© 2010 mcgraw-hill higher education. all rights reserved. understanding the basics of injury...

© 2010 McGraw-Hill Higher Education. All rights reserved.

Understanding the Basics of Injury Rehabilitation


• ______________________– Exercise used as part of a rehabilitation

program

• _____________________– Activities that are used to minimize injury

and maximize performance


Basic Components and Goals of a Rehabilitation Program

• Must address several basic components• _____________ term goals

– Provide correct and immediate first aid to control swelling

– Control ______________– Restore full ______________– Restore core stability– Restore and increase strength, endurance and

power– Re-establish _______________________ control

and balance– Maintain levels of cardiorespiratory fitness


Providing Correct First Aid and Controlling Swelling

• Initial first aid is critical

• Should be directed towards __________________ control

• Utilize the _______________ principle– Each factor is critical in limiting swelling


Controlling Pain• Some degree of pain will be experienced

– Pain will be dependent on the severity of the injury, athlete’s response, perception of pain and the circumstances

• PRICE and additional modalities (electrical stimulation, heat…etc.) can be used to help modulate pain

• Pain can ______________ w/ rehab and therefore must be addressed throughout the rehab process


Restoring Range of Motion

• Injury to a ________________ will always be associated w/ some loss of ______________– Due to contracture of connective tissue or

resistance to stretch of injured area

• Athlete will need to engage in dynamic, static or PNF ______________ activities to improve _________________


Stretches• _____________-bouncing, jerky movements

• ______________-controlled body movements different from ballistic

• ______________- Static/maintained

• _____________-Someone else or something helps hold the stretch

• ______________-static stretching without motion

• __________-the fastest and most effective way to increase static-passive flexibility (combines passive and isometric stretching)


Restore ________ Stability

• Involves strengthening the _____________ region and is critical for dynamic functional strength and movement

• Without proximal core stability, distal extremity function become compromised– Core strength & power must be emphasized

early in the strength training program


Restoring Muscular Strength, Endurance, and Power

• Among the most essential factors necessary when restoring function of a body part to pre-injury status

• Variety of techniques can be utilized– _____________________– ______________________– ______________– ______________

• Emphasize work through a full ROM


• __________________– Performed in early part of rehab following period

of immobilization– Used when resistance through full range could

make injury worse– Increase static strength, work to decrease/limit

atrophy, create a muscle pump to decrease swelling

• _______________________________PRE)– Can be performed using a variety of equipment– Utilizes isotonic contractions to generate force

while muscle changes length– Concentric and eccentric strengthening

exercises should be utilized


Progressive Resistance Exercises


• _____________ Exercise– Incorporated in later stage of

rehabilitation process– Uses fixed speeds w/

accommodating resistance to provide maximal resistance throughout ROM

– Speed of movement can be altered

– Commonly used as part of the criteria for return to functional activity


• ______________Exercise– Incorporated into later

stages of program– Use quick stretch of

muscle to facilitate subsequent concentric contraction

– Useful in production of dynamic movements

• Associated with muscular power

• Generation of force rapidly – key to successful performance in many activities


Re-establishing _____________ Control

• Neuromuscular control is ___________ attempt to teach the body conscious control of a specific movement (_________________)

• Relies on CNS to interpret and integrate sensory and movement information and then control _______________ and ______________ to produce coordinated movement

• Re-establishing neuromuscular control requires repetition of same movement, step by step until it becomes automatic (progression from simple to difficult task)

• Functional exercises are critical for re-establishing control


Regaining ______________

• Ability to balance and maintain postural stability is essential to reacquiring athletic skills

• Program should incorporate _____________________________that involve balance training

• Failure to include balance training may predispose the athlete to _________________


• When balance is challenged the response is __________________ and __________________

• The primary mechanism for controlling balance occurs in the joints of the lower extremity

• The ability to balance and maintain it is critical for athletes

• If an athlete lacks balance or postural stability following injury, they may also lack proprioceptive and kinesthetic information or muscular strength which may limit their ability to generate an adequate response to disequilibrium

• A rehabilitation plan must incorporate functional activities that incorporate balance and proprioceptive training


Maintaining Cardiorespiratory Fitness

• Single most ___________________component of rehabilitation

• When injury occurs athlete is forced to miss training time which results in decreased cardiorespiratory endurance unless training occurs to help maintain it

• __________________________ must be substituted that allow athlete to maintain fitness– Put into rehabilitation program as early as possible


Functional Progressions• Involves a series of gradually

__________________ activities designed to prepare the individual for return to a specific sport/activity

• Sport-specific skills are broken into separate components – Athlete works to reacquire skills over time

• Should be incorporated into treatment as early as possible – Athlete’s ________________________ must be

monitored• If __________ and ________________ do not

arise, the activity can be advanced -- new activities should be added as quickly as possible


• Will gradually assist injured athlete in achieving normal, pain-free ROM, strength and neuromuscular control


Functional Testing– Uses functional progression drills for the

purpose of assessing the athlete’s ability to perform a specific activity

– Entails a single maximal effort to gauge how close the athlete is to full return

– Pre-season baseline testing for comparison post injury

– Variety of tests• Shuttle runs -Vertical jumps• Agility runs -Balance• Figure 8’s -Hopping for distance• Cariocca tests -Co-contraction test


Using________________• Incorporated into rehabilitation program as

adjuncts to exercise– Cryotherapy and thermotherapy– Ultrasound and electrical stimulation– Massage and traction

• Require special instruction and supervised clinical experience

• 3 types– ________________-used to move heat into or out

of the body (heat & cold)– __________________-ultrasound, massage,

traction– _____________________-muscle stimulation


Stages of Tissue Healing• ___________________

– Injury just happened (bringing in the positive

– Bleeding could last up to 6-8 hours depending on injury

– Typically 2-3 days

• _____________________– Developing scar tissue– Can last 2-3 weeks to several

months

• ______________________– Turning the scar into usable

tissue


Cold Modality

• 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)


Physiological Effects of Cold• Decrease tissue

temperature• Decrease blood flow• Decrease inflammation• Decrease pain-analgesic• Decrease muscle spasm


Indications and Contraindications for Cold Therapy

• Indications• Acute injuries• Pain• Swelling• Inflammation• Soreness prevention

• Contraindications• Open wounds• Cold related allergy

Raynaud’s Phenomenon• Areas with sensory or

circulatory deficits (Diabetes?)


