Rehabilitation Techniques in Athletic Therapy Tara Sutherland 867-2231 tsutherl@stfx.ca

SOAP REVIEW (HORSP) S- subjective O- objective A- Assessment P-Plan History taking , MOI , Pain etc O- objective Observing , special tests , palpations A- Assessment Impression as to what is wrong P-Plan Rehabilitation plan

Principles Design of Rehab plans Assess needs Develop plan Implement plan Evaluate plan

Assess needs Subjective information Objective data List problem areas

Develop plan Establish goals Select techniques based on available resources Establish how changes will be documented and monitored Implement return to plan /activity criteria

Implement Plan Use procedures and techniques that will fulfill the plan and meet the goals Incorporate the following into plan Verbal motivation, visualization, imagery etc

Evaluate Plan Compare original data with current data at frequent intervals Modify goals according to changes in patient progress and activity level

Principles Knowledge of the inflammatory process is crucial in understanding injury rehabilitation Goals of Rehabilitation will be achieved through the use of therapeutic exercise to develop , improve , restore/maintain Neuromuscular control ROM and flexibility Muscular strength Postural stability and balance Cardiorespiratory fitness

GOAL SETTING: GOALS BASED ON STAGES OF HEALING Provide correct immediate first aid and management of the injury ↓ swelling, pain, inflammation Re-establish neuromuscular control Restore ROM Restore and increase muscular strength, endurance and power Improve postural stability and balance Maintain (improve) cardio fitness Protect/prevent further injury

GOAL SETTING: LONG TERM GOALS Invariably to return the athlete to practice and or competition as quickly and safely as possible

BALANCE BETWEEN HEALING AND RETURN TO PLAY “Walking a thin line” Walking the tightrope Pushing the envelope REMAIN SAFE WITHIN CONFINES OF HEALING PROCESS

Rehab , what we know RECOLLECT PAST LEARNING: Physiology and Exercise Physiology Histology Human growth and development Motor Learning Biomechanics and Kinetics Strength and Conditioning Personal Training Sport Psychology

What we will cover

Inflammatory / Healing Process PHASES OF HEALING: Inflammatory Phase 2-4 days Fibroblastic-Repair Phase First few hours post-injury to 4-6 weeks Maturation-Remodeling 3 weeks to several years

PATHOMECHANICS Knowledge of NORMAL and ABNORMAL mechanics of biomechanics and functional anatomy is crucial Once again you need to know anatomy

Kinetic Chain The therapist must understand the kinetic chain If a system within kinetic chain is not working efficiently, the other systems are forced to adapt and compensate, this can lead to tissue overload, decreased performance and predictable injury patterns

Psychological Aspects Individuals deal with injuries differently Injuries and illnesses produce a wide range of emotions Athletes vary in terms of pain threshold, cooperation , compliance, competitiveness, denial, depression, anger, fear , guilt and the ability to adjust to the injury Belief that therapists are 95% psychologist and 5 % clinician

Tools Electrical modalities, medications, massage, flexibility, strengthening, joint play, proprioception, alternative therapies, plyometrics, cardiovascular conditioning….

PAIN All injuries will experience some kind of pain Severity may help to determine extent of pain, however athletes individual pain threshold will determine a major component of the pain. PAIN IS REAL

PAIN The therapist should address pain levels at each therapy session, modalities and medicines will be used to help reduce the pain. Pain levels will dictate the rate of progression, as pain decreases.. Healing will progress.

Re-establish neuromuscular control Re-establish neuromuscular control is a prime concern Traditionally, certified athletic therapists have used the terms proprioception, strength, and functional exercise. Neuromuscular control relates to all of these concepts.

Restoring ROM Loss of movement can be attributed to a number of pathological factors Resistance of Musculotendinous units to stretch Contracture of connective tissue Or combination of two Crucial to restore normal ROM , with out it difficult to achieve many other goals of the rehab program

Restoring ROM Stretching is utilized to increase flexibility when Musculotendinous units are involved OR Joint mobilizations are used to increase accessory movement with in a joint

Restoring Muscular strength , Endurance and Power A major goal in performing strengthening exercises is to work through a full pain free range of Motion A functional rehab strength program should involve exercises in all three planes of motion, with concentric and eccentric exercise.

Restoring Muscular strength , Endurance and Power Isometric Progressive resistive exercise Isokinetic Plyometric Core Open and closed??

Maintain (improve) cardio fitness This stage can be neglected by many Injured athlete miss training time , the cardio fitness decreases rapidly Activities must be found to replace this training time that they miss.. Alternative can be found..what are some of them ??

Criteria for Full Recovery Physiological healing constraints Pain Status Swelling ROM Strength Neuromuscular control Cardio fitness Sport specific demands Functional testing Prophylactic strapping and or bracing Responsibility of athlete Predisposition to injury Psychological factors Athlete education

FUNCTIONAL TESTS Valid and reliable Easy to apply, cost efficient, minimal time and space demands, applicable Unilateral and bilateral function to ensure no compensation Normative/pre-injury values exceptionally helpful Limb symmetry Ipsilateral limb/contralateral limb