Chapter 12 - Basics of Injury Rehabilitation

1. Chapter 12 - Basics of Injury Rehabilitation

2. Philosophy of Athletic Injury Rehabilitation • Injury is the nature of sport • Most injuries do not require a long term rehab • Long term rehabs must be safe and effective • Athletics are competitive and thus necessitate an aggressive rehab • Goal is to return as soon as possible • Thin line between not pushing hard enough and being to aggressive

3. Goals of a Rehabilitation Program • Short term goals are: • 1 - Provide correct immediate first aid and management following injury to limit or control swelling • 2 - Reducing or minimizing pain • 3 - Restore full ROM • 4 - Restoring or increasing muscular strength, endurance, and power • 5 - Reestablishing neuromuscular control • 6 - Improve balance • 7 - Maintaining cardiorespiratory fitness • 8 - Incorporating appropriate functional progressions

4. Providing Correct First Aid and Controlling Swelling • Most critical • Should be directed towards controlling swelling • RICE principle

5. Controlling Pain • Amount of pain is determined by extent of injury, individual’s response or perception of pain, and circumstances of the injury • RICE for acute pain • Appropriate modalities can be used during rehab to help with pain

6. Restoring Range of Motion • Injury always results in some loss of ROM • Stretching

7. Restoring Muscular Strength, Endurance, and Power • Most important factors in returning to normal activities • Always work in a full, pain-free ROM

8. Isometric Exercise • Commonly performed in early phases of rehab when a joint is immobilized • Useful when exercises in the full ROM will make the injury worse • Increase static strength and decrease atrophy • May lessen swelling by pumping action

9. Progressive Resistance Exercise • PRE can be done with free weights, exercise machines, or rubber tubing • Isotonic contractions with muscle changing in length

10. Isokinetic Exercise • Common in later phases of rehab • Uses a fixed speed and accommodating resistance • Speed can be changed • Used for testing, more functional

11. Plyometric Exercise • Often in later stages • Uses a quick eccentric stretch of a muscle and a subsequent concentric contraction of that same muscle • Helps the athlete develop dynamic strength (in motion) • Ability to generate force rapidly is a critical element in athletics

12. Reestablishing Neuromuscular Control • The mind’s attempt to teach the body how to control movement • Mind must read the body and respond efficiently • The CNS forgets how to do things • Strengthening exercises help to retrain pathways

13. Regaining Balance • Rehab must incorporate balance drills to prepare the athlete for return to competition

14. Maintaining Cardiorespiratory Fitness • Usually the most neglected component of rehab • Level decrease rapidly • Must substitute alternate activities (pool, bike, etc)

15. Functional Progressions • Purpose of rehab is to restore normal function • Those skills necessary for a sport are broken down into component parts • If each new activity does not produce pain or swelling, it should be advanced, introducing new activities

16. Functional Testing • Uses functional progression drills to test • Figure 8s, shuttle runs, cariocas, side stepping, vertical jumps, hopping, back pedaling

17. Criteria for Full Recovery • Besides physical well being, the athlete must be confident in returning to participation • The decision should consult opinions of the entire sports medicine team • Team physician is ultimately responsible