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Basic Principles in Treating Athletic Injuries

Basic Principles in Treating Athletic Injuries. 1. Acute Phase. 2. Healing Phase. 3. Rehabilitation Phase. Acute Inflammation ( 24-48 hours ) Chronic Inflammation ( 3-7 days ) Healing ( 3-6 WEEKS ) Rehabilitation ( up to a year ) Min 3 months. Einstein on Insanity.

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Basic Principles in Treating Athletic Injuries

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  1. Basic Principles in Treating Athletic Injuries 1. Acute Phase 2. Healing Phase 3. Rehabilitation Phase Dr. Jack Dolbin DC Session 3

  2. Acute Inflammation ( 24-48 hours ) • Chronic Inflammation ( 3-7 days ) • Healing ( 3-6 WEEKS ) • Rehabilitation ( up to a year ) Min 3 months Dr. Jack Dolbin DC Session 3

  3. Einstein on Insanity “ Doing the same thing over and over expecting a different result.” Dog lady Dr. Jack Dolbin DC Session 3

  4. Evidence based Practice • A method of integrating clinical expertise with the best available evidence from clinical research to make decisions about the care of individual patients Dr. Jack Dolbin DC Session 3

  5. Levels of EBP • Research report or original research with systemic reviews • Case-control studies or reports • Expert opinions leads to clinical commentary • Application= Therapeutic Value Dr. Jack Dolbin DC Session 3

  6. Treating Athletic Injuries Acute Phase • Control tissue injury complex • Enforce rest of injured area with protection • Maintain conditioning: anaerobic-aerobic 2. Treat Inflammation • Pain meds. • Bromelain: Studies • Modalities Dr. Jack Dolbin DC Session 3

  7. Treating Athletic Injuries Acute Phase (Cont.) 3. If not overt signs of inflammation no meds or modalities necessary 4. When healing allows : • Protected ROM • Isometric activity • Resisted short arc isotonic contractions Dr. Jack Dolbin DC Session 3

  8. Treating Athletic Injuries Acute Phase (Cont.) 4. Goals: a. Reduced Swelling b. Decrease Pain c. Tissue Healing d. Improved ROM When achieved - Proceed to healing phase. Dr. Jack Dolbin DC Session 3

  9. Treatment Protocols: “Exercise is not an adjunctive therapy, exercise is the therapy” Ken Hutchins. Dr. Jack Dolbin DC Session 3

  10. Ardnt-Schultz Law • Weak stimuli increases physiological activity and very strong stimuli inhibits or abolishes physiological activity. Dr. Jack Dolbin DC Session 3

  11. Law of Least Action • Maupertius: The quantity of action necessary to effect any change is the least possible, the decisive amount is always the minimal, the infintesimal. Dr. Jack Dolbin DC Session 3

  12. Treatment Protocols: • Phase 1: Acute Inflammatory Phase: • Question: Does inflammation cause pain or does pain cause inflammation? • For a long time pain has been summarily dismissed as the outcome of direct stimulation of sensory nerve endings by injury and the pressure of inflammation exudates. This opinion completely neglects the observation that pain often initiates the inflammatory response and may become less severe as that process gains speed. Robbins pg.44 • Goal is to control the pain and inflammation • PRICE • Protection • Rest • Ice • Compression • Elevation Dr. Jack Dolbin DC Session 3

  13. Treatment Protocols: • Ice: 15-30 minutes of cryotherapy reduces temperature 3-7 degrees C. • Method of delivery: • Ice Pack • Ice Massage • Versacooler: Adds compression to the TX. • Immersion • Cryotherapy to the point of cold vasodilation is counter productive. Hunter Reaction is the bodies reaction to excessive cryotherapy causing increase hemorrhage and inflammation. Dr. Jack Dolbin DC Session 3

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  17. Treatment Protocols: • ICE Suggested Protocol: • 10 minutes: C-Spine, wrist, elbow, ankle shin • 15 minutes T-Spine, knee, shoulder • 20 minutes, L-Spine, pelvis, thigh. Frequency: 2-4 times/day, Maximum hourly: 15-20 /45 Dr. Jack Dolbin DC Session 3

  18. Treatment Protocols: • ICE vs HEAT IceHeat Grade 2 Sprain-strain: Within 24 hours After 24 hours 6 days 11 days 15 days Grade 3 13 days 30 days 33 days • Sensory Fiber Analgesia: 4-5 minutes with cryotherapy which lasts for 30 minutes. Cryotherapy gives comparable relief to local anaesthesia and morphine. Dr. Jack Dolbin DC Session 3

