Functional Progressions and Functional Testing in
Rehabilitation
Rehabilitation Techniques for Sports Medicine and Athletic Training
William E. Prentice
IntroductionTo reduce lasting effects of injury, athletic trainer
should direct rehabilitation toward improving neuromuscular coordination and agility as well as strength and enduranceReturn athlete to pre-injury activity levels
Function refers to patterns of motion that use multiple joints acting with various axes and multiple planes
Focus on functional rehabilitation will ready patient for activity and competition
Role of Functional Progressions in Rehabilitation
A.T. must adapt rehabilitation to the sports specific demands of each individual sport and position
Functional ProgressionSuccession of activities that simulate actual motor
and sport skillsEnable patient to acquire or reacquire skills needed
to perform athletic endeavors safely and effectivelyPlaces stresses and forces on each body system in a
well-planned positive and progression fashionImproves patients overall ability to meet the demands
of daily activities as well as sport competition
Role of Functional Role of Functional Progressions in Rehabilitation
A.T. breaks down activities involved in a given sport into individual componentsPatient concentrates on components in a
controlled environment before combining them together in an uncontrolled environment
Essential in the rehabilitation processTissues not placed under performance level
stresses do not adapt to the sudden return of such stresses when full activity is resumed
Benefits of using Functional Progressions
Assist patient and A.T. in reaching the goals of the entire programRestoration of joint ROMStrengthProprioceptionAgilityConfidence
Allow patient to reach desired level of activity safely and effectively
Physical Benefits Improving functional stability
Maintained by neuromuscular control mechanisms involved in proprioception and kinesthesia
Performance during functional task can be evaluated and corrected Functional testing can be used to provide objective measure of ability
Muscle strength Muscles involved will be strengthened dynamically under stresses
similar to those encountered in competition Using SAID and Overload Principles
Endurance Muscular and cardiorespirtaory endurance can be enhanced with
functional progressions Through repetition of of individual activities and their combination into
one general activity
Physical Benefits Flexibility
Injured area stressed within a controlled range during functional progression
Improved mobility and flexibility crucial to patient return to activity
Strength and endurance do not mean much if injured area cannot move through normal ROM
Muscle relaxation Functional progression can teach an individual to
recognize muscle tension and eventually control or remove it by relaxing muscles after exerciseRelieve muscle guarding that may inhibit normal ROM
Physical Benefits
Motor SkillsCoordination, agility and motor skills are complex
aspects of normal functionNeeded to transform strength, flexibility and
endurance into full-speed performanceRepetition and practice are are important to
learning motor skillsRehabilitation exercises must stress
neuromuscular coordination and agility to increase performance and decrease chance of reinjuryDevelop automatic reactions needed during activity
Psychological BenefitsFunctional progression can help reduce common
emotions found after injuryAnxiety
Athlete gradually placed into more demanding situations.Experience success and not be as concerned with failure
DeprivationAthlete can engage in activity during practice to remain close
in proximity and socially feel little loss in team cohesionApprehension
Enable patient to adapt to imposed demands of their sport in a controlled environment
Restore confidence
Components of a functional progression
Four principles Individuality of the patient, sport and the injuryActivities should be positive not negative; no
increase in signs or symptomsOrderly progressive programProgram should be varied to avoid monotony
Vary exercise techniquesAlter the program at regular intervalsMaintain fitness baseSet achievable goals , reevaluate, and modify regularlyUse clinical, home and on field programs
Use sport specific activities to enhance patients return to activity
Designing a Functional Progression
No cookbook, be creative and specific to athletes goals and injury status
Progressions should start early in rehabStart with low impact and progress to high impact
Assess athlete periodically to determine ability to progress to next exercise
Achieving a certain skill level occurs when a the skill can be completed at functional speed with high repetition without increase in pain, swelling or a decrease in ROM
Functional TestingPatient performs certain tasks appropriate to their
stage in rehab Isolate specific deficits
A.T. able to determine current functional level and set functional goals
Indirect measure of muscular strength and power
Uses maximal performance of an activity
Provide A.T. with objective data
Functional TestingThree purposes
Determine risk of injury due to limb asymmetry
Provide objective measure of progress during rehab plan
Measure the ability of the individual to tolerate forces
Functional TestingA.T. must evaluate what test will be used
Validity : test should measure what it intends to measure
Reliability: Test should consistently provide similar results regardless of evaluator
Observe unilateral and bilateral function to determine compensation patterns
A.T. should also consider stage of healing, strength, patients ability and physician approval
Functional TestingPreseason baseline measurements are preferred
so A.T. has data to compare post injury activity levels
Not always obtained by A.T., however individual sports may do baseline testing
With or without baseline measurements a score of 85% or better compared to noninjured side is recognized as standard for limb symmetry scores
Functional TestingUses 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 injuryVariety of tests
Shuttle runs -Vertical jumpsAgility runs -BalanceFigure 8’s -Hopping for distanceCarioca tests -Co-contraction test
Lower Extremity Functional Progression
Walking: Normal Gait
Walking: Heels walks
Walking: Toe walks
Side step/Shuffle
Lunge 90° to Lunge 180°
Step ups forward to lateral step ups Increase speeds
JoggingBegin straight ahead, gradually increase intensity 50%-
100% Introduce curves: Oval,“S” course, figure “8” course, “Z”
course
SprintStraight ahead varying intensitiesAdd acceleration/deceleration drills
Box Runs
Carioca
Hopping:Double Leg to Single Leg to Alternate
Jumping:Plyometrics
Progress intensitiesSport specific
Speed and Agility drills:Sport specificLadder drillsCutting, jumping on command
Position specific activities
Upper Extremity Functional Progression
Assisted PNF techniques
T-band exercises simulating specific sport/position motionsStrength and endurance
Closed chain exercises: Push up progression
Upper Body Plyometrics
Interval throwing programFocus on mechanics and biomechanical dysfunctionsBegin with general warm upStep 1: 45 ft. phase
Warm up throwing25 throwsRest 10 minutesWarm up throwing25 throws
Step 2: 45 ft. phaseWarm up throwing’25 throws15 minute restWarm up throwing25 throwsRest 10 minutesWarm up throwing25 throws
Repeat steps 1 & 2 for 60, 90, 120, 150, 180 ft.Only progress if pain free and no signs or symptoms
developWhen program completed move to position specific
throwingFor example: pitcher throw off mound
Designing a Functional Progression
Full Return to PlayPhysicians releasePain freeNo SwellingNormal ROMNormal strength (in reference to contralateral
limb)Appropriate functional testing completed with no
adverse reactions