Download Presentation Package

chapter
Rehabilitation and Reconditioning
12
Open vs. Closed Chain
Exercises in
Rehabilitation
Macrotrauma
• Macrotrauma is a specific, sudden episode
of overload injury to a tissue, resulting in
disrupted tissue integrity.
– Dislocation/subluxation: the complete/partial
separation of surfaces within a joint
– Sprain: trauma to a ligament
– Strain: indirect musculotendinous trauma resulting in
tearing of fibers
– Contusion: direct trauma to soft tissue resulting in an
excess blood and fluid accumulation
Microtrauma
• Microtrauma results from repeated,
abnormal stresses applied to a tissue by
continuous training or training with too little
recovery time; overuse injury
– Stress fracture: small bone breaks usually resulting
from excessive training on hard surfaces
– Tendonitis: inflammation of a tendon
– Tendonosis: degeneration of the tendon caused by
chronic inflammation
Table 20.1
Tissue Healing
• Inflammation Phase
– Inflammation is the body’s initial reaction to injury
and is necessary for normal healing to occur.
•
•
•
•
Pain, swelling, redness
Decreased collagen synthesis
Increased number of inflammatory cells
Increased blood flow removes tissue debris
• Lasts approximately 2-3 days, longer if
injury is severe or blood flow is poor
Tissue Healing
• 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.
•
•
•
•
Reduction in inflammatory cells
New tissue and scar tissue formed
New capillaries form
Collagen fibers laid out randomly as structure for repairs
– Not optimal for strength
• Begins as early as two days after injury and
may last up to two months.
Tissue Healing
• Remodeling Phase
– The weakened tissue produced during the repair
phase is strengthened during the remodeling phase
of healing.
• Improved collagen alignment
• Usually never as strong as before injury
– Tissue remodeling can last up to two to four months
after injury.
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.
Loading During Rehabilitation
• Figure 20.3 (next slide)
– Loading during rehabilitation should neither overload
nor underload the athlete’s healing tissue.
Figure 20.3
Soft Tissue Injury Response
• Figure 20.4 (next slide)
– 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.
Figure 20.4
Rehabilitation and
Reconditioning Strategies
• Goals of Rehabilitation and Reconditioning
– Inflammation 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
– RICE: rest, ice, compression, elevation
» Cooling to re-warming ratio of 1:2
» Also ultrasound and electrical stimulation
– Some passive movement of injured area if tolerable
Rehabilitation and
Reconditioning Strategies
• Goals of Rehabilitation and Reconditioning
– Repair Phase
• Treatment Goals
– Preventing excessive muscle atrophy and joint deterioration
in the injured area; maintaining muscular and cardiovascular
function in uninjured areas
– Avoid disruption of collagen mesh
– Non-movement can cause adhesions in the collagen mesh
• Exercise Strategies (after consultation with team physician,
athletic trainer, or physical therapist)
– Submaximal isometric exercise
– Isokinetic exercise
– Specific exercises to improve neuromuscular control
Rehabilitation and
Reconditioning Strategies
• Goals of Rehabilitation and Reconditioning
– 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
– Apply progressive amounts of stress to injured area
– Helps collagen align and grow
• Exercise Strategies: progress from ones used in repair
phase
– 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)
Return-to-Activity Phase
• Return to normal activity should be based
on therapist recommendations as well as
testing
– ROM- equal to contralateral limb desirable
– Strength- at least 20% of contralateral limb
– Functional capacity tests- assess functional
limitations in injured limb as a whole
• Several injury/sport specific rehab/return
plans exists
Post-injury Programming
• Examine the goals of rehab to determine if
athlete has satisfied all of them
– Ex. Back to a certain % of original strength or ROM
• Determine program based on athlete’s
needs for sport
– Ex. Pulled hamstring in marathon runner vs. pulled
hamstring in Olympic lifter
• Keep open communication w/therapists
Rotator Cuff Rehabilitation
• Figure 20.5 (next two slides)
– Exercises generally transition from
• (a, b) isolation exercises to
• (c, d) multijoint, sport-specific exercises.
Figure 20.5a and b
Figure 20.5c and d
Closed Kinetic Chain
• 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.
Closed Kinetic Chain Exercises
• Figure 20.6 (next slide)
– Closed kinetic chain exercises:
• (a) squat exercise
• (b) push-up exercise
Figure 20.6
Open Kinetic Chain
• 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
• Figure 20.7 (next slide)
– Example of an open kinetic chain exercise—leg
(knee) extension exercise
Figure 20.7
Kinetic Chain: Sprinting
• Figure 20.8 (next slide)
– Sprinting offers an example of open and closed
kinetic chain movements occurring together.
Figure 20.8
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.