Rehabilitation

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Rehabilitation ReconditioningCh. 23
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Sports Medicine Team

• All members responsible for educating coaches
  athletes regarding injury risks, precautions,
  treatments
• Must also prevent injuries rehab those already
  sustained
• Several different professionals play role in
  assisting injured athlete to playing field

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• Team Physician- provides medical care to
  organization, school, or team
• Makes final determination of athletes readiness
  for return to competition
• Responsibilities may also include injury
  prevention, supervision of athletes during games,
  injury illness education diagnosis, referral
  to other professionals as needed
• Family, orthopedic, etc.
• Also prescribes medications as needed
  anti-inflammatories, pain, cold, etc.

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• Athletic Trainer- person typically responsible
  for day-to-day physical health of athlete
• Works under supervision of team physician
• Responsibilities include acute injury mgmt.,
  rehab, application of prophylactic treatment,
  including preventive exercise equipment (tape
  brace), serves as administrator for sports
  medicine team
• Since has significant amount of contact with
  athlete, key role in promoting communication of
  sports medicine team, coach, athlete

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• Physical Therapist- background in orthopedics or
  sports medicine
• Typically in clinics have close relationship
  with variety of medical specialists
• Consulted for specific treatment strategies or
  supervise long-term rehab
• Becoming more involved with sports

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• Strength Conditioning Professional
• Consults with ATC or PT uses understanding of
  proper technique application of several types
  of exercises to develop conditioning program to
  ready injured athlete for return to competition
• Exercise Physiologists
• Uses expertise in exercise science to assist with
  design of conditioning program that considers
  bodys metabolic responses to exercise how
  reaction aids healing process

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• Nutritionist
• Provide guidelines regarding proper food choices
  to optimize tissue recovery
• Psychologist
• Provide strategies that help injured athlete
  better cope with mental stress accompanying an
  injury

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Communication

• Communication between SMT is essential
• ST C pro. deals mostly with ATC
• ST C pro. must understand diagnosis of injury
  ex. indication contraindication
• Indication- form of treatment required by
  rehabing athlete
• Contraindication- activity that is inadvisable or
  prohibited due to given injury

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Types of Injury

• Macrotrauma- specific, sudden episode of overload
  injury to given tissue, resulting in disrupted
  tissue integrity
• Bone trauma- can lead to contusion or fracture
• Skeletal fractures can result from direct blow
  be given variety of classifications (closed,
  open, avulsed, incomplete)

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• Joint trauma- may result in laxity or instability
• Dislocation- complete displacement of jt.
  surfaces
• Subluxation- partial displacement of jt. surfaces
• Ligamentous trauma- termed sprain
• 1st degree- partial tear of lig. without
  increased jt. laxity
• 2nd degree- partial tear with minor joint
  instability
• 3rd degree- complete tear with full joint
  instability

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• Musculotendinous trauma-
• Contusion- direct trauma
• Area of excess accumulation of blood fluid in
  tissues surrounding injured muscle
• May severely limit injured muscles mvmt. (ROM)

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• Strains- indirect trauma, tears of muscle fibers
• 1st degree- partial tear of individual fibers
• Characterized by strong, but painful muscle
  activity
• 2nd degree- partial tear with weak
• Painful muscle activity
• 3rd degree- complete tear of fibers
• Very weak, painless muscle activity

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• Tendon- can rupture if tensile load applied
  exceeds its limit
• Tendons collagen fibers stronger than muscle
  fibers
• Failure occurs more within muscle belly,
  musculotendinous junction, or tendons attachment
  to bone than within tendon itself

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• Microtrauma- overuse injury
• Results from repeated, abnormal stress applied to
  tissue by continuous training with too little
  recovery time
• May be due to
• Training errors (poor program design)
• Suboptimal training surfaces (too hard or uneven)
• Faulty biomechanics or technique during
  performance
• Insufficient motor control
• Decreased flexibility
• Skeletal malalignment predisposition

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• 2 most common overuse injuries
• Bone- stress fracture
• From body type structure often from excessive
  volume on hard surfaces
• Tendinitis- inflammation of tendon
• If cause left uncorrected, chronic tendinitis or
  tendinopathy may develop
• Each injury requires specific rehab strategies to
  allow return to function

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Tissue Healing

• Severity rate of events occurring within each
  phase are different for each tissue type
• But, all tissues follow same basic pattern of
  healing
• 3 phases inflammation, repair, remodeling
• Phases overlap one another

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Inflammation Phase

• Inflammation- bodys initial reaction to injury
• Necessary for normal healing to occur
• Injured area becomes red swollen due to
  increased blood flow, changes in vascularity,
  capillary permeability
• Hypoxic environment lead to tissue death
• Release of histamine bradykinin- increases
  blood flow capillary permeability
• Edema created escapes into surrounding tissue
• Inhibits contractile tissue limit athletes
  function

