Phases of Rehabilitation

Phase I- Control Inflammation PRICE- Protect Injury with elastic wrap, tape, sling, cast, etc Cryotherapy- analgesic effect, stop muscle spasm, swelling (cryotherapy/thermotherapy notes) Cardiovascular- swimming, UBE, stationary bike

2 1 3 4 5 6

Phase II- Increase ROM and (flexibility) Scar tissue not as strong Prolonged immobilization  Contractures Full pain free motion Can be passive or active (finger ladder, manipulation) e.g. CPM

Flexibility Increase muscle length Ballistic stretching Static Stretching PNF- Proprioceptive neuromuscular fascilitation http://www.youtube.com/watch?v=791XXiYzNbE http://www.youtube.com/watch?v=d4F4Rj8s8qQ

Phase III- Strength Areas addressed: Overload Principal: by frequency, intensity, and duration Endurance- repetitions Power: amount force in one given time.

Types of Strength Training ISO’s- Isometric, Isotonic, isokinetic Plyometrics Concentric vs Eccentric Agonist vs Antagonist (including reciprocal inhibition) Open Chain vs Closed Chain (Leg lifts vs squats)

1) ISO’s Isometric- Contraction without movement Used when immobile or when pain limits movement. Isotonic- Contraction with movement- free wgts, tubing, concentric/eccentric, open and closed. Disadvantage- not constant force Isokinetic- contraction with controlled speed, so resistance throughout full range. Disadvantage- need machine

1 2 3 4 5 6 7

3) Concentric vs. Eccentric Concentric is when muscle is shortening during lifting phase. Eccentric is when muscle is lengthening lowering phase.

2) PLYO’s Rapid eccentric and then explosive concentric – so big stretch of muscle and then quick contraction

** may cause injury!!!

4) Agonist vs Antagonist Muscles pectorals/latissimus dorsi anterior deltoids/posterior deltoids trapezius/deltoids abdominals/spinal erectors left and right external obliques quadriceps/hamstrings shins/calves biceps/triceps forearm flexors/extensors

Agonist and Antagonist muscles are controlled by Reciprocal Inhibition. When an agonist contracts the stretch reflex is activated (safety mechanism that prevents injury) so the antagonist muscle is told to relax. A message is sent to the Spinal cord via the Inhibitory interneron

Reciprocal Inhibitions: This inhibition is accomplished by the action of an inhibitory interneuron in the spinal cord https://www.youtube.com/watch?v=80mpdqBZl2A

http://www.bandhayoga.com/keys_recip.html

http://www.bandhayoga.com/keys_recip.html

5) Closed Chain vs Open Chain Open Chain- distal end of the extremity being exercised is open or free to move Closed Chain- distal end of extremity being exercised is on contact with surface

Examples Bicep Curl Squats

Delayed Onset Muscle Soreness DOMS Eccentric Muscle Contraction causes DOMS Examples: the lengthening of the thigh muscles while the limb brakes against your body’s momentum as it walks or jogs down a hill. Jogging or running on a flat surface can also elicit DOMS symptoms for those who are unaccustomed to this type of activity.

TX of DOMS: How to Avoid DOMS: Causes of DOMS??: *Active cool down *Foam rubber *Active cool down *Stretching after *RICE/NSAIDS *Ice bath *Time How to Avoid DOMS: *Warm up *Cool down *10% rule Causes of DOMS??: *Micro tears *Repair of tissue causes soreness *not lactic acid build up

Phase IV- Return to Sport Proprioception/Balance- BAPS Bd, Wobble Bd, etc. (Balance activity) Coordination- Fine and Gross motor Sport Specific (incorporate in all phases) CV- always with Overload principal

Intermittant Compression boot

Vapocoolant Spray

Ice Immersion therapy

Paraffin bath

Hydroculator

Therapeutic Ultrasound

Intermittent Compression Boot