Chapter 11 Understanding the Basics of Injury Rehabilitation PDF

Chapter 11 Understanding the Basics of Injury Rehabilitation Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  The...

Chapter 11 Understanding the Basics of Injury Rehabilitation Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  The Healing Process Three phases Inflammatory response phase 0-4 days Prepares the wound for healing Fibroblastic-repair phase 2 days – 6 weeks Rebuilds the damaged tissue and strengthens the wound Maturation-remodeling phase 3 weeks – 2 years Modifies scar tissue into its mature form Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Therapeutic Exercise versus Conditioning Exercise Therapeutic exercise Exercises used in a rehabilitation program Conditioning exercise Activities that maximize performance while minimizing the possibility of injury State laws and statutes limit anyone other than licensed health care providers in the extent to which he or she can legally be involved in supervising or designing the rehabilitation program Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Philosophy of Athletic Injury Rehabilitation Majority of injuries are not serious and lend themselves to rapid rehabilitation Long-term rehabilitation requires the supervision of a highly trained professional to be safe and effective In an athletic setting, athletic trainer or physical therapist assumes responsibility for design, implementation, and supervision of the program The goal for the injured athlete is to return to activity as quickly and safely as possible Responsibility of health care professionals overseeing rehabilitation programs Make decisions on executing the program based on the limitations of the healing process Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Basic Components and Goals of a Rehabilitation Program, 1 Addressed by an effective rehabilitation process Short-term goals are as follows: (1-2Weeks) Provide correct immediate first aid and management to limit or control swelling Reduce or minimize pain Restore full range of motion Reestablish core stability Restore or increase muscular strength, endurance, and power Reestablish neuromuscular control Improve balance Maintain cardiorespiratory fitness Incorporate appropriate functional progressions Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Basic Components and Goals of a Rehabilitation Program, 2 Long-term goal Return the injured athlete to practice or competition as quickly and safely as possible Restore the individual’s ability to complete functional tasks 2-4 weeks Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Let’s Practice Patient 1 Patient 2 Ms Garcia recently injured Mr Green has been her Right knee. She has having elbow pain for 3 swelling, pain is a 5/10 weeks. He has decreased with walking, and she is ROM, pain with grabbing having trouble going up his tennis racket, and and down stairs. trouble completing a full tennis match. Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Impairments? Limitations? Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  What are therapeutic interventions? Therapeutic ROM exercises AROM & PROM Stretching Joint mobilizations Therapeutic exercises Isometric exercises Isotonic exercises Isokinetic exercises PRE’s Therapeutic Modalities Cold packs Hot Packs E-stim Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Providing Correct First Aid and Controlling Swelling First aid can be administered by anyone who is qualified to do so First-aid techniques can be considered the most critical part of a rehabilitation program Initial management of an injury critically influences the rehabilitative process First-aid management should be directed toward controlling swelling POLICE principle: Each factor is critical Protection, optimal loading, ice, compression, and elevation Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Reducing Pain Extent of pain is partly dependent on the following: Severity of the injury Athlete’s response to pain Athlete’s perception of pain Circumstances under which the injury occurred POLICE and additional appropriate therapeutic modalities can be used to help modulate pain throughout the rehabilitation process Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Restoring Full Range of Motion Injury to a joint is always followed by some associated loss of motion Caused by either of the following or a combination of both factors: Resistance of the muscle and its tendon to stretch Contracture of the ligaments and capsule around a joint Athlete will need to engage in dynamic, static, or proprioceptive neuromuscular facilitation (P N F) stretching activities to improve flexibility Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Reestablishing Core Stability Core: Lumbo-pelvic-hip region Dynamically stabilizes the entire kinetic chain during functional movements Without proximal core stability, distal movers will not be able to function optimally Core stability should be addressed prior to engaging in any form of strengthening Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Restoring Muscular Strength, Endurance, and Power Essential factors in restoring the function of a body part to preinjury status Variety of techniques can be utilized Isometric exercises Progressive resistance exercises Isokinetic exercises Plyometric exercises Major goal: Working through a full and pain-free range of motion (R O M) Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Isometric Exercises and Progressive Resistance Exercises Isometric exercises Performed in the early phase of rehabilitation when a joint is immobilized for a period of time An alternative for cases in which use of resistance training through full R O M could make the injury worse Increase static strength, assist in decreasing the amount of atrophy, and reduce swelling Progressive resistance exercises (P R E) Can be performed using a variety of equipment Utilize isotonic contractions to generate force against resistance while the muscle changes length Concentric and eccentric strengthening exercises should be used Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Isokinetic Exercises Incorporated in the later phases of the rehabilitation program Use fixed speed with accommodating resistance to provide maximal resistance throughout R O M Speed of movement can be altered Isokinetic measures are used as criteria in making decisions for athlete’s return to functional activity following injury Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Plyometric Exercises Incorporated into the later stages of a rehabilitation program Use a quick stretch of a muscle to facilitate a subsequent concentric contraction Useful in restoring or developing an athlete’s ability to produce dynamic movements associated with muscular power Rapid generation of force: Key to successful performance in many