Rehabilitation and Therapeutic Exercise

Goals of Rehabilitation (short-term) Control pain and swelling Restore range of motion (ROM) Restore strength Restore neuromuscular control Maintain cardiovascular fitness

Goals (long-term) Return athlete to participation at or near pre- injury level Return quickly and safely Considerations Rehabilitation is different for every person Rehabilitation is a process Athletics usually require a more aggressive approach.

Injury Considerations Inactivity – in conditioned athletes, there is a rapid loss of fitness with inactivity. Immobilization - Can affect a body part in as little as 24 hours - causes atrophy, decreased neuromuscular control - Causes loss of joint lubrication, which leads to joint degeneration - Ligaments and bone become weaker - CV system loses efficiency

Pain Control Modalities Ice, heat, e-stim, US Medications NSAID’s, analgesics

Range of Motion Loss of ROM may be due to contracture, swelling, pain, obstruction Active ROM – the patient moves a joint through ROM w/o assistance Passive ROM – the examiner moves a joint through ROM w/o assistance from the patient Resisted ROM – the patient moves a joint through ROM against some type of resistance

Muscle Strength Strength must be restored through a full, pain-free, ROM. Isometrics: variable resistance, no movement Example: pushing against a wall Isotonics: variable resistance, variable speed Example: free weights Isokinetic: fixed resistance, variable speed Example: Cybex, Kin-Com Plyometrics: explosive movement Example: jump training

Muscular Strength Progressive Resistive Exercise (PRE) done with weights, machines, tubing, etc. must use concentric and eccentric contractions Functional patterns

Neuromuscular Control Proprioception: awareness of body position in space Kinesthesia: awareness of movement Mechanoreceptors: detect changes in the rate and direction of joint movement 1. Muscle Spindle: detect changes in muscle length 2. Golgi Tendon Organ: detects changes in muscle tension Stretch Reflex: protective mechanism of the body’s musculoskeletal system

Neuromuscular Control The body must relearn neuromuscular control after an injury, or after repeated injury. Balance: - also called “postural stability,” or “postural sway.” - Involves muscular strength and sensory information

Kinetic Chain Exercises are either open-chain (OKC), or closed- chain (CKC) OKC: hand or foot is off the ground CKC: hand or foot is in contact with the ground CKC is preferred: more functional, less stress on joints, helps to re-establish proprioception

Functional Progression Final step before return to play Helps to regain sport-specific motions Helps to determine whether an athlete will be able to function safely and effectively in his/her respective sport. Help athletes to be prepared mentally.

Functional Progression Example: Walk  jog forward  jog backwards  figure 8’s  zig-zag  lateral slides  stop- and-go  jumping (2 legs)  jumping (1 leg)

Return to Play Criteria Minimal swelling Full, pain free ROM 80%-90% strength of unaffected side No balance/coordination deficits Increased fitness level Completed functional progression

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