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Rehabilitation. Sabino Sports Medicine I. Developing a rehab program. Assess the injury Establish goals Long term—return athlete to full activity Short term Execute program Reassess as athlete progresses through program . Format for rehab program.

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  1. Rehabilitation Sabino Sports Medicine I

  2. Developing a rehab program • Assess the injury • Establish goals • Long term—return athlete to full activity • Short term • Execute program • Reassess as athlete progresses through program

  3. Format for rehab program Phase I—time period immediately following injury/surgery during which movement in the affected part is either involuntarily limited because of pain, swelling, muscle spasm, etc, or purposely restricted by immobilization in casts, splints, slings, etc.

  4. Phase I-therapeutic objectives Teach proper ambulation techniques Assist the healing process using appropriate modalities Minimize loss of muscular strength and slow muscle atrophy Maintain overall level of physical fitness

  5. Criteria for progression to phase II Remove cast, splint, sling, etc. Sufficient reduction of pain, swelling, inflammation to allow for use of safe and effective therapeutic exercise Acceptable degree of tissue healing to allow use of therapeutic exercise without aggravating injury

  6. Phase II Period of time when more vigorous therapeutic exercise, including joint ROM, is started. Using appropriate therapeutic modalities during the time will enhance the healing process and assist in facilitating the use of therapeutic exercise.

  7. Therapeutic Objectives Phase II • Establish weight bearing and restore normal gait patterns • Restore joint ROM equal to the unaffected part • Restore flexibility equal to or exceeding unaffected part • Restore muscular strength & endurance equal to unaffected part and consistent with demands of sport involved • Maintain acceptable level of physical fitness

  8. Criteria to progress to Phase III • Acceptable reduction of local symptoms • Acceptable level of healing of “wound” • Adequate restoration of gait, ROM, flexibility, strength, endurance, power, & CV fitness to resume at least part of regular practice/conditioning • Satisfactory assurance of adequate protection from reinjury • Great level of motivation and confidence of athlete

  9. Phase III • Period of time during which participation (in part or completely) of the normal practice and conditioning is resumed

  10. Therapeutic Objectives Phase III • Continue restoration of joint ROM, flexibility, muscular strength and endurance to safely resume full participation • Continue to work on overall physical fitness • Re-establish nornal pattern of motor activity—gait patterns, coordination agility, balance, proprioception—as they relate to the sport specific skills • Restore athlete’s confidence in resuming full participation

  11. Criteria to progress to Phase IV • Restoration of all components of physical fitness • Resuming full---complete and unrestricted--- participation

  12. Phase IV • That period of time after which “complete” rehabilitation” is achieved and full activity is resumed.

  13. Therapeutic Objectives Phase IV • Maintain muscular strength, endurance, power, and flexibility • Maintain optimal CV fitness • Maintain overall rehabilitated state

  14. Assessing the injury • Use SOAP notes (systematic means of documenting the assessment and recording progress of rehab program

  15. SOAP notes • S = Subjective • Patient history, symptoms, chief complaint • O = Objective • Signs, information from observation, palpation, stress tests • A = Assessment • Type and severity of injury, any associated problems • P = Plan • What will you do? Long & short term goals, what is working, how the athlete is progressing

  16. Establish Goals • Short term goals • Control swelling using proper immediate first aid • PRICE • Reduce/minimize pain • PRICE, use of modalities such as ice, heat, e-stim • Restore full ROM • Dynamic, static, PNF stretching activities • Restore/increase muscular strength, endurance, power • Isometrics, isotonics, isokinetics, plyometrics through full, pain-free ROM

  17. Isometrics • Performed early in rehab when joint is immobilized • Used when performing exercises through full ROM may be detrimental • Increase static strength • Assist in decreasing amount of atrophy • Lessen swelling by causing muscle pumping action

  18. Isometrics

  19. Isometrics

  20. Isotonics (progressive resistance exercises or PRE’s) • Most commonly used strengthening technique • Use free weights, exercise machines, tubing, bands, etc., with fixed weight through ROM • Use isotonic muscle contractions • Force is generated while the muscle is changing length • Use eccentric (lengthening) and concentric (shortening) muscle contractions

