Download Rehabilitation and Reconditioning Strategies

chapter
22
Rehabilitation
and Reconditioning
Chapter Objectives
• Identify members of the sports medicine team and
their responsibilities during injury rehabilitation
and reconditioning.
• Recognize types of injuries athletes sustain.
• Comprehend timing and events of tissue healing.
• Understand goals of each tissue healing phase.
• Describe the strength and conditioning professional’s role during injury rehabilitation and
reconditioning.
Rehabilitation and Reconditioning
• Principles of Rehabilitation and Reconditioning
– Healing tissues must not be overstressed.
– The athlete must fulfill specific criteria to progress from
one phase to another during the rehabilitative process.
– The rehabilitation program must be based on current
clinical and scientific research.
– The program must be adaptable to each individual and his
or her specific requirements and goals.
– Rehabilitation is a team-oriented process requiring all the
members of the sports medicine team to work together.
Sports Medicine Team
• Sports Medicine Team Members
– All members of the sports medicine team are
responsible for educating coaches and athletes
regarding injury risks, precautions, and treatments.
– The sports medicine team also works to prevent
injuries and rehabilitate injured athletes.
– Several different professionals play important roles
in assisting an injured athlete’s return, so effective
communication is necessary.
Key Terms
• team physician: A person that provides medical care to an organization, school, or team.
• athletic trainer: A person typically responsible
for the day-to-day physical health of the athlete;
certified by the National Athletic Trainers’
Association Board of Certification as a Certified
Athletic Trainer (ATC).
Key Terms
• physical therapist: A person with a background in orthopedics or sports medicine that
can play a valuable role in reducing pain and
restoring function to the injured athlete.
Key Terms
• strength and conditioning professional:
A person who plays a valuable role within the
sports medicine team and is an integral part of
the rehabilitation and reconditioning process.
Ideally, this person should be certified by the
National Strength and Conditioning Association
(NSCA) Certification Commission as a Certified
Strength and Conditioning Specialist (CSCS) to
ensure that he or she has the knowledge and
background to contribute to the rehabilitation
process.
Key Terms
• exercise physiologist: A person who has a
formal background in the study of the exercise
sciences and uses his or her expertise to assist
with the design of a conditioning program that
carefully considers the body’s metabolic
response to exercise and the ways in which
that reaction aids the healing process.
Key Terms
• nutritionist: A person who has a background in
sport nutrition may provide guidelines regarding proper food choices to optimize tissue
recovery. Ideally, the nutritionist has been
formally trained in food and nutrition sciences
and is a Registered Dietitian (RD) recognized
by the American Dietetic Association.
Key Terms
• psychologist or psychiatrist: A licensed
professional with a background in sport may
provide strategies that help the injured athlete
better cope with the mental stress accompanying an injury.
Sports Medicine Team
• Communication
– Strength and conditioning professionals must
understand the following:
• The diagnosis of the injury
• Indications—forms of treatment required
• Contraindications—activity or practice prohibited
due to the injury
– They must also inform the rest of the sports
medicine team about the exercises performed by the
athlete and the athlete’s response to the exercise.
Key Point
• 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.
Types of Injury
• Macrotrauma: A specific, sudden episode of
overload injury to a given tissue
• Dislocation: A complete displacement of the
joint surfaces
• Subluxation: A partial displacement of the joint
surfaces
• Sprain: Trauma to a ligament, classified as 1st,
2nd, or 3rd degree depending on severity
(continued)
Types of Injury (continued)
• Contusion: A musculotendinous injury caused
by direct trauma
• Strain: Tears in the muscle fibers caused by
indirect trauma that are classified into 1st, 2nd,
or 3rd degree based on severity
• Microtrauma: An overuse injury caused by
repeated, abnormal stress applied to a tissue
by continuous training or training with too little
recovery time
(continued)
Types of Injury (continued)
• Stress fracture: The most common type of
overuse injury that occurs in bones
• Tendinitis: An overuse injury that results in
inflammation of a tendon
Tissue Healing
• All tissues follow the same basic pattern of
healing:
– Inflammation
– Repair
– Remodeling
(continued)
Tissue Healing (continued)
• The timing of events within each phase of
tissue healing differs for each tissue type
and is affected by a variety of factors:
–
–
–
–
Age
Lifestyle
Degree of injury
The structure that has been damaged
Key Point
• The process of returning to competition
following injury involves
– Healing of the injured tissues
– Preparation of these tissues for the return to function
– Use of proper techniques to maximize rehabilitation
and reconditioning
Table 20.1
Tissue Healing
• Inflammatory response phase
– Inflammation is the body’s initial reaction to injury
and is necessary for normal healing to occur.
– The injured area will become red and swollen.
• Fibroblastic repair phase
– Once the inflammatory phase has ended, tissue
repair begins; this phase allows the replacement of
tissues that are no longer viable following injury.
– This phase of tissue healing begins as early as 2
days after injury and may last up to 2 months.
