Rehabilitation Techniques in Athletic Therapy

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Rehabilitation Techniques in Athletic Therapy

• Tara Sutherland
• 867-2231
• tsutherl_at_stfx.ca

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SOAP REVIEW (HORSP)

• S- subjective
• History taking , MOI , Pain etc
• O- objective
• Observing , special tests , palpations
• A- Assessment
• Impression as to what is wrong
• P-Plan
• Rehabilitation plan

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Principles

• Design of Rehab plans
• Assess needs
• Develop plan
• Implement plan
• Evaluate plan

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Assess needs

• Subjective information
• Objective data
• List problem areas

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Develop plan

• Establish goals
• Select techniques based on available resources
• Establish how changes will be documented and
  monitored
• Implement return to plan /activity criteria

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Implement Plan

• Use procedures and techniques that will fulfill
  the plan and meet the goals
• Incorporate the following into plan
• Verbal motivation, visualization, imagery etc

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Evaluate Plan

• Compare original data with current data at
  frequent intervals
• Modify goals according to changes in patient
  progress and activity level

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Principles

• Knowledge of the inflammatory process is crucial
  in understanding injury rehabilitation
• Goals of Rehabilitation will be achieved through
  the use of therapeutic exercise to develop ,
  improve , restore/maintain
• Neuromuscular control
• ROM and flexibility
• Muscular strength
• Postural stability and balance
• Cardiorespiratory fitness

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GOAL SETTING GOALS BASED ON STAGES OF HEALING

• Provide correct immediate first aid and
  management of the injury
• ? swelling, pain, inflammation
• Re-establish neuromuscular control
• Restore ROM
• Restore and increase muscular strength, endurance
  and power
• Improve postural stability and balance
• Maintain (improve) cardio fitness
• Protect/prevent further injury

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GOAL SETTING LONG TERM GOALS

• Invariably to return the athlete to practice and
  or competition as quickly and safely as possible

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BALANCE BETWEEN HEALING AND RETURN TO PLAY

• Walking a thin line
• Walking the tightrope
• Pushing the envelope
• REMAIN SAFE WITHIN CONFINES OF HEALING PROCESS

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Rehab , what we know

• RECOLLECT PAST LEARNING
• Physiology and Exercise Physiology
• Histology
• Human growth and development
• Motor Learning
• Biomechanics and Kinetics
• Strength and Conditioning
• Personal Training
• Sport Psychology

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What we will cover
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Inflammatory / Healing Process

• PHASES OF HEALING
• Inflammatory Phase
• 2-4 days
• Fibroblastic-Repair Phase
• First few hours post-injury to 4-6 weeks
• Maturation-Remodeling
• 3 weeks to several years

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PATHOMECHANICS

• Knowledge of NORMAL and ABNORMAL mechanics of
  biomechanics and functional anatomy is crucial
• Once again you need to know anatomy

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Kinetic Chain

• The therapist must understand the kinetic chain
• If a system within kinetic chain is not working
  efficiently, the other systems are forced to
  adapt and compensate, this can lead to tissue
  overload, decreased performance and predictable
  injury patterns

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Psychological Aspects

• Individuals deal with injuries differently
• Injuries and illnesses produce a wide range of
  emotions
• Athletes vary in terms of pain threshold,
  cooperation , compliance, competitiveness,
  denial, depression, anger, fear , guilt and the
  ability to adjust to the injury
• Belief that therapists are 95 psychologist and 5
  clinician

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Tools

• Electrical modalities, medications, massage,
  flexibility, strengthening, joint play,
  proprioception, alternative therapies,
  plyometrics, cardiovascular conditioning.

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PAIN

• All injuries will experience some kind of pain
• Severity may help to determine extent of pain,
  however athletes individual pain threshold will
  determine a major component of the pain.
• PAIN IS REAL

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PAIN

• The therapist should address pain levels at each
  therapy session, modalities and medicines will be
  used to help reduce the pain.
• Pain levels will dictate the rate of progression,
  as pain decreases.. Healing will progress.

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Re-establish neuromuscular control

• Re-establish neuromuscular control is a prime
  concern
• Traditionally, certified athletic therapists have
  used the terms proprioception, strength, and
  functional exercise. Neuromuscular control
  relates to all of these concepts.

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Restoring ROM

• Loss of movement can be attributed to a number of
  pathological factors
• Resistance of Musculotendinous units to stretch
• Contracture of connective tissue
• Or combination of two
• Crucial to restore normal ROM , with out it
  difficult to achieve many other goals of the
  rehab program

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Restoring ROM

• Stretching is utilized to increase flexibility
  when Musculotendinous units are involved
• OR Joint mobilizations are used to increase
  accessory movement with in a joint

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Restoring Muscular strength , Endurance and Power

• A major goal in performing strengthening
  exercises is to work through a full pain free
  range of Motion
• A functional rehab strength program should
  involve exercises in all three planes of motion,
  with concentric and eccentric exercise.

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Restoring Muscular strength , Endurance and Power

• Isometric
• Progressive resistive exercise
• Isokinetic
• Plyometric
• Core
• Open and closed??

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Maintain (improve) cardio fitness

• This stage can be neglected by many
• Injured athlete miss training time , the cardio
  fitness decreases rapidly
• Activities must be found to replace this training
  time that they miss.. Alternative can be
  found..what are some of them ??

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Criteria for Full Recovery

• Physiological healing constraints
• Pain Status
• Swelling
• ROM
• Strength
• Neuromuscular control
• Cardio fitness
• Sport specific demands
• Functional testing
• Prophylactic strapping and or bracing
• Responsibility of athlete
• Predisposition to injury
• Psychological factors
• Athlete education

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FUNCTIONAL TESTS

• Valid and reliable
• Easy to apply, cost efficient, minimal time and
  space demands, applicable
• Unilateral and bilateral function to ensure no
  compensation
• Normative/pre-injury values exceptionally helpful
• Limb symmetry
• Ipsilateral limb/contralateral limb