  21. Isotonics

  22. Isotonics

  23. Isokinetics • Occasionally used in rehab • Incorporated in later phases of rehab • Used primarily for diagnostic purposes • Uses a fixed speed with accommodating resistance to provide maximal resistance throughout ROM • Measures commonly used as criteria for return to functional activity

  24. Isokinetics • Cybex

  25. Isokinetics • Cybex Kincom

  26. Isokinetics

  27. Isokinetics • Kin com Biodex

  28. Plyometrics • Incorporated in later stages of rehab • Use a quick stretch of muscle to facilitate a subsequent concentric muscle contraction • Useful in restoring/developing athlete's ability to produce dynamic movements associated with muscular power • Ability to generate force rapidly is key to successful performance in many sports

  29. Plyometrics

  30. Plyometrics

  31. Plyometrics

  32. Short term goals • Reestablish neuromuscular control • Mind’s attempt to teach the body conscious control of specific movements—using strengthening exercises that are more functional • Improve balance • Balance training and postural stability • Maintain cardiorespiratory fitness • Single most neglected component, use pool, bike, upper body ergometer, stairclimber, elliptical trainer, etc.

  33. Incorporate appropriate functional progressions • Involve series of gradually progressive activities designed to prepare athlete for return to participation • Monitor activity to determine athlete’s ability to perform and physical tolerance • Advance the activity as long as there is not any swelling or additional pain • Use position specific drills and activities • Walking, jogging on track-walk curves, jogging full track, running on track—jog curves, running full track, running 2-3 miles 3x week, lunges—90 degree pivot, 180 degree pivot, sprints—”W”, Triangle, 20 yd, 40 yd, 120 yd, acceleration/deceleration runs, shuffle runs, carioca

  34. Modalities Those things you can use to assist/enhance the healing of injuries 3 categories Thermal-used to move heat into or out of the body-----heat & cold Mechanical---ultrasound, massage, traction, intermittent compression Electrical—muscle stimulation

  35. Cold • Types of cold use • Ice pack (15-20 minutes) • Ice massage (5-15 minutes) • Cold whirlpool (15-20 minutes) • Slush bucket (15-20 minutes) • Cryokinetics (10 -15 minutes) • Chemical cold packs (15 minutes??? Watch for chemical burns)

  36. Cold

  37. Cold

  38. Cold • Physiological effects • Decrease tissue temperature • Decrease blood flow • Decrease inflammation • Decrease pain---analgesic • Decrease muscle spasm • Increase muscle tone

  39. Cold • Indications for use • Acute injuries • Pain • Swelling • Inflammation • Preparing for exercise

  40. Cold • Contraindications for use • Open wounds • Cold related allergy • Areas with sensory or circulatory deficits

  41. Heat • Types of heat modalities • Hydrocollator pack (moist heat) (10-15 minutes) • Electrical heat pack (15-20 minutes) • Warm whirl pool (10-15 minutes) • Paraffin bath (dip several times--10-15 minutes)

  42. Heat

  43. Heat

  44. Heat

  45. Heat • Physiological effects • Increase tissue temperature • Increase blood flow • Increase tissue extensibility • Increase ROM • Decrease swelling • Decrease muscle tone

  46. Heat • Indications for use • Chronic inflammatory conditions • Tight tissue—connective, muscle, tendon , ligament • Chronic pain • Chronic muscle spasm

  47. Heat • Contraindications for use • Acute injuries • Areas with sensory deficits

  48. Ultrasound • Thermal or non-thermal modality that stimulates blood flow • Continuous or pulsed • Sound waves pass through pizoelectric crystal in sound head to create mechanical energy • Mechanical energy cause vibration of tissue cells which create heat • Heat can reach depth of 3-5 centimeters

  49. Ultrasound

  50. Ultrasound • Application • Must use a coupling agent • Conductive gel, lotion, water • Keep sound head moving with even pressure over the area being treated • Area shouldn’t be larger than 3-4 inches • Treatment time 3-8 minutes

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