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Key principles of rehabilitation
Ortho teaching 2015
D Morrissey NIHR/HEE Consultant physiotherapist and Clinical Reader
Sports and Exercise Medicine, QMUL
Learning outcomes
For each participant to have: • An overview of the rehab process • A structure for understanding the
rehabilitation process • Considered the fundamentals of a
rehabilitation process for injured ‘athletes’ • Why?
– Better understand patient progress – Understand quality care
FIRST - Bubbles
Overview
Workshop
Pain control Training principles
Stages S.A.I.D.
Psychology
Kinetic chain
Motor control
Movement patterns
Estimated reps to failure
Time under tension
Intensity Periodisation
Structure of programme
Modes Machines
Occlusion therapy
Transference
Groups
Protocols
Core stability
H.A.R.M. Inflammation Risks and
complications
Prevention
Rest and recovery
Supplements P.R.I.C.E.R
Functional testing
Return to sport
Diagnosis and grade
Anatomy Co-morbidities
Goal setting Grieving process
Locus of control
Psycho-social factors
Miscellany
Tissue adaptation
Proprioception
ROM
Sports specificity
Special groups
Hydrotherapy Muscle balance Art vs
science
Evidence Muscle stim
MDT Maintain CV
fitness
taping
Manual therapy
Medication
Tickets to treatment
Acupuncture
Injection Electrotherapy
Overview
Workshop
Pain control Training principles
Stages S.A.I.D.
Psychology
Kinetic chain
Motor control
Movement patterns
Estimated reps to failure
Time under tension
Intensity Periodisation
Structure of programme
Modes Machines
Occlusion therapy
Transference
Groups
Protocols
Core stability
H.A.R.M. Inflammation Risks and
complications
Prevention
Rest and recovery
Supplements P.R.I.C.E.R
Functional testing
Return to sport
Diagnosis and grade
Anatomy Co-morbidities
Goal setting Grieving process
Locus of control
Psycho-social factors
Miscellany
Tissue adaptation
Proprioception
ROM
Sports specificity
Special groups
Hydrotherapy Muscle balance Art vs
science
Evidence Muscle stim
MDT Maintain CV
fitness
taping
Manual therapy
Medication
Tickets to treatment
Acupuncture
Injection Electrotherapy
Overview
Pyramid
1. Return to activity 2. Tickets to treatment 3. Motor relearning 4. Sports-specific
agility drills 5. Flexibility 6. Muscle conditioning 7. Proprioception 8. PRICER / HARM
Overview
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Aim of rehabilitation
The goal of a rehabilitation programme is to return the person to an optimal activity level
without further injury or restriction of activity
Overview
Rehabilitation structure at BH NHS trust
• Clear format • Home exercises
– Video? – Paper – Online resources
• Gym-based sessions • Committed to completing the
process
Diagnosis and assessment ò
Manual therapy treatment and home exercise / ergonomics
ò +/- ‘tickets’
ò Rehabilitation
Initial programme teaching Groups with individual programmes
ò Late stage
Return to training Return to sport
Liaison Testing (IKD, sports specific,
functional tests)
Overview
Independence
Phases
• Early / middle / late – Based on goal attainment
• Acute / sub-acute / chronic – Inflammatory / repair / remodelling – Post –injury model
Overview
Phases: WB proprioception and … Phases: WB proprioception and …
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Phases: WB proprioception and … Phases: WB proprioception and …
Eg Tendinopathy recovery
Time 0 2 4 6 8 10 12 14 16 18 20 22 24 weeks
Hig
h pa
in lo
w fu
nctio
n ……
.…. N
o pa
in, h
igh
func
tion
Plateau or failure to improve
Proprioception challenge
• Static • Conscious • High base of support • Eyes open • Abstract
Dynamic Automatic Lower Closed? Functional
SAID
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Sports specificity
• Transference – psychology, visualisation, cerebllar connections,
cognitive to automatic – Eg Gymnast with pars lesion
SAID
Risk phase
SDL 1: Brukner and
Khan: Clinical Sports
Medicine 2: MDT visits
Overview