Ice Packs (Bags)

• Used for minimizing swelling and analgesia following injury

• Ice may be flaked or crushed and will be encapsulated in wet towel or plastic bag– Both are easily moldable to body

• Elastic wrap generally utilized to secure pack in place for 20 minutes

• Compression and elevation are also used in conjunction with ice


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)


Physiological Effects of Heat

• Physiological effects– Increase tissue temperature– Increase blood flow– Increase tissue extensibility– Increase ROM


Indications and Contraindications for Heat

• Indications:– Chronic inflammatory

conditions– Tight tissue—

connective, muscle, tendon , ligament

– Chronic pain– Chronic muscle spasm

• Contraindications:– Acute injuries– Areas with sensory

deficits


Ultrasound• ____________ or ____________

modality that stimulates blood flow– Continuous or pulsed

• _____________ waves pass through crystal in sound head to create mechanical energy

• Mechanical energy cause vibration of tissue cells which create heat

• Heat can reach depth of ______________ centimeters


Therapeutic Ultrasound

• Sound Wave Technology


Ultrasound Applications• Application

– Must use a coupling agent• Conductive gel, lotion, water

– Keep sound head _____________ with even pressure over the area being treated

– Area shouldn’t be larger than 3-4 inches

– Treatment time 3-8 minutes


Indications and Contraindications for Ultrasound

• Indications:– Chronic injuries– Acute injuries (non-

thermal setting)– Strains– Sprains– Tendonitis– Contusions– Tight tissue

• Contraindications:– Heart, eyes, ears, brain,

spinal cord, genitals– Epiphyseal plates– Acute injuries– Areas with poor

circulation– Stress fractures– Open wounds– Infected areas– Tumors


Traction• Pulling force that deliberately

__________________ joints of the body that have been compressed together or are stiff

• Commonly used at cervical or lumbar area

• Can be done mechanically or manually

• Separates bones• Puts ______________ stretch on

area


Indications and Contraindications for Traction

• Indications:– Disc

herniation/protrusion– Degenerative disc

disease– Degenerative joint

disease– Soft tissue compression– Nerve root compression– Muscle spasm

• Contraindications:– Osteoporosis– Fractured vertebrae– Spinal hypermobility– Infections of spine


Electrical Muscle Stimulation

• The application of electrical current to the surface of the skin

• Types– Premodulated stimulation– TENS– Interferential– Combo (US & e-stim)


Electrical Stimulation• Used generally for _____________

management sometimes muscle _____________________ – ____________________

• 2 pads generating a linear electrical pathway

– ___________________• 4 pads creating a cross current electrical

pathway

– _______________________• Used primarily in rehabilitation for muscle strengthening

(post-operatively)–5 sec on 5 sec off or 10 sec on 10 sec off

– _____________________– _______________________________


Premodulated Stim

• Used for treatment of– Contusions– Sprains– Strains– Acute edema– Muscle re-education


Premodulated stim

• Physiological response of body depends on the _____________ of the current

• _____________ current: vasoconstriction, hardens tissues, local analgesic, decreases nerve excitability

• ______________ current: vasodilatation, softens tissue, increases nerve excitability, increases venous and lymphatic return


Premodulated stim

• Place electrodes so pain is “_________________” the pads

• Place electrodes at either end of the muscle being treated

• Can be used in conjunction with heat or cold• Treatment time is 10-20 minutes


E-Stim


Interferential Stimulation

• Uses __________________ electrical currents to regulate blood flow, reduce pain, decrease edema, relieve muscle spasm, strengthen muscle tissue

• Used to treat: contusions, sprains, strains, etc.

• Should feel slight vibration


Inferential

• Uses 4 electrodes set at a __________________ pattern

• Covers “larger” area• Electrical currents “interfere” with each other

to create a bigger surface areas• Can be used with heat or cold• Treatment time is 10-20 minutes


TENS (transcutaneous electrical muscle stimulation)

• Used primarily for ______________ control• Electrodes are placed on skin over painful area

to “______________” the sensation of chronic or acute pain

• Cause a muscle ________________• Used for 30 minutes to 1 hour treatment time• Can be used so patient can exercise without

pain


TENS


Ultrasound/muscle stim combo

• US combined with muscle stim• Electricity comes through the US head• Combine deep heating with benefits of muscle

contraction• Used for treating strains, muscle spasms,

trigger points, tight muscles• Treatment time is 5-15 minutes


Combo


Criteria for Full Return to Activity• _____________ plan must determine what is meant by

complete recovery– Athlete is fully reconditioned, achieved full ROM, strength,

neuromuscular control, cardiovascular fitness and sports specific functional skills

– Athlete is _______________ prepared

• The decision to return to play should be a __________________ decision (sports medicine team)– Team physician is ultimately responsible

© 2010 mcgraw-hill higher education. all rights reserved. understanding the basics of injury...

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