Basics of Injury Rehabilitation Chapter 12

Philosophy of Athletic Injury Rehabilitation  The athletic trainer is responsible for designing, implementing and supervising the rehabilitation of an injured athlete  Because of the competitive nature of athletics the rehabilitation program should be more aggressive than what you would normally do for a non- athlete  The goal of rehabilitation is to return the athlete to activity as soon and as safely as possible  Athletes should never be pushed to return to competition too soon but should be pushed to work harder at their rehabiltation program as strength and endurance increase.

Goals of Rehabilitation Programs  Short Term Goals: goals which can be attained quickly. 1. Provide correct immediate first aid and management following the injury to limit/control swelling 2. Reduce/minimize pain 3. Restore full range of motion 4. Increase muscular strength, endurance and power 5. Re-establish neuromuscular coordination 6. Improve balance 7. Maintain cardiorespiratory fitness 8. Incorporate appropriate functional progressions

Goals of Rehabilitation Programs  The long term goal will be to get the athlete back to safe competition/practice quickly

1. Providing correct first aid and controlling swelling  Initial first aid is the MOST CRITICAL component to a good rehabilitation program.  How the injury is managed initially will have a great impact on the way the injury heals  Apply the RICE principle to control swelling which will aid in quicker rehabilitation.

2. Controlling Pain  Extent of pain is determined by: Severity of injury Athletes response to pain Circumstances in which the injury occured  Use of RICE immediately will aid in decreasing pain  Use of the appropriate therapeutic modality can also aid in decreasing the pain quickly.

3. Restoring Range of Motion  Injury to a joint will always result in some degree of loss of range of motion and it is important to regain this loss quickly to move your athlete through the rehabilitation process quickly.  Begin by implementing stretching techniques  You may have to implement other modalities or techniques to regain ROM if the loss is due to: Contracture of the ligament or capsule Resistance of the muscle and its tendon to stretch Combination of both

4. Restoring muscular strength, endurance and power  Restoring the strength of the muscle is critical to getting the athlete back to their pre-injury condition.  There are 4 major components that can be used in your rehabilitation programs: Isometric exercise  Mostly used in the beginning stages of rehab  Useful in cases where moving the joint through full range of motion may be contraindicated  Increases static strength and decreasing atrophy Progressive resistance exercise (PRE)  Most common type of rehabilitative exercise and can be done using weights, tubing, & weight machines.  PRE uses isotonic contractions to gain strength Isokinetic exercise  Commonly used in the later phases of rehabilitation  Requires expensive machines to provide consistant resistance through full range of motion PLyometric exercise  Most often used in the later stages of rehabilitation to regain the quick stretch contraction of the muscle  Also helpful in developing dynamic strength

5. Regaining Balance  Balance and postural stability are key in athletic performance so must be worked on in order to regain their athletic skill.  A lot of times the athlete will not have worked on basic balance and postural stability exercises which are specific to certain areas so they will have to be taught and re-emphasized throughout the rehabilitation process.

6. Maintaining Cardiorespiratory fitness  This is the most basic but most neglected part of the rehabiliation process!  It is critical that you keep the athlete doing some type of cardiovascular exercise to maintain the function of their heart and lungs for athletics.  The exercises they do will begin out simple and become more complex or at a higher intensity as the affected joint can tolerate the specific movement. For example if it is an athlete with an ankle sprain you will begin by having them work on the bike then progress to the eliptical and then work on running on the treadmill.

7. Functional Progression  It is EXTREMELY important to have your athlete progress in a quick manner but also in a functional manner so that they are regaining strength along with a certain athletic skill required within their sport.  The functional progression activities are designed to prepare the athlete to return to activity.  The skill of the sport will be broken down into simpler components and then gradually re-learned and put back together  This phase of rehabilitation requires constant monitoring of the athlete so that you can catch and re-educate any mistakes they may be making which will eventually lead to further injury if they are not trained correctly!  A good way of knowing when to progress is by asking the athlete how the activity felt during and then the next day finding out if there was any pain or discomfort or any swelling. If pain and discomfort occur during the activity stop and back down a bit. If pain and discomfort occur the next day then slow the activity down or break it down further but still complete all components of it. If swelling occurs then go back to the last activity they could perform without swelling.

Your Task!  Now that you know the goals and phases of rehabilitation complete critical thinking questions #1-3 in your book (chapter 12) Turn in to me when you are finished!