sports activities Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Reestablishing Neuromuscular Control Neuromuscular control: Mind’s attempt to teach the body conscious control of a specific movement Relies on the central nervous system to interpret and integrate sensory and movement information Controls muscles and joints to produce coordinated movement Involves regaining the ability to follow some previously established sensory pattern Strengthening exercises that tend to be more functional are essential for reestablishing neuromuscular control Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Regaining Balance Ability to balance and maintain postural stability is essential to reacquiring athletic skills Rehabilitation program should include functional exercises that incorporate balance training Failure to address balance problems may predispose athlete to reinjury Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Maintaining Cardiorespiratory Fitness Most neglected component of a rehabilitation program When injury occurs, the athlete is forced to miss training sessions Levels of cardiorespiratory fitness may decrease rapidly Alternative activities must be used that allow athletes to maintain existing levels of cardiorespiratory fitness Activities are to be initiated as early as possible Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Functional Progressions, 1 Series of gradually progressive activities designed to prepare an individual for return to a sport Sport-specific skills are broken into components Athlete works to reacquire skills within limitations of his or her progress Athlete’s physical tolerance must be monitored while introducing new activities If additional pain and swelling do not occur, the level should be advanced Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Functional Progressions, 2 Ultimately, position-specific drills and activities are introduced in the program Assist injured athletes in the following: Achieving normal and pain-free R O M Restoring adequate strength levels Regaining neuromuscular control Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Functional Testing Uses functional progression drills for the purpose of assessing the athlete’s ability to perform a specific activity Involves a single maximal effort to gauge how close the athlete is to a full return to activity Preseason baseline testing information, if available, can be used to compare the athlete’s current performance Helps in determining if the athlete is functionally ready to return to full activity Types of tests Agility runs, side stepping, vertical jumps, hopping, and co- contraction Copyright © testsAll rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 2020 McGraw-Hill Education.  Therapeutic Modalities Incorporated into rehabilitation programs Cryotherapy and thermotherapy Ultrasound and electrotherapy Light therapy and massage Traction and intermittent compression Administered by athletic trainers and physical therapists It is essential to be aware of and follow the laws of different states that specifically dictate how certain therapeutic modalities can be used Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Ice Packs (Bags) Used for minimizing swelling and providing analgesia following injury Ice may be flaked or crushed and can be encapsulated in a wet towel or self-sealing plastic bag Both are easily moldable to the injured area Elastic wrap is used to secure the pack in place Compression and elevation are used in conjunction with ice packs Used for 20 minutes Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Hot Packs, 1 Used postacutely (after swelling stops) Increase blood and lymphatic flow Facilitate reabsorption of by-products of injury process into the lymphatic system Used for analgesic and relaxation effects Caution should be exercised in using heat too early following injury Cold should be used for at least 72 hours postinjury prior to using heat Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Hot Packs, 2 Moist heat packs (hydrocollator packs) Silicate gel in cotton pads Immersed in thermostatically controlled hot water at a temperature of 160 degrees Fahrenheit Retain water and relatively constant heat for 20 to 30 minutes Require the use of six layers of toweling to avoid burns Athlete should not lie on top of the pack Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Criteria for Return to Play Rehabilitation plan must determine what is meant by complete recovery from injury Athlete is fully reconditioned Athlete has regained full R O M, strength, neuromuscular control, cardiovascular fitness, and sports-specific functional skills Athlete is mentally prepared Releasing an athlete recovering from injury should be a joint decision by the sports medicine team Team physician is ultimately responsible Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  How should we use therapeutic interventions In Rehabilitation process? Identify Stage of Healing Identify Impairments Pain Swelling Loss of ROM Loss of Strength Decreased Function Identify treatment goals Decrease Pain and/or swelling Non-thermal effects to increase healing Increase circulation Increase ROM and/or strength Identify contraindications Anything about the patient that would make the intervention unsafe and dangerous for the patient Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Modality use in the Inflammatory-Response Phase: Days 0-4 post initial injury Cryotherapy Decrease Inflammation and pain Intermittent compression Decrease Inflammation Electrical Stimulation Currents Decrease Pain Low-power laser Decrease Pain ROM activities Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Modality use in the Fibroblastic-Repair Phase: Days 2- 6 weeks post initial injury Cryotherapy Decrease Inflammation and decrease pain Thermotherapy Increased circulation and decrease pain Intermittent compression Decrease Inflammation Electrical stimulation Decrease pain, muscle re-education, wound healing Low-level laser Decrease pain, facilitate wound healing Ultrasound Non-thermal effects on healing, increase circulation ROM/Strengthening exercises Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Modality use in the Maturation- Remodeling Phase: 3 weeks-2 years post initial injury Pain should be decreased in this stage and may only be present with motion Goal is to return patient to activity Electrical Stimulation May be used for muscle re-education as well as pain Ultrasound and Shortwave diathermy Increase circulation to deeper tissues Massage and Mobilizations Decrease pain, spasm and increase ROM Low-level laser Pain modulation to improve functional activities ROM, strengthening, plyometric and functional exercises Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Action Plans Patient 1? Patient 2? Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.