Functional Exercise

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Functional Exercise

• CHAPTER 10

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Functional exercise in rehabilitation

• Must prepare athlete for stresses of their sport
• Adapt rehab to sport-specific skill demands
• Also rehab confidence
• Functional exercise vs. Functional evaluation
• Functional progressions
• Succession of activities that simulate sport
  skills
• Takes an activity and breaks it down into its
  component parts
• Reintroduce parts in controlled environment
• Places stress on the body in a positive,
  progressive fashion

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Contributions to therapeutic exercise

• Normal motion
• Multifaceted muscle activity
• Stabilization and acceleration changes
• Proprioceptive stimulation
• Agility and power development
• Skill development
• Confidence development

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Functional activities

• Basic
• Introduce early in program
• Evaluations should be objective
• Advanced
• Use more specific sport skills
• Ensure success at fundamental level before
  increasing complexity or intensity

• Advanced functional progression
• Proprioception is a transition parameter
• Adjustments made via overload
• Force and intensity
• Speed
• Distance
• Complexity
• Support
• Should challenge without causing failure

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Precautions

• Explain exercise to patient
• Demonstrations
• Give cues during performance
• Try uninvolved side first
• Avoid pain and swelling
• Tissue limits
• Work within confidence
• Avoid progression tolerance

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Psychological and social considerations

• Negative feelings and emotions common
• Anxiety uncertainty about the future
• Apprehension adapting to demands in controlled
  environment restores confidence
• Deprivations losing contact
• Exercise during regular team practice times on
  site
• Close proximity reduces feeling of loss of
  cohesion

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Functional evaluation

• Ongoing process
• Guides advancements
• Final evaluation gauges return to play readiness
• Highly individualized
• Pain free/no edema
• Full ROM, strength, endurance, agility, etc.
• Performance levels are at pre-injury levels
• Confidence is at pre-injury level

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Sample progressions

• Lower extremity
• Warm-up
• NWB ? PWB ? FWB
• BAPS, trampoline, foam roller
• Combine with other activity
• Lunges, step-ups, jogging
• Running progression
• Jumping progression
• Tests
• Running for time/distance
• Repeated/single jump for distance
• Agility tests

• Upper extremity
• Warm-up
• NWB ? PWB ? FWB
• Wall, trampoline, swiss ball
• Fitter, slide board
• Push-up progression
• Implement progression
• Speed
• Distance
• Weight
• Length
• Testing more subjective