Chapter 12 - Basics of Injury Rehabilitation

Philosophy of Athletic Injury Rehabilitation

• Injury is the nature of sport• Most injuries do not require a long term rehab• Long term rehabs must be safe and effective• Athletics are competitive and thus necessitate an

aggressive rehab• Goal is to return as soon as possible• Thin line between not pushing hard enough and

being to aggressive

Goals of a Rehabilitation Program

• Short term goals are:• 1 - Provide correct immediate first aid and management

following injury to limit or control swelling• 2 - Reducing or minimizing pain• 3 - Restore full ROM• 4 - Restoring or increasing muscular strength, endurance,

and power• 5 - Reestablishing neuromuscular control• 6 - Improve balance• 7 - Maintaining cardiorespiratory fitness• 8 - Incorporating appropriate functional progressions

Providing Correct First Aid and Controlling Swelling

• Most critical

• Should be directed towards controlling swelling

• RICE principle

Controlling Pain

• Amount of pain is determined by extent of injury, individual’s response or perception of pain, and circumstances of the injury

• RICE for acute pain

• Appropriate modalities can be used during rehab to help with pain

Restoring Range of Motion

• Injury always results in some loss of ROM

• Stretching

Restoring Muscular Strength, Endurance, and Power

• Most important factors in returning to normal activities

• Always work in a full, pain-free ROM

Isometric Exercise

• Commonly performed in early phases of rehab when a joint is immobilized

• Useful when exercises in the full ROM will make the injury worse

• Increase static strength and decrease atrophy

• May lessen swelling by pumping action

Progressive Resistance Exercise

• PRE can be done with free weights, exercise machines, or rubber tubing

• Isotonic contractions with muscle changing in length

Isokinetic Exercise

• Common in later phases of rehab

• Uses a fixed speed and accommodating resistance

• Speed can be changed

• Used for testing, more functional

Plyometric Exercise

• Often in later stages• Uses a quick eccentric stretch of a muscle

and a subsequent concentric contraction of that same muscle

• Helps the athlete develop dynamic strength (in motion)

• Ability to generate force rapidly is a critical element in athletics

Reestablishing Neuromuscular Control

• The mind’s attempt to teach the body how to control movement

• Mind must read the body and respond efficiently

• The CNS forgets how to do things

• Strengthening exercises help to retrain pathways

Regaining Balance

• Rehab must incorporate balance drills to prepare the athlete for return to competition

Maintaining Cardiorespiratory Fitness

• Usually the most neglected component of rehab

• Level decrease rapidly

• Must substitute alternate activities (pool, bike, etc)

Functional Progressions

• Purpose of rehab is to restore normal function

• Those skills necessary for a sport are broken down into component parts

• If each new activity does not produce pain or swelling, it should be advanced, introducing new activities

Functional Testing

• Uses functional progression drills to test

• Figure 8s, shuttle runs, cariocas, side stepping, vertical jumps, hopping, back pedaling

Criteria for Full Recovery

• Besides physical well being, the athlete must be confident in returning to participation

• The decision should consult opinions of the entire sports medicine team

• Team physician is ultimately responsible