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Therapeutic Exercises Chapter 7 Therapeutic Exercises Goal is to return injured athlete to pain-free full function participation. Areas of Focus: Pain Modulation Normal ROM Kinematics Flexibility Muscular Strength Endurance Coordination Power Rehabilitation Areas Psychological Physical Emotional Social Performance Cognitive Model Personal Factors Performance Anxiety Self-esteem/motivation Extroversion/ Introversion Psychological Investment Coping resources History with stress Previous intervention Cognitive Responses Outcome of the Situational Factors Type of Sport Relationship with coach and team Timing of the injury Level and intensity of the player Point in athletes career Role on the team Emotional Responses Behavioral Responses Rehabilitation Kubler-Ross Emotional Stages Denial Isolation Anger Bargaining Depression Acceptance Goal Setting Specific and measurable Positive rather than negative Challenging yet realistic Established time table for completion Integration of shortintermediate- and long term goals Personalized and internalized Monitored and evaluated LINKED TO LIFE GOALS!!! Factors that Inhibit Progress Lack Lack Lack Lack of of of of Knowledge Skill Risk-Taking Ability Social Support Psychological Influences Confidence Motivation Anxiety Focus Management of Pain Confidence Program Confidence Adherence Confidence Physical Confidence Return-to-sport Confidence Motivation Poor Attendance Incomplete Exercises Low Effort Low Intensity Lack of Attentiveness to Instructions Undefined Goals Using Pain to Avoid Exercise Unsupportable Excuses Anxiety Caused by pain, slow healing, low confidence, pressure, lack of familiarity, predictability, and control Signs: Physical Cognitive Emotional Social Performance Focus Ability to perceive and address various internal and external cues. Athlete should focus on: Positive attributes Present time The Process of their rehabilitation Their individual Progress Pain Benign pain Harmful pain Use a variety of methods to deal with pain. The Rehabilitation Process Phase I Assess the Patient Interpret the Assessment Establish Goals Develop and Supervise the Treatment Plan Reassess the Progress of the Program Inflammation Control CRIPES ROM Cardiovascular Fitness Affects on: Muscle Articular cartilage Ligaments Bone Remobilization Phase II Wolff’s Law Affects on: Muscle Articular Cartilage Ligaments Bone Restoration of Motion Cryokinetics PROM AROM Joint Mobilization Grade Grade Grade Grade Grade I II III IV V Flexibility Agonist Antagonist Ballistic Stretching Static Stretching Proprioceptive Neuromuscular Facilitation (PNF) Active Inhibition Contract-Relax Reciprocal Inhibition Muscle/Movement Reeducation AAROM AROM RROM Proprioception Closed kinetic chain exercises (CKC) Open kinetic chain exercises (OKC) Muscular Strength, Endurance and Power Phase III Muscular Strength Isotonic Isokinetic Muscular Endurance Muscular Power Functional Exercise Rehabilitation Guidelines Intensity Duration Frequency Specificity Speed Progression Sport Specific Functioning Phase IV Coordination Sport Specific Skill Conditioning Cardiovascular Endurance