Therapeutic exercises and modalitiesLecture 20

The ultimate goal of rehabilitation is to return the injured athlete to activity, pain free and fully functional.

Therapeutic modalities, exercise and medications are used to create an optimal environment for injury repair

Controlling Inflammation

primary goal is to control inflammation by limiting hemorrhage, edema, muscle spasm and pain

PIER maintain ROM , strength, flexibility and

CV endurance in unaffected body parts

Restoration of Motion

goal here is to restore range of motion , flexibility to 80 % of unaffected limb

begin strengthening exercises begin proprioceptive work maintain other areas

Flexibility Static – movement slow and deliberate muscle stretched to point of mild tension

and maintained for a time period Ballistic – repetitive bouncing may carry joint past point of comfort not advisable to do

Developing Muscular Strength , Power and Endurance focuses on developing muscular

strength, endurance and power restore full ROM and proprioception initiate sport specific activity – on a

controlled level

Strengthening isometric contraction muscle is at a constant tension muscle length and joint angle remain the same Isotonic contraction muscle contraction generated a force to move

a constant load through a ROM at a variable speed

free weights , tubing allows for both concentric and eccentric

strengthening

Isokinetic contraction accommodating resistance muscular overload and angular movement

to rotate a lever arm at a controlled velocity

Cybex, Kin Con

Open vs Closed Chain Exercises open or non weight bearing exercises are

exercises in which the distal joints function independently of other joints

greater potential for joint shear eg. quad extension machine , hamstring

curls closed or weight bearing exercises are

ones in which movement at one joint will produce predictable motion at another joint

multiple joints are exercised through weight bearing

velocity and torque are more controlled shear forces are reduced proprioceptors better trained eg. squats

Return to Sport

continue to improve strength , endurance and power

restore co-ordination and balance improve CV endurance analyse skill performance and correct increase sport related activities

Therapeutic Modalities

Indication a condition that could benefit from a

specific action or modality Contraindication a condition adversely affected by a

specific action or modality

Modalities may be indicated or contraindicated for the same condition , depending on the phase of the therapy

Categories of Modalities

Cryotherapy

umbrella term that describes a multiple number of cold therapies

Primarily induces vasoconsctriction immediate response to cold is a decrease in

circulation and cell metabolism cold can penetrate 1- 5 cms this does depend

on subcutaneous insulation, temperature and duration of application

usually applied for 15 to 30 minutes , may be applied hourly during the first 24 to72 hours

ice, ice massage, ice tubs, cold whirlpools , gel packs , chemical packs , vapo-coolant sprays

Magnitude of temperature change depends on;

Type of cooling agent Temperature difference between the cold

object and the tissue Amount of subcutaneous insulation (fat) Thermal conductivity of the area being

cooled Limb circumference Duration of application

15-26

Thermotherapy or heat application usually used after the acute phase to

increase blood flow and promote healing heat has an analgesic or sedative effect, it

is used to decrease muscle spasm and pain

vasodilatation and increased circulation result in a influx of oxygen and nutrients to help promote healing

depth of penetration is generally 2 cm - warm whirlpools, hot pack , hot rubs , ultrasound

Electric modalities

electrical current refers to a string of electrons that pass along a conductor such as a wire.

depending on the electrical current parameters, you may be able to affect sensory , motor or pain fibres

used to relieve pain , reduce swelling, muscle spasm, increase blood flow muscle strength , re-educate muscle

TENS – used to produce analgesia and decrease acute and chronic pain

thought to work on gate therapy – overriding pain signals

or to stimulate release of endorphins EMS – used to re-educate , increase

muscular strength , reduce muscle spasm IFC- used to decrease pain , muscle

spasm and swelling helps increase circulation and wound healing

15-14

Massage soft tissue massage is a good means to

increase cutaneous circulation , cell metabolism , venous and lymphatic flow in the removal of edema, stretch scar tissue

15-15

Ultrasound

high frequency sound waves ( beyond the range of the human ear) to elicit thermal and non thermal effects in deep tissue

Chronic use- thermal effects elevate temperature and increase collagen tissue extensibility , blood flow and nerve conduction, as well as reduce muscle spasm, joint stiffness and pain

Acute injuries- nonthermal effects increase cell membrane permeability, tissue regeneration , protein synthesis and reduce edema

depth of penetration depends on frequency of the sound head

most common sound head is 1 MHz = 1 million cycles per sec

3.0 MHz more superficial