Therapeutic Exercises Chapter 7

Therapeutic Exercises Goal is to return injured athlete to pain-free full function participation. Areas of Focus: Pain ModulationMuscular Strength Normal ROMEndurance KinematicsCoordination FlexibilityPower

Rehabilitation Areas Psychological Physical Emotional Social Performance

Cognitive Model Personal Factors Performance Anxiety Self-esteem/motivation Extroversion/ Introversion Psychological Investment Coping resources History with stress Previous intervention Cognitive Responses Outcome of the Situational Factors Type of Sport Relationship with coach and team Timing of the injury Level and intensity of the player Point in athletes career Role on the team Emotional Responses Behavioral Responses Rehabilitation

Kubler-Ross Emotional Stages  Denial  Isolation  Anger  Bargaining  Depression  Acceptance

Goal Setting Specific and measurable Positive rather than negative Challenging yet realistic Established time table for completion Integration of short- intermediate- and long term goals Personalized and internalized Monitored and evaluated LINKED TO LIFE GOALS!!!

Factors that Inhibit Progress Lack of Knowledge Lack of Skill Lack of Risk-Taking Ability Lack of Social Support

Psychological Influences Confidence Motivation Anxiety Focus Management of Pain

Confidence Program Confidence Adherence Confidence Physical Confidence Return-to-sport Confidence

Motivation Poor Attendance Incomplete Exercises Low Effort Low Intensity Lack of Attentiveness to Instructions Undefined Goals Using Pain to Avoid Exercise Unsupportable Excuses

Anxiety Caused by pain, slow healing, low confidence, pressure, lack of familiarity, predictability, and control Signs: Physical Cognitive Emotional Social Performance

Focus Ability to perceive and address various internal and external cues. Athlete should focus on: Positive attributes Present time The Process of their rehabilitation Their individual Progress

Pain Benign pain Harmful pain Use a variety of methods to deal with pain.

The Rehabilitation Process Phase I Assess the Patient Interpret the Assessment Establish Goals Develop and Supervise the Treatment Plan Reassess the Progress of the Program

Inflammation Control CRIPES ROM Cardiovascular Fitness Affects on: Muscle Articular cartilage Ligaments Bone

Remobilization Phase II Wolff’s Law Affects on: Muscle Articular Cartilage Ligaments Bone

Restoration of Motion Cryokinetics PROM AROM Joint Mobilization Grade I Grade II Grade III Grade IV Grade V

Flexibility Agonist Antagonist Ballistic Stretching Static Stretching Proprioceptive Neuromuscular Facilitation (PNF) Active Inhibition Contract-Relax Reciprocal Inhibition

Muscle/Movement Re- education AAROM AROM RROM Proprioception Closed kinetic chain exercises (CKC) Open kinetic chain exercises (OKC)

Muscular Strength, Endurance and Power Phase III Muscular Strength Isotonic Isokinetic Muscular Endurance Muscular Power Functional Exercise

Rehabilitation Guidelines Intensity Duration Frequency Specificity Speed Progression

Sport Specific Functioning Phase IV Coordination Sport Specific Skill Conditioning Cardiovascular Endurance