Rehabilitation and Reconditioning

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Rehabilitation and Reconditioning
chapter 20
Rehabilitationand Reconditioning
David H. Potach, PT MS CSCS,D
NSCA-CPT,DTerry L. Grindstaff, DPT ATC SCS
CSCS,D
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Chapter Objectives

• Identify members of the sports medicine team and
  their responsibilities during injury
  rehabilitation and reconditioning.
• Recognize types of injuries athletes sustain.
• Comprehend timing and events of tissue healing.
• Understand goals of each tissue healing phase.
• Describe the strength and conditioning
  profes-sionals role during injury rehabilitation
  and reconditioning.

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Rehabilitation and Reconditioning

• Principles of Rehabilitation and Reconditioning
• Healing tissues must not be overstressed.
• The athlete must fulfill specific criteria to
  progress from one phase to another during the
  rehabilitative process.
• The rehabilitation program must be based on
  current clinical and scientific research.
• The program must be adaptable to each individual
  and his or her specific requirements and goals.
• Rehabilitation is a team-oriented process
  requiring all the members of the sports medicine
  team to work together.

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Section Outline

• Sports Medicine Team
• Sports Medicine Team Members
• Communication

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Sports Medicine Team

• Sports Medicine Team Members
• All members of the sports medicine team are
  responsible for educating coaches and athletes
  regarding injury risks, precautions, and
  treatments.
• The sports medicine team also works to prevent
  injuries and rehabilitate injured athletes.
• Several different professionals play important
  roles in assisting an injured athletes return,
  so effective communication is necessary.

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Key Terms

• team physician A person that provides med-ical
  care to an organization, school, or team.
• athletic trainer A person typically responsible
  for the day-to-day physical health of the
  athlete certified by the National Athletic
  Trainers Association Board of Certification as a
  Certified Athletic Trainer (ATC).

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Key Terms

• physical therapist A person with a back-ground
  in orthopedics or sports medicine that can play a
  valuable role in reducing pain and restoring
  function to the injured athlete.

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Key Terms

• strength and conditioning professional A person
  who plays a valuable role within the sports
  medicine team and is an integral part of the
  rehabilitation and reconditioning process.
  Ideally, this person should be certified by the
  National Strength and Conditioning Association
  (NSCA) Certification Commission as a Certified
  Strength and Conditioning Specialist (CSCS) to
  ensure that he or she has the knowledge and
  background to contribute to the rehabilitation
  process.

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Key Terms

• exercise physiologist A person who has a formal
  background in the study of the exercise sciences
  and uses his or her expertise to assist with the
  design of a conditioning program that carefully
  considers the bodys metabolic response to
  exercise and the ways in which that reaction aids
  the healing process.

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Key Terms

• nutritionist A person who has a background in
  sport nutrition may provide guidelines regard-ing
  proper food choices to optimize tissue recovery.
  Ideally, the nutritionist has been formally
  trained in food and nutrition sciences and is a
  Registered Dietitian (RD) recognized by the
  American Dietetic Association.

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Key Terms

• psychologist or psychiatrist A licensed
  professional with a background in sport may
  provide strategies that help the injured athlete
  better cope with the mental stress accom-panying
  an injury.

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Sports Medicine Team

• Communication
• Strength and conditioning professionals must
  understand the following
• The diagnosis of the injury
• Indicationsforms of treatment required
• Contraindicationsactivity or practice prohibited
  due to the injury
• They must also inform the rest of the sports
  medicine team about the exercises performed by
  the athlete and the athletes response to the
  exercise.

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Key Point

• The sports medicine team includes a large number
  of professionals working together to provide an
  optimal rehabilitation and reconditioning
  environment. The relation-ship among members
  requires thoughtful communication to ensure a
  safe, harmoni-ous climate for the injured athlete.

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Section Outline

• Types of Injury

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Key Point

• Macrotrauma is a specific, sudden episode of
  overload injury to a tissue, resulting in
  disrupted tissue integrity. Microtrauma results
  from repeated, abnormal stresses applied to a
  tissue by continuous training or training with
  too little recovery time. Each injury requires
  specific rehabilitation strategies to allow
  return to function.

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Section Outline

• Tissue Healing
• Inflammation Phase
• Repair Phase
• Remodeling Phase

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Table 20.1
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Tissue Healing

• Inflammation Phase
• Inflammation is the bodys initial reaction to
  injury and is necessary for normal healing to
  occur.

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Tissue Healing

• Repair Phase
• Once the inflammatory phase has ended, tissue
  repair begins this phase allows the replacement
  of tissues that are no longer viable following
  injury.
• This phase of tissue healing begins as early as
  two days after injury and may last up to two
  months.

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Tissue Healing

• Remodeling Phase
• The weakened tissue produced during the repair
  phase is strengthened during the remodeling phase
  of healing.
• Tissue remodeling can last up to two to four
  months after injury.

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Key Point

• Following injury, all damaged tissues go through
  the same general phases of heal-ing
  inflammation, repair, and remodeling.
  Characteristic events define each phase and
  separate one phase from another.

