The Rehabilitation Team

Transcription

1 Considerations in Designing a Rehab Program Philosophy of Sports Medicine Healing Process Pathomechanics of Injury Psychological Aspects Goals of Rehab Chapter 1 Group effort The Rehabilitation Team AEP/Athletic trainer involved with rehab process from assessment to treatment and R2S New England Patriots Importance of the Rehab Team Coach Athletic trainer Physician Athlete AEP Athletes family S&C Responsibilities Exercise Physiologist 1. Injury prediction / prevention 2. Recognition, evaluation and assessment 3. Exercise rehabilitation of injuries 4. Healthcare administration 5. Professional development Work under physician supervision Rehabilitation program design 1

2 Philosophy of Sports Medicine Rehabilitation Aggressive Rehabilitation Competitive nature of athletics necessitates aggressive approach Is the injury completely healed? Pushing too hard or not hard enough Tight-rope approach negative impact on athlete s R2S The Healing Process Progression through rehab based on injury healing 1. AEP must possess understanding of time sequences physiological events associated with healing process 2. Must create environment conducive to healing process 2

3 SAID Principle Ability of body to adapt to stress/ol imposed on it Critical to consider during rehabilitation Indications of having applied too much stress: Pain swelling loss or plateau in strength or ROM laxity in healing ligaments As healing progresses exercise intensity Understanding Pathomechanics of Injury Due to injury normal joint/anatomic function compromised Adaptive changes occur result in alterations in biomechanics Background in anatomy/biomechanics critical in rehabilitation program Must identify adaptive or compensatory actions resulting from injury and correct the pathomechanics Core function 1 Identify 2 key points from these clips Core function 2 Core function 3 Core function 4 Page, P. (2006). Sensorimotor training: A global approach for balance training. Journal of Bodywork and Movement Therapies, 10(1),

4 Concept of the Kinetic Chain KC is an integrated functional unit involving: Muscles, tendons, bones, ligaments, fascia Articular and neural system Each system works to provide structural/functional efficiency Contributing ti components 1. Length-tension relationships 2. Force couples 3. Precise arthrokinematics 4. Optimal neuromuscular control Malfunctioning systems result in compensatory OL = perf predictable injury patterns KC injury rarely involves one structure Comprehensive rehabilitation must examine Muscle imbalances Myofascial adhesions Altered arthrokinematics Neuromuscular control Goal is to restore optimal KC functioning Therapeutic Ex vs. Conditioning Ex Ex essential in conditioning, injury prevention and rehab Unfit athletes are more susceptible to injury Basic conditioning principles apply Therapeutic ex Ex specifically concerned with restoring normal function following injury (ex associated with rehab) Name 2 basic conditioning principles 4

5 Importance of Controlling Swelling Initial injury management an swelling control is critical Swelling = pressure = pain = altered neuromuscular function Slows healing process and normal function is not regained until Pain will dictate rate of progression Interfere with rehab process Comfortably uncomfortable PRICER principle should be applied Reestablishing Neuromuscular Control Joint position sense is mediated by mechanoreceptors NM control relies on CNS to interpret and integrate proprioceptive/kinesthetic information translating it into coordinated motion Injuries alter this ability Early stages of rehab: regain previously established sensory patterns Practice is required until the patterns become automatic Brant, J. J., & Findley, B. W. (2001). Postrehabilitation balance training for the strength and conditioning professional. Strength and Conditioning Journal, 23(5), Page, P. (2006). Sensorimotor training: A global approach for balance training. Journal of Bodywork and Movement Therapies, 10(1), Restoring Range of Motion Loss of ROM is associated with Resistance of musculotendinous units Connective tissue stretch contractures Muscle imbalances What principle is related to Postural imbalances greatest gains on ROM? Neural tension Joint dysfunction Physiological mvt constraints/ accessory motion deficits must be determined and treated accordingly Stretching Joint mobilization/ traction 5

6 Regaining Muscular Strength, Endurance and Power Essential to restoring pre-injury status Work through full pain-free ROM Incorporate both single plane force production mvts and functional activities that stress tri-planar motion Combinations of muscle contractions emphasized Core stabilization and NM control should be incorporated What is the athletic postural environment? Liebenson, C. (2002). Functional training part 1: New advances. Journal of Bodywork and Movement Therapies, 6(4), Isometric Used during initial stages of rehabilitation Useful when training through a full ROM is contraindicated Serve to increase static strength, decrease atrophy, create muscle pump to reducing edema Progressive Resistance Exercise (PRE) Most commonly used strengthening technique Incorporates free weights, machines and tubing Utilizes isotonic contractions (CON and ECC actions) Isokinetic Incorporated in later stages of rehabilitation Uses fixed speeds with accommodating resistance Provides maximal resistance through full range of motion Commonly used as criteria for return to functional activity 6

7 Plyometrics Generally incorporated in later stages of rehab Relies on a quick ECC stretch to facilitate a subsequent CON action Encourages dynamic mvts associated with power Due to the need to generate power in athletic activities, it is critical to incorporate it within a the rehab process Core Stabilisation Essential for functional strength Core functions to dynamically stabilize the kinetic chain What core muscle works in feedforward activation? Core strength enables distal segments to function optimally and efficiently during force and power generation Open vs. Closed Kinetic Chain Exercise Deals with the functional relationship in upper and lower extremities OKC = CKC = CKC ex incorporate isometric, CON and ECC muscle contractions simultaneously in differing muscle groups within the chain. Examples??????? OKC CKC 7

8 Restoring Balance and Postural Stability (BAPS) Involves integration of muscular forces, neurologic sensory information and biomechanical information Postural stability essential to reacquiring complex motor tasks linked with deficits in kinesthetic/ proprioceptive function and/or muscle weakness May limit ability to adjust to postural disturbances Maintaining Cardiorespiratory Fitness Most neglected aspect of rehabilitation Cardiorespiratory fitness rapidly during periods of inactivity Alternative activities should be substituted to minimize the decrements in fitness levels Functional Progression Gradual progressive activities designed to prepare for return to play Skill progression/reacquisition within limitation of injury and rehab Functional progression will help injured athlete return to normal pain-free ROM, strength th and NM control Progression based on injury response Beam, J. W. (2002). Rehabilitation including sport-specific functional progression for the competitive athlete. Journal of Bodywork and Movement Therapies, 6(4),

9 Functional Testing Drills assess athletes ability to perform a specific activity May involve single maximal effort Commonly used tests Agility runs Sidestepping Vertical jump Hops for distance/time Functional loading patterns Co-contraction test Lindstedt, S.L. et al. (2001). When active muscles lengthen: Properties and consequences of eccentric contractions. News in Physiological Sciences, 16(6), Criteria for Full Recovery What is complete recovery? Restoration to normal function all aspects Determined by nature of injury and philosophy of physician and athletic trainer Based on objective and subjective criteria Strength testing and questionnaires Functional tests Physician has the final say in return to play Do you have a Return-to-Play Criteria? Clover, J., & Wall, J. (2010). Return-to-play criteria following sports injury. Clinics in Sports Medicine, 29(1), Factors to Consider Prior to Return to Play Physiological healing Pain status Swelling Range of motion Strength Neuromuscular control Cardiorespiratory fitness Sports-specific demands Functional testing Strapping and bracing Responsibility of athlete Predisposition to injury Psychological factors Athlete education 9

10 Documentation in Rehabilitation Detailed records must be maintained Injury evaluations Treatment records Progress notes Lawsuits and malpractice Clinical setting record keeping critical for third-party billing While time consuming it can not be neglected 10