  19. Treatment Protocols: • Electrotherapy: Used for edema reduction and pain control: • High Volt • Low volt • Interferential • Faradic • Galvanic: Iontophoresis Dr. Jack Dolbin DC Session 3

  20. Treatment Protocols: • Ultrasound: • Promotes healing of soft tissue. • Continuous • Pulsed • Phonophoresis Dr. Jack Dolbin DC Session 3

  21. Hands Free Ultra Sound • Low intensity • Longer treatment time • Stationary • Results: Stress Fractures, Soft Tissue Injuries Dr. Jack Dolbin DC Session 3

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  23. Low Level Pulsed Ultrasound • Reduced healing time in fracture repair by 30-38% • When applied to non union fractures it stimulated union in 86% of cases • Potential for use in tendon, ligament, muscle and cartilage injuries • Conclusion: may have a beneficial effect in treating sports injuries: accelerated healing Dr. Jack Dolbin DC Session 3

  24. Treatment Protocols: • Joint mobilization: Tissue must heal in the presence of motion. • Cyriax Cross Fiber: • Laser : • Exercise: Dr. Jack Dolbin DC Session 3

  25. Joint mobilization • Activates mechanoreceptors • Breaks down adhesions • Decrease congestion in joint • Relieves compressive forces on articular capsular and cartilagenous structures • Relieves contracture of connective tissue transversing joint Dr. Jack Dolbin DC Session 3

  26. Mobilization • The strength of healed tendons is superior to that of controls where mobilization was delayed. • An augmentation of extrasynovial tendon healing by continuous passive motion has been demonstrated in the rabbit model Dr. Jack Dolbin DC Session 3

  27. Mobilization • Mobilization stimulates the intrinsic tendon healing response, specifically the fibroblasts, resulting in healing with minimal scar formation. • . Early passive mobilization reduces adhesions Dr. Jack Dolbin DC Session 3

  28. Transverse FM • Transverse friction massage of the injured tendon in chronic tendonitis is thought to be beneficial in breaking down adhesions, • Tissue mobilizations maybe beneficial in tendon healing by the transport of nutrients to the area. Dr. Jack Dolbin DC Session 3

  29. Cyriax Crossfiber • Mobilize scar tissue • Reduce adhesions • Activates phagocytes • Neurological component • Should be preceeded by ice massage • Followed by isometric stretches Dr. Jack Dolbin DC Session 3

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  31. Muscle Energy Dr. Jack Dolbin DC Session 3

  32. Muscle energy Dr. Jack Dolbin DC Session 3

  33. Laser/Light • Tissue heals relative to the reversal of glycolytic damage. • Oxygen utilization major key to healing • Laser is directed at mitochondrial activity • Increases cellular metabolism Dr. Jack Dolbin DC Session 3

  34. Laser v Light Therapy Dr. Jack Dolbin DC Session 3

  35. Light v Laser Dr. Jack Dolbin DC Session 3

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  37. Multiradiance Dr. Jack Dolbin DC Session 3

  38. Light with Stim Dr. Jack Dolbin DC Session 3

  39. Interferential Light Therapy Dr. Jack Dolbin DC Session 3

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  42. Physics • UV light < 400nm < infrared • 600-750 nm = Red • 750 < Infra Red- not visible • Depth of penetration = NM = Wave Length Dr. Jack Dolbin DC Session 3

  43. Physics ( Cont ) • Depth of Penetration • 400 nm = 2-3 mm • 600-750 = 10 mm • 880 nm = 30-40 mm • Multiradiance: 5-6 inches • Dose = sec x power/ area = JCm2 Dr. Jack Dolbin DC Session 3

  44. LLLT Effect on Inflamation Dr. Jack Dolbin DC Session 3

  45. LLLT ( cont ) Dr. Jack Dolbin DC Session 3

  46. LLLT ( cont ) Dr. Jack Dolbin DC Session 3

  47. LLLT effect on pain Dr. Jack Dolbin DC Session 3

  48. LLLT effect on healing time Dr. Jack Dolbin DC Session 3

  49. Application Dr. Jack Dolbin DC Session 3

  50. Electrotherapy • Low Frequency • High Volt • Interferential Current Dr. Jack Dolbin DC Session 3

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