Return to Play

1. ↓ swelling, pain, inflammation 2. ↑ ROM 3. ↑ muscular strength, endurance, power 4. Maintain cardiovascular fitness 5. Re-establish neuromuscular control 6. Improve stability and balance 7. Address psychological reaction to injury/pain 8. Posture & core stability 9. Protect/prevent further injury 10. Kinetic Chain/ Jt above/below 11. Functional Progressions- sport specific 12. Return to Activity Criteria 13. Home Program

* Overlap with each other * Inflammatory Phase: 2-4 days, SHARP/D, Goals; 1- 3,9 * Fibroblastic-Repair Phase: first few hours post injury to 4-6 weeks, Goals; (1-3), 4-9, (10-11) * Maturation- Remodeling Phase: 3 weeks to several years, Goals; (1-9), 10-13

* PRICE –Protect, Rest, Ice, Compression, Elevation for the first 72 hours * Rest- Active Rest or AAROM (active-assisted ROM) * Ice- Decreases pain, vasoconstriction of vessels to control hemorrhage(bleeding) and edema (swelling) * Compression-decreases hemorrhage and hematoma formation * Elevation- reduces internal bleeding

* Several factors can limit flexibility and ROM: shape of jt, capsule, ligaments, mm, scars, neural tissue * Reflex Autogenic Inhibition: Golgi Tendon Organs = relaxation in antagonist mm * Flexibility can be lost quickly * Can be maintained with 1 session/week * Need 3-5 sessions a week to improve!

* MUST use ALL 3 (ISOM,CONC,ECCEN) for program, watch out for Rehabilitative Overload * First weeks of program is focused on training to be efficient ex. Technique, target fiber and contraction * Strength directly related to efficiency of neuromuscular sys; increase motor unit recruitment, firing rate, enhancing synchronization of motor unit firing

* Critical and often most neglected, improvements may be lost in as little as 12 days * Regardless of training schedule/techniques; Main goal is to increase ability of Cardioresp sys. to supply a sufficient amt of oxygen to the mm. * Upper vs Lower body injury

* After injury, the CNS “forgets” how to put together information from mm and jt receptors * Attempt to teach the body conscious control of a specific movement * Requires many repetitions, from simple to complex movements * CNS will compare the specific movement with stored information and adjust until any discrepancy in movement is corrected. * MOST critical during the early stages of rehab to avoid reinjury

* Involves integration of muscular forces, neurological sensory information, and biomechanical information * Alignment of joint segments in an effort to maintain COG within an optimal range of the max limits of stability * Static and Dynamic stability * Associated with Closed Kinetic Chain (fixed base of support)

* Psychological and sociological consequences of injury are just as debilitating as the injury itself * Can have an adverse impact on RTP * Barriers to rehabilitation * Focus on prevention: Listen, Educate on injury and rehab, Goal setting, Meditation/Progressive Relaxation, Imagery, REFERRAL * Maintain confidentiality!

* Core= Lumbo-pelvic-hip complex, location of COG and where all movements begin * Weak core= fundamental problem of many inefficient movements that lead to injury * Inner (pelvic floor mm, TA, multifidus, diaphragm) and Outer unit (posterior oblique, deep longitudinal, anterior oblique, lateral) * If one sys is out of alignment= patterns of dysfunction= Mechanical imbalance= bad posture (kyphosis, lordosis, sway back)

* Equipment= Helmets!, facial protection (face, throat, mouth, ears, and eyes), neck protecting, trunk and thorax, hips/ buttock, groin/ genetalia, upper leg, lower leg, footwear * Protect with injury= crutches, splints, tensors, tape, slings, foam padding * Rehab program must allow for Rest!

* Kinetic Chain- integrated functional unit, includes mm, fascia, ligaments, tendons, articular sys, and neural sys * Open- Kinetic Chain Exercise- distal segment is mobile and not fixed (foot or hand not in contact with ground or surface) * Closed-Kinetic Chain Exercise- when the distal segment of the lower extremity is stabilized or fixed

* A series of gradually progressive activities designed to prepare the individual for RTP * Progress from simple to complex sport specific skills * Skills are broken down into component parts and the athlete gradually reacquires those skills within the limitations of progress * May be broken down into 3 phases: stabilization, strengthening, power

* Physicians Release * Pain Free * No swelling * Normal ROM * Normal Strength * Mentally Prepared * Pass Functional Tests!

* All exercises completed during rehab should be completed at home or at practice