C H A P T E R

1. 2 3 C H A P T E R Rehabilitation and Reconditioning

2. Chapter Outline Sports medicine team Types of injury Tissue healing Rehabilitation and reconditioning strategies

3. Principles of Rehabilitation and Reconditioning Healing tissues must never be overstressed. Athlete must fulfill criteria. Program must be based on current research. Program must be adaptable to each individual. Rehabilitation is a team-oriented process.

4. Sports Medicine Team Members Team physician Athletic trainer Physical therapist Strength and conditioning professional Exercise physiologist Nutritionist Psychologist or psychiatrist

5.  The sports medicine team includes a large number of professionals working together to provide an optimal rehabilitation and reconditioning environment. The relationship among members requires thoughtful communication to ensure a safe, harmonious climate for the injured athlete.

6. Types of Injury Macrotrauma: caused by a specific, sudden episode of overload injury to a tissue; results in disrupted tissue integrity Microtrauma: caused by repeated, abnormal stresses applied to a tissue through continuous training or training with too little recovery time

7. Tissue Healing: Inflammation Phase Pain, swelling, and redness Decreased collagen synthesis Increased number of inflammatory cells

8. Tissue Healing: Repair Phase Collagen fiber production Decreased collagen fiber organization Decreased number of inflammatory cells

9. Tissue Healing: Remodeling Phase Proper collagen fiber alignment Increased tissue strength

10. Rehabilitation and Reconditioning Goals and Strategies: Inflammation Prevention of new tissue disruption and prolonged inflammation. Function of cardiorespiratory and surrounding neuromusculoskeletal systems must be maintained. No active exercise for injured area.

11. Rehabilitation and Reconditioning Goals and Strategies: Repair Prevention of excessive muscle atrophy and joint deterioration. Function of neuromusculoskeletal and cardiorespiratory systems must be maintained. Possible exercises include - submaximal isometric, isokinetic and isotonic exercise and - balance and proprioceptive training activities.

12. Rehabilitation and Reconditioning Goals and Strategies: Remodeling Optimization of tissue function Progressive loading of neuromusculoskeletal and cardiorespiratory systems Possible exercise options: - joint-angle specific strengthening - velocity-specific muscle activity - closed and open kinetic chain exercises - proprioceptive training activities

13.  Designing strength and conditioning programs for injured athletes requires the strength and conditioning professional to examine the rehabilitation and reconditioning goals to determine what type of program allows the quickest return to competition.

15. DeLorme’s method Based on repetition maximum of 10 Designed for early rehab Designed for beginning rehab Introduced PRE – “progressive loading” Builds in warm-up period MacQueen’s method Utilizes varying sets for beginning/intermediate & advanced Set of 10 RM Oxford method Used during early, intermediate & advanced levels of rehabilitation Percentages of 10 RM Diminishes resistance as muscle fatigues – “regressive load” Sander’s program Utilized in advanced stages of rehabilitation Utilizes percentages of body weight Resistance Training Techniques Used in Rehabilitation

16. Knight (DAPRE) Daily Adjustable Progressive Resistive Exercise Adjusted based on individual’s progress Based on 6 RM working weight Berger Adjusts within individual’s limitations Should allow for 6-8 RM repetitions on 60-90 seconds Must be able to achieve 3 sets of at least 6 RM and no more than 8 RM Increases occur in 10% increments For rehabilitation Base program on pain and healing process Should be performed daily early on Reduce workout to every other day as progress is made

17. Isokinetic Exercise • Involves muscle contractions where length change of muscle is set at a constant velocity • Maximal resistance throughout the range of motion • Variety of machines/manufacturers are available • Can be used with eccentrics & concentric exercise

18. Isokinetics as a Conditioning Tool • Maximal effort for maximal strength gains • Dynamometer will move at a set speed whether maximal or half of maximal effort is put forth • Athlete can cheat with machine and not put forth the effort • Not cost effective • Isokinetics in Rehabilitation • Gained popularity in rehabilitation during the 1980’s • Provide objective means of athlete/patient evaluation • Training at fast vs. slow speeds • Functional speeds

19. De Lorme Program • Uses 3 sets of 10 repetitions • 1st set: 10 reps of 50% of 10RM • 2nd set: 10 reps of 75% of 10RM • 3rd set: 10 reps of 100% of 10RM • The Oxford system is the reverse of De Lorme, it progresses from heavy to light

20. Daily Adjustable Progressive Resistance Exercise (DAPRE by Ken Knight) • DAPRE involves four sets with repetitions ranging from 10 to possibly 1 during the final set. • 1st set: 10 reps of 50% of 1RM • 2nd set: 6 reps of 75% of 1RM • 3rd set: maximum number of reps of 100% of 1RM • The number of repetitions performed in the 3rd set determines the adjustments to be made in the fourth set. (Table 23.2, p 542).