Basic Injury Rehabilitation

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Basic Injury Rehabilitation
2
The Rehabilitation Team

• Group Effort
• Athlete
• Athletic Trainer
• Physician
• Strength Conditioning personnel
• Coaches
• Athletes family
• Involved with rehab process from beginning to end

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Athletic Trainers Role in Rehab

• As an Athletic Trainer you are involved from the
  initial injury to unrestricted return to play
• Your responsibilities include
• Injury prevention
• Recognition, evaluation and assessment
• Immediate care
• Treatment and rehabilitation of injuries
• Healthcare administration
• Professional development
• You work under the supervision of a physician
• Develop the rehabilitation program design

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Athletic Trainers Role in Rehab

• Your treatment philosophy
• There must be an understanding tempered by
  flexibility
• Variations occur athlete to athlete and physician
  to physician
• Communication is critical on all levels
• Trust confidence involved in the working
  relationship must evolve
• Goal directed approach
• Involving multiple individuals
• All parties must be involved in the
  rehabilitation process and must communicate
  effectively at every level of athletic
  participation

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Philosophy in Rehabilitation

• Aggressive Rehabilitation
• Competitive nature of athletics necessitates
  aggressive approach
• Pushing too hard or not hard enough may have
  negative impact on athletes return to play
• Quick, safe, effective rehabilitation and return
  to play
• Is the injury completely healed if you return too
  quickly?

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Rehabilitation Tools

• Avoid the cookbook approach
• Each patient is different!
• Develop a broad knowledge base of specific
  techniques and tools that can be used in your
  rehab plans
• Tools therapeutic modalities, manual therapy,
  aquatic therapy, physician prescribed medications

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Tissue Healing Process

• You, as the Athletic Trainer, need to know the
  healing process.
• You must create an environment conducive to the
  healing process.
• You must understand the timing of sequences and
  physiological events associated with healing
  process.

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Goal Setting

• Rehabilitation should be goal directed
• Short-term goals
• First aid care
• Reduce/minimize pain
• Re-establish neuromuscular control
• Restore full ROM
• Restore strength, endurance, power
• Improve postural stability balance
• Maintain cardiovascular fitness
• Incorporate into a functional progression
• Long-term goals Return to play, Life-long
  normal movement

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Goal Setting

• Goals should be reasonable and attainable
• Integrate specific activities to achieve goals
• Due to the goal-oriented nature of athletes,
  rehabilitation program should have progressive
  steps
• Avoid exact time frames or dates
• Athlete should be encouraged to meet sequential
  challenges involving increased skill and ability
• The athlete should be actively engaged in the
  rehabilitation process

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Controlling Pain

• Extent of pain is dependent on
• Severity of the injury,
• Athletes individual response perception, and
• The circumstances in which the injury occurred
• Pain can be modulated through modality
  medication use
• Pain may interfere with the rehabilitation
  process
• Pain will dictate the rate of progression

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Exercise Intensity

• SAID Principle Specific Adaptations to Imposed
  Demands
• Ability of the body to adapt to stress overload
  imposed on it
• IMPORTANT to consider during rehab
• Indications of too much stress applied
• Pain, swelling, loss of ROM or strength,
  increased laxity of healing tissues
• Indications of too little stress being applied
• No change in strength, ROM
• As healing progresses exercise intensity should
  progress

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The Kinetic Chain

• The Kinetic Chain is an integrated functional
  unit involving
• Muscles, tendons, ligaments, bone, fascia
• Articular neural system
• Each system works to provide structural
  functional efficiency
• Contributing Components
• Length-Tension relationships
• Force couples
• Precise arthrokinematics
• Optimal neuromuscular control

• Malfunctioning systems result in
• Compensatory overload,
• ? performance,
• Predicable injury patterns
• Kinetic chain injuries rarely involve only one
  joint
• Comprehensive rehab must examine
• Muscle imbalances,
• Myofascial adhesions,
• Altered arthrokinematics,
• Neuromuscular control
• Goal Restore optimal kinetic chain functioning

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• Open vs. Closed Kinetic Chain Exercises
• Deals with the functional relationship in upper
  and lower extremities
• Open kinetic chain foot or hand operating in
  space
• Closed kinetic chain foot or hand are
  weight-bearing
• Closed kinetic chain exercises incorporate
  isometric, concentric and eccentric muscle
  contractions simultaneously in differing muscle
  groups within the chain.