(continued)
Tissue Healing (continued)
• Maturation–remodeling phase
– The weakened tissue produced during the repair
phase is strengthened during the remodeling phase
of healing.
– Tissue remodeling can last up to 2 to 4 months after
injury.
Key Point
• Healing tissue must not be overstressed,
but controlled therapeutic stress is
necessary to optimize collagen matrix
formation. The athlete must meet specific
objectives to progress from one phase of
healing to the next.
Rehabilitation and
Reconditioning Strategies
• Goals of Rehabilitation and Reconditioning
– Choose a level of loading that neither overloads
nor underloads healing tissue.
• Healing tissue must never be overstressed.
• But, controlled therapeutic stress is needed to
optimize collagen matrix formation.
– The athlete must meet specific objectives
(established by the physician, athletic trainer,
physical therapist, or a combination of these) to
progress from one phase of healing to the next.
Goals of Rehabilitation
and Reconditioning
• Inflammatory response phase
– Treatment goal
• Preventing disruption of new tissue
– Exercise strategies
• General aerobic and anaerobic training and
resistance training of uninjured extremities, with
priority given to maximal protection of the injured
area
(continued)
Goals of Rehabilitation
and Reconditioning (continued)
• Fibroblastic repair phase
– Treatment goal
• Preventing excessive muscle atrophy and joint
deterioration in the injured area; maintaining muscular
and cardiovascular function in uninjured areas
– Exercise strategies (after consultation with team
physician, athletic trainer, or physical therapist)
• Submaximal isometric exercise
• Isokinetic exercise
• Specific exercises to improve neuromuscular control
Goals of Rehabilitation
and Reconditioning (continued)
• Maturation–remodeling phase
– Treatment goal
• Optimizing tissue function by continuing and progressing
the activities performed during the repair phase and
adding more advanced, sport-specific exercises
– Exercise strategies
• Transition from general exercises to sport-specific
exercises
• Specificity of movement speed an important variable
• Velocity-specific strengthening exercises (velocities
must progress to those used in the athlete’s sport)
Loading During Rehabilitation
Figure 20.3
Soft Tissue Injury Response
Figure 20.4
•
•
Pain is often used as a guide for tissue health.
Pain levels often decrease well before tissue healing is
complete, which may lead athletes to believe they can return
to competition before the body is actually ready.
Rotator Cuff Rehabilitation
Figure 20.5a and b
• Exercises generally transition from
– (a, b) isolation exercises to (c, d) multijoint, sport-specific exercises.
Key Term
• closed kinetic chain: An exercise in which
the terminal joint meets with considerable
resistance that prohibits or restrains its free
motion; that is, the distal joint segment is
stationary. Typically a weight bearing exercise.
Closed Kinetic
FigureChain
20.6 Exercises
Squat (a) and Push-up (b)
Key Term
• open kinetic chain: An exercise that uses a
combination of successively arranged joints in
which the terminal joint is free to move; open
kinetic chain exercises allow for greater
concentration on an isolated joint or muscle.
Open Kinetic Chain Exercise
(Seated
Knee20.7
Extension)
Figure
Kinetic Chain: Sprinting
Figure 20.8
• Sprinting offers an example of open and closed
kinetic chain movements occurring together.
Rehabilitation and
Reconditioning Strategies
• Program Design
– Resistance Training
• Several programs have been developed to assist with
the design of resistance training programs for injured
athletes, including the De Lorme and Oxford programs
and Knight’s DAPRE (Daily adjustable progressive
resistive exercise) program.
• DAPRE allows more manipulation of intensity & volume.
• The demands of the athlete’s sport determine the
training goal, which should dictate the design of the
resistance training program during the remodeling
phase.
Rehabilitation and
Reconditioning Strategies
• Program Design
– Resistance Training
• (DAPRE) system
– First set requires 10 repetitions of 50% of the estimated
1RM.
– Second set requires six repetitions of 75% of the
estimated 1RM.
– Third set requires the maximum number of repetitions
of 100% of the estimated 1RM.
– The number of repetitions performed during the 3rd set
determines the adjustment to be made in resistance for
the 4th set.
Table 20.2
Rehabilitation and
Reconditioning Strategies
• Program Design
– Aerobic and Anaerobic Training
• Although research has yet to determine an
optimal aerobic training program for use in the
rehabilitation setting, the program should mimic
specific sport and metabolic demands.
Key Point
• 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 will allow the quickest return to
competition.
Reducing Risk of Injury
and Reinjury
• Previous injury is the most substantial risk
factor for future injury in active individuals.
• Risk factors for upper extremity injury
– Decreased glenohumeral ROM
– Scapular dyskinesis
– Decreased shoulder strength
(continued)
Reducing Risk of Injury
and Reinjury (continued)
• Risk factors for lower extremity injury
– Decreased balance
– Decreased neuromuscular control during jump
landing
– Decreased lower extremity muscle strength
• Structured programs should be specific to
sport demands.