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Therapeutic Exercise:Basic Concepts

Definitions

Therapeutic exercise is the systemic performance or execution of planned physical movements, postures, or activities intended to:

1) Remediate or prevent impairments2) Enhance function3) Reduce risk4) Optimize overall health5) Enhance fitness & well-being APTA, Phys Ther, 2001

TREAT THE ENTIRE ATHLETE

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Treat the Entire Athlete

Affected Area

Unaffected Areas/Systems

Their “Head”

Psycho-Social Considerations

Emotional Responses

Social Support Systems

Adherence and Recovery

Emotional Responses

1) Denial

2) Anger

3) Bargaining

4) Depression

5) AcceptanceKubler-Ross, 1969

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Signs of Adjustment Problems

Displays of anger, depression, confusion, apathy“When will I be able to play again?”DenialHistory of coming back too fastExaggerated storytelling/braggingDwelling on minor complaints

Petitpas & Danish, 1995

Adjustment Problems (con’t)

Remarks about letting the team down or feeling guiltyDependence on ATCWithdrawal from teammates, coaches, or friendsRapid mood swingsFeelings of helplessness to impact recovery

Petitpas & Danish, 1995

Developing a Social Support System

Confidence in your competence

Coach

Teammates

Family

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Adherence and Recovery

Motivation

Goal Setting

Visualization / Imagery

Self Talk

Roles & Responsibilities

AthleteFeel understoodAccept the reality of the injuryUnderstand the rehab programAdhere to the rehab program

ATCBuild rapport EducateTeach coping skillsID and help develop social support system

Pease, 2004

BE SMART

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Be SMART

Specific

Measurable

Attainable

Relevant

Time-based

SPECIFICITY

Two Important Ideas

SAID Principle

Wolff’s Law

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Biomotor Abilities

MobilityStrengthPowerEndurance

Which type?

Neuromuscular Control

MEASURABLEATTAINABLE

Assessing the Athlete

Qualitative vs. Quantitative

Reliability and Validity

Examination is continuous

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Return to Play Criteria

Physiological healing constraintsPain statusSwellingROMStrength, Power, EnduranceNeuromuscular ControlConditioning

Prentice, 2006

RTP Criteria (con’t)

Sport-specific demandsProphylactic strapping, bracing, paddingResponsibility of the athletePredisposition to injuryPsychological factorsEducationPreventative maintenance program

Prentice, 2006

RELEVANCE

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Needs Analysis

What muscles need to be trained?Joint(s) involvedROMPattern of ResistancePattern of VelocityTypes of muscle action

Fleck & Kraemer, 1997

Needs Analysis (con’t)

What energy systems need to be trained?Competition model criteriaNature and scope of tactical eventsAthlete or “hero?”Idealistic or realistic conditions?

Plisk and Gambetta, Strength & Conditioning, 1997

TIME – BASED

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Tissue Response to Injury

AcuteInflammation

FibroblasticRepair

Maturation –Remodeling

4-5 21-24 365Days

Phases of Rehabilitation

Pre-injury

Pre-surgery

Post-surgery

Maintenance

Advanced StrengtheningPhaseRTP Phase

Maturation /Remodeling

Subacute(Intermediate) Phase

FibroblasticRepair

Acute PhaseAcute Inflammation

Wilk et al., Am J Sports Med, 2002

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Goals During the Acute Phase

Control inflammation

Minimize effects of immobilization

Reduce joint effusion

Maintain condition of non-inured areas

Kinser & Colby, 2002

Goals During the Sub-Acute Phase

Control inflammation

Increase mobility

Strengthen muscles

Maintain condition of non-injured areas

Kinser & Colby, 2002

Goals During the Chronic Phase

Decrease pain from adhesions

Increase extensibility from other structures

Strengthening of affected and supporting musculature

Neuromuscular control, coordination, agility

Kinser & Colby, 2002

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0

2

4

6

8

10

12

14

0 2 4 6 8 10 12

Months

A rough timeline to “normal”

Bone

Muscle /Cartilage

Ligament /Tendon

Houglum, 2005

PROGRAM DESIGN

Principles

AdaptationOverloadMinimum IntensityProgressionWindow of AdaptationLimits of Ability Development

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Principles (con’t)

SpecificityInterferenceReversibilityConsistencyVariability

Acute Program Variables

Choice of exerciseIntensityNumber of RepetitionsNumber of SetsVolumeRest IntervalsNumber of SessionsFrequency

Other Important Concepts

Arthrogenic Inhibition

Crossover Training Effect

Proprioception

Rehab as Motor Learning

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Periodization

Long-term planning

Peaking?

Training several biomotor abilities “simultaneously”