Rehabilitation Concerns with Injury

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Rehabilitation Concerns with Injury

• By Aaron Bridgmon, ATC

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General Topics

• Psychological Factors
• Physiological Factors
• Rehabilitation
• Immobilization
• Range of Motion
• Strengthening
• Sport-Specific Exercises

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Psychological Factors

• Athlete can experience due to injury
• Shock
• Disbelief
• Loss Self-Esteem
• Depression

• Athletes Reaction to injury
• Impatience
• Optimism
• Loss of vigor
• Irrational thoughts
• Alienation
• Dependence or Independence
• Apprehension
• Loss of athletic injury

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Psychological Factors Cont

• Reaction to return
• Eagerness
• Anticipation
• Acknowledgement
• Confident or skeptical
• Closure and renewal

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Physiological Factors Acute Vs. Chronic

• Acute
• Deined as conditions that have a sudden onset
  and are of short duration.
• Typically a result from a a one-time traumatic
  event or mechanism.

• Chronic
• Defined as usually have a gradual onset and are
  of prolonged duration.
• Chronic injury usually results from an
  accumulation of minor insults or repetitive
  stress.

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Acute Injury

• Three phases
• Acute Phase
• Designed to protect. localize, and remove waste
  matierals
• External or internal injury is associated with
  tissue death.
• Caused by lack of oxygen, phagocytes spilling
  over to kill normal cells.

• First Hour
• Vasoconstriction
• Decreased blood flow
• Coagulation (sealing of broken vessels Second
  Hour
• Second Hour
• Vasodilation
• Blood Flow to area.
• Inflammation caused by trauma, chemical agents.
• Chemotaxis

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Physiological Factors Cont.

• Repair phase (Healing Phase)
• 48 hours to 6 weeks
• Begins when the area has been removed of cellular
  debris (Prostaglandins, Leukotrienes, and
  Bradykinin).
• Replaced or formation of scar tissue into injured
  area.
• Connection of gaps

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Physiological Factors Cont.

• Remodeling Phase
• Can continue from 3 months to 6 weeks
• Strength of Scar tissue is increased by
  realignment of tissue

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Physiological Factors Cont.

• Chronic
• Caused from repetitive acute micro trauma and
  overuse.

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Rehabilitation

• Major Goals
• Decrease in pain.
• Decrease in inflammatory response to trauma.
• Return of full, pain-free, active range of
  motion.
• Decrease in Effusion.
• Return of full muscular strength, power, and
  endurance. (Neurogenic Inhibition)
• Return to full asymptomatic functional activities
  at pre-injury level.

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Rehab cont.

• Inflammatory Stage
• Key concept (R.I.C.E.)
• Rest
• Ice
• Compression
• Elevation
• Range of Motion
• Passive (without pain)
• Muscle pumping

• Pain Control
• Modalities
• Ice
• Electrical Stimulation
• Gait Control Theory
• Muscle Pumping

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Gate Control Theory

• 3 ways in which electrical stimulation can help.
• Gate Control Theory
• Central Biasing Mechanism
• Endorphin Release

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Gate Control Theory

• Sensory Fibers travel faster than Pain fibers. (A
  gamma and A beta)

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Central Biasing Mechanism

• Pain decreases Pain

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Endorphin Release

• Anterior Pituitary Gland is stimulated by
  reticular formation.

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Rehab cont

• Range of Motion
• Active can begin once inflammatory phase has
  ended.
• Pain free Motion
• Muscle pumping
• Reduce atrophy

• Examples
• Alphabet
• Pendulum Exercises
• AAROM Exercises
• Wall crawls
• Knee and Shoulder

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Rehab Cont

• Strengthening
• Weight-Bearing
• Proprioception Exercises
• Start of with Isometrics then progress.
• Isometrics
• Concentric
• Eccentric
• Theraband
• Only limited in design by injury and therapist.

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Rehab Cont

• Light Activity Phase
• Endurance exercises begin
• Running program
• Upper body ergometer
• Sport-specific activity phase
• Slowing introduce athlete into practice
• Sport specific exercises

• Examples of Sport-Specific.
• Throwing baseball
• Kicking soccer-ball
• Hitting Volleyball
• Can incorporate exercises together
• Trampoline
• Rebounder

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References

• Andrews, J., Harrelson, G., Wilk, Kevin.
  (1998). Physical Rehabilitation of the Inured
  Athlete. W.B. Saunders Company. Pgs. 175,
  370-372, 512.
• Arnheim, D., Prentice, W., (2000). Principles
  of Athletic Training. McGraw-Hill Higher
  Education. Pgs. 259, 239-242.
• Perrin, D., Houglum, P., Shultz, S., (2000).
  Assessment of Athletic Injuries. Human Kinetics.
  Pg. 3.