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Section Outline

• Rehabilitation and Reconditioning Strategies
• Goals of Rehabilitation and Reconditioning
• Inflammation Phase
• Treatment Goal
• Exercise Strategies
• Repair Phase
• Treatment Goal
• Exercise Strategies
• Remodeling Phase
• Treatment Goal
• Exercise Strategies (continued)

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Section Outline (continued)

• Rehabilitation and Reconditioning Strategies
• Program Design
• Resistance Training
• Aerobic and Anaerobic Training

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Rehabilitation and Reconditioning Strategies

• Goals of Rehabilitation and Reconditioning
• Choose a level of loading that neither
  overloadsnor underloads healing tissue.
• Healing tissue must never be overstressed.
• But, controlled therapeutic stress is needed to
  optimize collagen matrix formation.
• The athlete must meet specific objectives
  (established by the physician, athletic trainer,
  physical therapist, or a combination of these) to
  progress from one phase of healing to the next.

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Loading During Rehabilitation

• Figure 20.3 (next slide)
• Loading during rehabilitation should neither
  overload nor underload the athletes healing
  tissue.

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Figure 20.3
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Soft Tissue Injury Response

• Figure 20.4 (next slide)
• Pain is often used as a guide for tissue health.
• Pain levels often decrease well before tissue
  healing is complete, which may lead athletes to
  believe they can return to competition before the
  body is actually ready.

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Figure 20.4
Reprinted, by permission, from Leadbetter, 1992.
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Rehabilitation and Reconditioning Strategies

• Goals of Rehabilitation and Reconditioning
• Inflammation Phase
• Treatment Goal
• Preventing disruption of new tissue
• Exercise Strategies
• General aerobic and anaerobic training and
  resistance training of uninjured extremities,
  with priority given to maximal protection of the
  injured area

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Rehabilitation and Reconditioning Strategies

• Goals of Rehabilitation and Reconditioning
• Repair Phase
• Treatment Goal
• Preventing excessive muscle atrophy and joint
  deterioration in the injured area maintaining
  muscular and cardiovascular function in uninjured
  areas
• Exercise Strategies (after consultation with team
  physician, athletic trainer, or physical
  therapist)
• Submaximal isometric exercise
• Isokinetic exercise
• Specific exercises to improve neuromuscular
  control

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Rehabilitation and Reconditioning Strategies

• Goals of Rehabilitation and Reconditioning
• Remodeling Phase
• Treatment Goal
• Optimizing tissue function by continuing and
  progressing the activities performed during the
  repair phase and adding more advanced,
  sport-specific exercises
• Exercise Strategies
• Transition from general exercises to
  sport-specific exercises
• Specificity of movement speed an important
  variable
• Velocity-specific strengthening exercises
  (velocities must progress to those used in the
  athletes sport)

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Rotator Cuff Rehabilitation

• Figure 20.5 (next two slides)
• Exercises generally transition from
• (a, b) isolation exercises to
• (c, d) multijoint, sport-specific exercises.

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Figure 20.5a and b
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Figure 20.5c and d
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Key Term

• closed kinetic chain An exercise in whichthe
  terminal joint meets with considerable resistance
  that prohibits or restrains its free motion that
  is, the distal joint segment is stationary.

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Closed Kinetic Chain Exercises

• Figure 20.6 (next slide)
• Closed kinetic chain exercises
• (a) squat exercise
• (b) push-up exercise

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Figure 20.6
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Key Term

• open kinetic chain An exercise that uses a
  combination of successively arranged joints in
  which the terminal joint is free to move open
  kinetic chain exercises allow for greater
  concentration on an isolated joint or muscle.

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Open Kinetic Chain Exercise

• Figure 20.7 (next slide)
• Example of an open kinetic chain exerciseleg
  (knee) extension exercise

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Figure 20.7
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Kinetic Chain Sprinting

• Figure 20.8 (next slide)
• Sprinting offers an example of open and closed
  kinetic chain movements occurring together.

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Figure 20.8
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Rehabilitation and Reconditioning Strategies

• Program Design
• Resistance Training
• Several programs have been developed to assist
  with the design of resistance training programs
  for injured athletes, including the De Lorme and
  Oxford programs and Knights DAPRE program.
• DAPRE allows more manipulation of intensity and
  volume.
• The demands of the athletes sport determine the
  training goal, which should dictate the design of
  the resistance training program during the
  remodeling phase.

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Rehabilitation andReconditioning Strategies

• Program Design
• Resistance Training
• Daily adjustable progressive resistive exercise
  (DAPRE) system
• First set requires 10 repetitions of 50 of the
  estimated 1RM.
• Second set requires six repetitions of 75 of the
  estimated 1RM.
• Third set requires the maximum number of
  repetitions of 100 of the estimated 1RM.
• The number of repetitions performed during the
  third setdetermines the adjustment to be made in
  resistance for the fourth set.

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Table 20.2
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Rehabilitation andReconditioning Strategies

• Program Design
• Aerobic and Anaerobic Training
• Although research has yet to determine an optimal
  aerobic training program for use in the
  rehabilitation setting, the program should mimic
  specific sport and metabolic demands.

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Key Point

• Designing strength and conditioning programs for
  injured athletes requires the strength and
  conditioning professional to examine the
  rehabilitation and recondi-tioning goals to
  determine what type of program will allow the
  quickest return to competition.