GUNGAHLIN COLLEGE

1. GUNGAHLIN COLLEGE Human Movement SPORTS INJURIES REHABILITATION

2. Objective • To return the player to their previous level of fitness, skill and competition. Return to play should only occur when the player has a pain free, full range of movement in the game situation.

3. Overview – Rehabilitation Program • Muscle and joint flexibility – is improved by stretching exercises that work the full range of motion. • Strength – exercises begin with an isometric program. As strength improves the athlete can begin concentric/eccentric exercises, which will significantly increase strength. • Proprioception – teach awareness of the position of joints and sense of balance. These begin when the athlete’s joints have established full range of movement and the muscles achieve strength and flexibility. If the athlete does not regain adequate balance sense, there is a significant chance of re-injury. Learning to balance on an unstable surface such as a wobble board develops strength and proprioception. • Muscle endurance – this can start with non-specific exercises such as swimming and rowing and proceed on to more specific exercises for the sport involved. • Motor re-education – as endurance improves, the athlete can start motor re-education to correct any of the problems that may have contributed to an injury. E.g.- a runner with a lack of pelvic control may have increased stress on lower limb muscles and tendons. Re-education can correct this and reduce the risk of further injury. • Drills specific to the sport - the final step in rehabilitation is for the athlete to commence their sport specific drills. E.g.- a sprinter commencing sprinting drills.

4. Recovery time varies according to the: • Tissue injured • Up to 12 weeks – Ligaments/Tendons • Up to 6 weeks – Muscles • 6-12 weeks – Bones/Joints • Severity • Application of initial treatment

5. Treatment (Healing) Flexibility Local Muscular Endurance Strength Proprioception Full Functioning OVERVIEW - Injury Management Procedures & Returning To Play:

6. Treatment • Healing process is facilitated by blood supply • Fibroblasts - Tissue repair • Collagen - Binds damaged tissue with scar tissue, which is inelastic (needs stretching) • Capillaries - Transport damaged tissue away from injury site • Heat Treatment • Stimulates blood flow • Aids in removal of injury debris • Increases elasticity of scar tissue

7. Stretching exercises improve: Muscle & joint flexibility ROM Can begin during treatment in the form of light stretching Stretching Exercises Static or PNF within pain tolerance Flexibility

8. Local Muscular Endurance • Increased neural control & strength • Form of progressive strengthening: • Static (isometric) activities without load • Muscles/joints worked in a fixed position • Static (isometric) exercises with a light load • Muscles are restricted at various joint angles with rubber bands, towels, weights etc • Dynamic exercises • Performed over a ROM allowed by the pain threshold

9. Athlete has re-established full ROM. Coordination & balance exercises Involves relearning: Awareness of joint position A sense of balance ‘Wobble Boards’ – ankle Prevents the reoccurrence of a future injury Proprioception

10. Full Functioning • Sports specific training undertaken • Fitness components have been re-established for competition • Psychological trauma of injury must be overcome • Rebuild self confidence

11. Delayed Onset Muscle Soreness (DOMS) Condition that affects the muscle following strenuous & unaccustomed exercise Results in localised pain & discomfort Usually within 24hrs of exercise – 1 week Associated with explosive types of exercise DOMS

12. DOMS • Causes of DOMS: • Damage to connective tissue due to high tension • Inflammation of muscle fibres • Accumulation of lactic acid • Treatment: • Stretching • Cryotherapy • Ultrasound • Anti-inflammatory Drugs • Non – Weight Bearing Exercise • Eccentric Training

13. Assists in pain relief Decreases muscle spasms & joint stiffness Massage Manual & emergency therapy for use in rehab Justified by it’s promotion of healing process Used in conjunction with other therapies Surgery Ruptured tendons/ligaments E.g. Arthroscope Options…

14. Options… • Electrotherapy • Laser Therapy (No Heat) • < pain, swelling & inflammation = promote healing • Doesn’t produce heat • Interferential Therapy (No Heat) • Electrical current applied through cups • Stimulate circulation & < pain • Infrared • Ultrasound • High frequency sound waves - break fluid • Heat & vibrate tissues

15. Involves inserting very fine needles into the skin Promotes blood flow Very effective in a wide range of conditions Dry Needling

16. Therapeutic Massage • Oldest & simplest forms of therapy • Excellent method of inducing relaxation • Helps reduce: • Blood pressure • Stress • Anxiety levels • Beneficial to the immune system

17. Massage • Other forms include: • Remedial Massage • Sports Massage

18. Use of water to maintain health or promote healing. Ice, steam, hot, tepid, & cold water are all used in different ways Encourages circulation Dilation and constriction of blood vessels Benefits: Treats wounds & burns Provides pain relief Facilitates physical rehabilitation Promotes relaxation Hydrotherapy

19. The following check list will help determine if an athlete is ready to return to sport. • The injured area: • Should be allowed adequate time to heal • Should move fully, freely and without pain • Should have no swelling • Should have adequate proprioception • The athlete generally: • Should have adequate fitness • Should have regained skills specific to their sport • Should have corrected any biomechanical abnormalities that could contribute to future problems • Should be confident in their ability to return to sport and psychologically ready to go • Should be educated in injury prevention

20. Common mistakes with rehabilitation • Focusing on the single injured area/muscle only. • Often rehabilitation is not continued until the injured side is equal to the uninjured side. • Proprioception exercises are often neglected. • Postural defects, anatomical alignment and biomechanical technique are often overlooked. • Specific sports skills are often not incorporated into the rehabilitation programme.