulative
effects of constant or repeated small stresses
over a period of time (muscle shortness,
muscle weakness, stretch weakness)
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* Kyphotic- lordotic- Csp hyperextended, Tsp Increased
flexion, Lsp hyperextended, pelvis anterior tilt
* Lordotic- Lsp hyperextended, pelvis anterior tilt
* Flat-back- Csp- extended, Tsp- upper flexion, lower flat,
Lsp- flexed (straight), pelvis- posterior tilt
* Sway-back- Csp- extended, Tsp- flexion with posterior
displacement of upper trunk, Lsp- flattening, pelvisposterior tilt, anterior displacement of hips
* Scoliosis
* Handedness Patterns
* Knees/ feet, Scapular movement
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* Equipment= Helmets!, facial protection (face,
throat, mouth, ears, and eyes), neck
protecting, trunk and thorax, hips/ buttock,
groin/ genetalia, upper leg, lower leg,
footwear
* Protect with injury= crutches, splints, tensors,
tape, slings, foam padding
* Rehab program must allow for Rest!
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* Tensor: ankle, calf, hip (x3), shoulder (x2),
wrist, elbow
* Sling-cervical sling, shoulder sling, sling and
swathe
* Taping
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* Kinetic Chain- integrated functional unit, includes mm,
fascia, ligaments, tendons, articular sys, and neural sys
* Joint above and below
* All of these systems function simultaneously as an
integrated unit to allow for structural and functional
efficiency
* If any system within kinetic chain is not working
efficiently, the other systems are forced to adapt and
compensate
*
* Compensation- leads to tissue overload, decreased
performance, and predictable patterns of injury
* During functional movements, some muscles contract
concentrically to produce movement, others contract
eccentrically to allow movement to occur, other muscles
contract isometrically to create a stable base on which
the functional movement occurs
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* Open- Kinetic Chain Exercise- distal segment is
mobile and not fixed (foot or hand not in
contact with ground or surface)
* Open- non-weight bearing, not all upper body
exercises are open some closed, bicep curls,
triceps extensions, bench press, leg
curl/extension- more isolating exercises to
target certain muscles, usually one jt
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* Closed-Kinetic Chain Exercise- when the distal segment of the
lower extremity is stabilized or fixed
* More sport or activity specific, exercises incorporate
strengthening the entire kinetic chain rather than an isolated
body segment
* Closed- associated with weight bearing activities and the
lower extremity , minisquats, push ups,lunges, wall slides, leg
press, stair climbing/ step ups, stationary bike, trampoline,
BAPS board, slide boards, usually multi jt
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* A series of gradually progressive activities
designed to prepare the individual for RTP
* Progress from simple to complex sport specific
skills
* Skills are broken down into component parts
and the athlete gradually reacquires those
skills within the limitations of progress
* May be broken down into 3 phases:
stabilization, strengthening, power
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* Physicians Release
* Pain Free
* No swelling
* Normal ROM
* Normal Strength
* Mentally Prepared
* Pass Functional Tests!
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* All exercises completed during rehab should be
completed at home or at practice
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