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Reestablishing Neuromuscular Control

• Joint position sense is mediated by
  mechanoreceptors
• Neuromuscular control relies on the CNS to
  interpret integrate proprioceptive and
  kinesthetic information, translating it into
  coordinated motion
• Injuries alter this ability
• Early stages of rehabilitation involve regaining
  previously established sensory patterns
• Practice is required until the patterns become
  automatic

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Restoring Range of Motion

• Loss of range of motion is associated with
• Resistance of musculotendinous units
• Connective tissue stretch contractures
• Muscle imbalances
• Postural imbalances
• Neural tension
• Joint dysfunction
• Physiological movement constraints and accessory
  motion deficits must be determined and treated
  accordingly
• Stretching
• Joint mobilization traction

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Restoring Muscular Strength, Endurance Power

• Essential to restoring pre-injury status
• Working through a full pain-free range of motion
  should be emphasized
• Strength training should incorporate both single
  plane force production movements functional
  activities in all planes of motion
• Combinations of muscle contractions should be
  emphasized
• Core stabilization neuromuscular control should
  also be incorporated

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Restoring Postural Control Stability

• Involves integration of muscular forces, sensory
  information biomechanical information
• Postural stability is essential to reacquiring
  complex motor tasks
• Decreased postural control may be linked with
  deficits in kinesthetic/proprioceptive function
  and/or muscle weakness
• May limit athletes ability to adjust to postural
  disturbances

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Maintaining Cardiorespiratory Fitness

• Most neglected aspect of rehabilitation
• Cardiorespiratory fitness decreases rapidly
  during periods of inactivity
• Alternative activities should be substituted to
  minimize the decrements in fitness levels

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Functional Progression

• Gradually progressive activities designed to
  prepare the athlete for return to play
• Skill progression and reacquisition within
  limitation of injury and rehabilitation
• Progression based on injury response
• Functional progression will help injured athlete
  return to normal pain-free range of motion,
  strength and neuromuscular control

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Functional Testing

• Drills used to assess athletes ability to perform
  a specific activity
• May involve single maximal effort
• Commonly used tests
• Agility runs
• Sidestepping
• Vertical jump
• Hops for distance/time

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Criteria for Full Recovery

• Restoration to normal function all aspects
• Determined by
• Nature of injury
• Philosophy of physician athletic trainer
• Based on objective and subjective criteria
• Strength testing and questionnaires
• Functional tests
• Physician has the final say in return to play

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Factors to Consider Prior to Return to Play

• Physiological healing constraints
• Pain status
• Swelling
• Range of motion
• Strength
• Neuromuscular control
• Cardiorespiratory fitness
• Sports-specific demands

• Functional testing
• Prophylactic strapping and bracing
• Responsibility of athlete
• Predisposition to injury
• Psychological factors
• Athlete education and preventative maintenance

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Understanding the Psychological Aspect of
Rehabilitation

• Critical factor that is often neglected and
  overlooked
• Injury/illness produce a variety of emotional
  responses
• Athletes vary on
• pain threshold competitiveness
  cooperation compliance depression
  anger
• fear guilt
• The psychological aspect can also play an
  important role in performance enhancement

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Documentation in Rehabilitation

• Detailed records must be maintained
• Injury evaluations
• Treatment records
• Progress notes
• In clinical setting record keeping is critical
  for third-party billing
• While time consuming it can not be neglected
• Can be used in lawsuits and malpractice

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Legal Considerations in Supervising a
Rehabilitation Program

• Educational backgrounds, licensure, and
  certification are controversial when considering
  patient care
• Laws vary state to state with regard to an
  athletic trainers ability to conduct
  rehabilitation programs
• Athletic trainers should be sure to operate
  within the limitations of their respective state
  laws