Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Rehabilitation exercise Lecture 4 Essential Considerations in Designing a Rehabilitation Program for the Injured Athlete FDSc FISM year 1 Janis Leach Session Outcomes ► At the end of this session you should be able to: ► Recognise the phases/stages of rehabilitation. ► Recognise the criteria for progression through the stages. ► Design a rehabilitation program. The Rehabilitation Team ► Group effort Sports Therapist Athlete Physician Coaches ► ► Sports Therapist Responsibilities Injury prevention Recognition, evaluation and assessment Immediate care Treatment and rehabilitation of injuries Rehabilitation program design Philosophy of Sports Medicine Rehabilitation ► Communication is critical on all levels ► Trust and confidence involved in the working relationship must evolve Goal directed approach Involving multiple individuals ► All parties must be involved in the rehabilitation process and must communicate effectively at every level of athletic participation The Healing Process ► Progression through rehabilitation should be based on injury healing ► Sports Therapists must possess an understanding of time sequences and physiological events associated with healing process ► The Sports Therapist must create an environment conducive to the healing process SAID principle ► Exercise Intensity SAID principle – Specific Adaptations to Imposed Demands ►Ability of the body to adapt to stress and overload imposed on it ►Critical to consider during rehabilitation ►Indications of having applied too much stress: Pain, swelling, loss or plateau in strength or range of motion, increased laxity in healing ligaments ►As healing progresses exercise intensity should increase Understanding Mechanics of Injury ► Due to injury normal joint and anatomic function is compromised ► Adaptive changes occur resulting in alterations in biomechanics ► A background in anatomy and biomechanics is critical in defining a rehabilitation program ► Must have the ability to identify adaptive or compensatory actions resulting from injury and correct the mechanism of movement Understanding the Psychological Aspect of Rehabilitation ► ► ► Critical factor that is often neglected and overlooked Injury/illness produce a variety of emotional responses Athlete’s vary on: pain threshold cooperation anger fear ► competitiveness compliance depression guilt The psychological aspect can also play an important role in performance enhancement Development of Athletic Injury Rehabilitation Programs ► A well-designed injury rehabilitation program should include three basic components 1. Identifiable, sequential phases individualised progression 2. Specific therapeutic objectives 3. Measurable and objective criteria for progression to the next phase 4. Knowledge of ROM at each joint ROM examples ► Ankle dorsi flexion – up to 20 degrees ► Knee – 150 degrees - flexion ► Shoulder ► Wrist – 180 degrees – flexion extension – 70 degrees Phases of Rehabilitation ► Immediate post injury (Phase 1) ► Acute stage (Phase 2) ► Sub-acute (Phase 3) ► Active rehabilitation (Phase 4) ► Functional rehabilitation (Phase 5) Phase 1 - Immediate ► Aims of treatment Initial first aid SALTAPS Possible referral Phase 2 (Acute) ► 0-48 hours post injury PRICE regime Signs and symptoms Pain Swelling Redness Heat Lack of function Importance of Controlling Swelling ► Initial injury management an swelling control is critical ► Swelling can result in increased pressure to the injured area, causing pain and altered neuromuscular function ► Swelling slows the healing process and normal function is not regained until swelling is eliminated ► To limit swelling the PRICE principle should be applied Phase 3 (Sub-acute) ► Therapeutic Objectives Limit inflammatory response and minimise effects of immobilisation Teach correct walking techniques Assist in the healing process using therapeutic modalities Maintain muscular strength and minimise muscular atrophy Minimise adhesions to the injured area Maintain overall fitness level Phase 3 ► Therapeutic Objectives Promote the healing process Early NWB mobilisations of the joint Increase flexibility Early NWB strengthening of muscles Recommendations for home care Phase 3 ► Completing aims of phase 3 Continue with cryotherapy NWB exercises Walking aids Compression bandaging Stretching and mobilising Phase 3 ► Before progression to phase 4, these aims should be addressed; Increase in ROM Increase in strength Increase in extensibility Scar tissue laid down to ensure that new fibres lay along lines of muscle stress Awareness of dietary requirements Phase 4 (Active Rehabilitation Stage) ► Aims of this phase of treatment Progression from NWB – PWB Taping techniques Maintenance of rest of body fitness Phase 4 ► Criteria for Progression to Phase 5 Sufficient reduction in local symptoms (pain, swelling, etc) and wound healing to allow for a safe return to competition Sufficient restoration of joint ROM, muscle strength, muscle endurance, gait mechanics, and fitness level to return to competition level Sufficient protection from re-injury by taping and/or bracing, safety of playing environment, and modification of practice activities Satisfactory motivation and confidence of the athlete Phase 5 (Functional Rehabilitation Phase) ► Definition The time period in the injury process when return to play/functional activities resume ► Therapeutic Objectives Continue to restore full ROM, strength, endurance, and flexibility necessary for full participation in the sport Continue development of overall fitness level Phase 5 ► Therapeutic Objectives Re-establish normal motor patterns specific to sports participation Restore athlete’s confidence in their ability to return to their sport Restore cardiovascular fitness to pre-injury levels ► Criteria for Progression Restore all components of normal physiologic function (strength, ROM, etc.) to optimal levels Resumption of unrestricted activity Re-establishing Neuromuscular Control Joint position sense is involved via mechanoreceptors ► Neuromuscular control relies on the CNS to interpret and integrate proprioceptive and kinesthetic information, translating it into coordinated motion ► Injuries alter this ability ► Early stages of rehabilitation involves regaining previously established sensory patterns ► Practice is required until the patterns become automatic ► Restoring Range of Motion ► Loss of range of motion is associated with Resistance of musculotendinous units Connective tissue stretch contractures Muscle/postural imbalances Neural tension Joint dysfunction ► Physiological movement constraints must be determined and treated accordingly Stretching Joint mobilisation & traction Maintenance ► Definition The time period after rehabilitation is complete and full activity is resumed, but during which specific conditioning and maintenance exercises may be performed to ensure continued safe participation Maintenance ► Therapeutic Objectives Maintain muscular strength in the affected area to levels equaling the unaffected side Maintain flexibility in the affected area to levels equaling the unaffected side Maintain muscular endurance in the affected area to a level consistent with the demands of the sport Maintain neuromuscular pathways Establishing Goals ► Rehabilitation should be goal directed ► Short term goals Provide immediate first aid and care Reduce/minimise pain Restore full range of motion Restore increase strength, endurance and power Improve postural stability and balance Maintain cardiovascular fitness Follow a functional progression ► Long term goal = return to play Practical session ►In groups of 3 research exercises for the ankle and access a journal on ankle rehab to help with this (Or find a suitable text book) ►Work on a 20 minute exercise routine for the foot and ankle in the NWB phase (Phase 2). This will be presented to the rest of the group.