Rehabilitation. Modalities and Rehabilitation. Basics of Injury Rehabilitation. Injury Rehabilitation. Vocabulary. Vocabulary

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1 Modalities and Rehabilitation Rehabilitation Chapter 12: Basics of Injury Rehabilitation Vocabulary Balance: ability to maintain our center of gravity over a base of support Kinesthesia: the ability to detect movement Vocabulary Kinetic Chain: combination of several joints linking several limb segments together during a specific movement Closed kinetic chain: exercise occurs when your foot or hand is in contact with the ground Proprioception: ability to determine the position of a joint in space Open kinetic chain: exercise occurs when your foot or hand is off the ground Basics of Injury Rehabilitation Rehabilitation is a restoration of the athlete to a pre-injury level through exercise Goal: Return athlete to activity as safely and quickly as possible Injury Rehabilitation Rehabilitation of athletic injuries requires clinicians to possess skills that allow them to: Control pain Restore ROM to injured joints Restore muscle strength and endurance Regain neuromuscular control and proper balance 1

2 Basics of Injury Rehabilitation Exercise rehabilitation is one of the most important therapeutic tools. Used properly it can help the athlete return safely to competition Often athletes return after injury before they have fully recovered, thereby risking a more serious injury. Rehab Rules 1. Each athlete & injury is different. 2. Don t cookbook! Follow general protocols BUT be creative. 3. Don t rush the rehab process. 4. Injury Specific & Sport Specific Rehab. 5. Specific Athlete Considerations. 6. DO NO HARM!! Phases of Physical Rehabilitation Phase I: begins immediately after injury Purpose: prevent additional injury, decrease pain, and control inflammation Phase II: begins process of repairing damaged tissue Strength and range of motion (ROM) are increased Phase III: Returning athlete to activity Rehabilitation Program Can be divided into specific components Each component is a short-term goals Long-term goals are big picture goals Return to preinjury health status Return to daily activiity Return to training Return to practice Return to competition Goals of a Rehabilitation Program 1. Providing correct immediate first aid and management following injury to limit or control swelling 2. Reducing or minimizing pain 3. Restoring full range of motion Goals of a Rehabilitation Program 4. Restoring or increasing muscular strength, endurance, and power 5. Reestablishing neuromuscular control 6. Improving balance 7. Maintaining cardio-respiratory fitness 8. Incorporating appropriate functional progressions 2

3 Initial First Aid Initial first-aid and management techniques are probably the most critical part of any rehabilitation program. How an injury is managed initially has a significant impact on the course of the rehabilitative process Everything should be directed towards controlling the swelling! - PRICE Controlling Pain When an injury occurs, there is going to be some degree of pain. Extent of the pain is determined in part by: Severity of the injury Athlete s individual response to and perception of pain Circumstances under which the injury occurred. PRICE and the use of other appropriate modalities (ice, heat, electric stimulation) Restoring Full ROM Injury to a joint is always followed by some associated loss of motion Swelling is a common cause of limitations in ROM Pain, muscle weakness Thus, athlete should engage in stretching activities designed to improve flexibility If normal ROM is not restored the injured tissue will heal in a shortened state Muscle Strength Muscular strength, endurance, and power are some of the most essential factors in restoring the function of a body part to pre-injury status. A major goal in strengthening exercises is to work through a full, pain-free range of motion. Isometric, Isotonic, Isokinetic, and plyometric exercises can benefit rehabilitation Muscle Strength Progressive Resistive Exercises (PRE) Gradual increases in muscle demand in order to achieve a desired outcome SAID principle Specific Adaptations to Imposed Demands Tissues will respond to the demands placed upon them Kinetic Chain Activities Open Chain Movement: Kinetic chain movement in which the distal end of the body part moves freely through space Close Chain Movement: Kinetic chain movement in which the distal end of the body part is fixed and the proximal body part moves Closed chain activities are more functional than open chain Most sports involve the foot in contact with the ground can involve hands in contact at all times 3

4 Closed Chain Examples Squats Bicycle Precor - Elliptical Push-ups Step-ups Leg Press Stair Master Mini-Squats The mind s attempt to teach the body conscious control of a specific movement Relies on the CNS to interpret and integrate proprioceptive and kinesthetic information and then to control individual muscles and joints to produce coordinated movements Following injury and subsequent rest & immobilization, the CNS forgets how to interpret & integrate proprioceptive and kinesthetic info and control individual muscles and joints to produce coordinated movement Regaining neuromuscular control means regaining the ability to follow some previously established sensory pattern Functional strengthening exercises help reestablish neuromuscular control Regaining Balance The ability to balance and maintain postural stability is essential to reacquiring athletic skills Should include functional activities that incorporate balance training, failure to do so may predispose athlete to re-injury Maintaining Cardiorespiratory Fitness Often neglected Cardiorespiratory fitness may decrease rapidly with time missed Must design or substitute alternative activities that allow the athlete to maintain existing levels of cardiorespiratory fitness early 4

5 Functional Progression Involves a series of gradually progressive activities designed to prepare the individual for return to a specific sport Skills are broken down into component parts and gradually put together Start with simple and progress to complex skills. simple to complex slow to fast short to long light to heavy Functional Progression Will gradually assist the injured athlete in achieving normal pain-free ROM, restoring adequate strength, and regaining neuromuscular control throughout the rehab program We use functional testing to see if the athlete is ready for full return to activity Functional Progression Lower Extremity: Return to running Walking Jogging on track with walking curves Jogging full track Running on track, jogging curves Running full track Running for fitness 2-3 miles Lunges Sprints Acceleration / deceleration runs Shuffle slides to shuffle run Carioca 5

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