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• Phagocytosis increased blood flow removes
  tissue debris pathogens
• Macrophages- search for remove cellular debris
  that may slow healing
• Inflammatory substances stimulate sensory nerve
  fibers causing athlete to sense pain can
  decrease function
• Typically lasts 2-3 days
• can last longer depending on blood supply
  structural damage
• If lasts too long, delays rehab process

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Repair Phase

• Allows replacement of tissues that are no longer
  useable
• Original, damaged tissue regenerated scar
  tissue formed
• New capillaries connective tissue form in area,
  collagen randomly laid down to serve as
  framework for repair

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• Collagen positioned randomly, alignment not
  optimal for sufficient strength
• Strongest when laid down longitudinally to line
  of stress, ones laid down transversely limit
  ability to transmit force
• Phase starts as early as 2 days after injury
  can last up to 2 months

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Remodeling Phase

• Weakened tissue produced in repair phase is
  strengthened, improves structure function
• Production of collagen fibers decreased
• Increased loading allows collagen of scar tissue
  to hypertrophy align themselves along lines of
  stress

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• The thicker better aligned collagen fibers are
  the stronger they become allow athlete to
  return to function
• New tissue will never be as strong as tissue it
  replaced
• Can last 2 months up to a year

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Rehabilitation Reconditioning Strategies

• Consider athletes subjective response
  physiological mechanisms of tissue healing
• Process of return to competition involves healing
  of tissues, preparation of tissues to function,
  use of techniques to maximize rehab
  reconditioning

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• Each athlete responds differently to injury, each
  rehab progresses uniquely
• Healing tissue must never be overstressed
• Athlete must meet specific objectives to progress
  from one phase of healing to next
• ROM, strength, activity

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Inflammation phase goals strategies

• Prevention of new tissue disruption prolonged
  inflammation with use of relative rest passive
  modalities
• R.I.C.E.- Rest, Ice, Compression, Elevation
• Function of cardiorespiratory surrounding
  neuromusculoskeletal systems must be maintained
• No active exercise for injured area
• ATC provides most of treatment during this phase

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Repair phase goals strategies

• Prevention of excessive muscle atrophy joint
  deterioration of injured area
• Function of neuromusculoskeletal
  cardiorespiratory systems must be maintained
• Possible exercise options include
• Submaximal isometric, isokinetic, isotonic ex.
• Balance proprioceptive training activities
• Proprioception- ability of muscle to respond to
  abnormal positions situations
• Provides sense of jt. position mvmt

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Remodeling phase goals strategies

• Optimization of tissue function
• Progressive loading of neuromusculoskeletal
  cardiorespiratory systems as indicated
• Possible exercise options include
• Joint-angle specific strengthening
• Velocity-specific muscle activity
• Closed open kinetic chain exercises
• Proprioceptive training activities

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• Kinetic Chain- combination of several
  successively arranged joints working together to
  successfully complete desired motor task of body
• Closed kinetic chain- exercise in which distal
  joint segment is stationary on ground, wall, etc.
• Open kinetic chain- exercise is combination of
  successively arranged joints in which distal
  joint is free to move

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Program Design

• Same principles used to design aerobic RT
  programs for uninjured athletes should be used
  during rehab reconditioning
• Resistance Training- several programs have been
  developed to assist with design of RT programs,
  many have been advocated for use in rehab setting
• DeLorme Watkins
• Oxford
• Daily Adjustable Progressive Resistive Exercise
  (DAPRE)

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DeLorme Watkins Strength Progression

• Set Reps
  Weight
• 1 10
  50 of 10RM
• 2 10
  75 of 10RM
• 3 10
  100 of 10RM

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Oxford Technique of Strength Progression

• Set Reps
  Weight
• 1 10
  100 of 10RM
• 2 10
  75 of 10RM
• 3 10
  50 of 10RM

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DAPRE System of Strength Progression

• Set Reps
  Weight
• 1 10 50 of
  working wt.
• 2 6 75 of
  working wt.
• 3 as many as possible 100 of
  working wt.
• 4 as many as possible adjusted
  from 3rd set
• Adjustment guidelines next slide

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DAPRE adjustment guidelines

• of reps done 4th set wt.
  Next day wt.
• in prior set based on 3rd set
  based on 4th set
• 0-2 decrease wt.redo set
  decrease wt.redo set
• 3-4 decrease by 0-5 lb.
  keep same
• 5-7 keep same
  increase by 5-10 lb.
• 8-12 increase by 5-10 lb.
  increase by 5-15 lb.
• 13 or more increase by 10-15 lb.
  increase by 10-20 lb.

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• Aerobic Training- designing implementing proper
  conditioning exercises to stress this energy
  system following indications contraindications
  of the particular injury rehabilitation phase
  of athlete
• No specific training program out there
• Use Upper Body Ergometer (UBE), bike, pool, etc.