Sports Injuries Rehabilitation

A Progressive Model for Rehabilitation A week – Several Years Adapted, by permission, from J. Hertel and C.R. Denegar, 1998, “A rehabilitation paradigm for restoring neuromuscular control following athletic injury,” Athletic Therapy Today 3 (5): 13-14.

Immediate Treatment The more immediate the treatment the better the outcome and the shorter the recovery time Unfortunately many performers delay seeking medical advice and continue to train with an injury This then exacerbates the situation and lengthens recovery time

Rehabilitation Used to return a performer to their pre- injury fitness Time varies with injury type It usually comprises of 5 phases Focusing on a progressive approach

Rehabilitation Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Medical management with the focus placed on pain relief, swelling reduction and protected mobilisation Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Focus on restoring range of motion, non-weight bearing exercises Flexibility and restoration of strength. Initially starts with isometric exercises, then isotonic with no load then onto proprioceptive exercises Retain sport specific movement patterns and improve co-ordination and agility Return to sport specific training

Rehabilitation Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Prevent swelling, Protect, Control bleeding, Relieve pain Cold compression, elevation and rest Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Control bleeding, Relieve pain, protect, Advise PRICED Absorbtion of swelling, removal of debris, growth of new vessels, development of scar tissue Contrast bathing, elevation, massage, passive exercises No swelling, No inflammation, some ROM, ability to undertake weight bearing ROM, mobilisation and strength exercises, supports Improve balance, coordination, skills and movement

Task Draw a diagram highlighting the 5 different phases showing the progression between each stage. Include exercises you think would be beneficial at each stage for a chosen injury

Hierarchy of Rehabilitation Goals Adapted, by permission, from J. Hertel and C.R. Denegar, 1998, “A rehabilitation paradigm for restoring neuromuscular control following athletic injury,” Athletic Therapy Today 3 (5): 13–14.

Rehabilitation Patterns of motion that use multiple joints acting with various axes & in multiple planes Essential part of rehab that places tissues under stresses that return tissues to levels of full activity Places stresses & forces on each body system Traditional rehab techniques often stress only single joints in single planes of motion

Progression Functional progression = succession of activities that simulate actual motor & sport skills Enables the patient to acquire or reacquire the skills needed to perform activity Must be able to adapt rehab to the sport-specific demands & specific position The clinician breaks down the activities into individual components. The patient can focus on each specific part of an activity.

Benefits for Using Functional Progression Helps patient reach goals of entire program Goals of functional progression: Restoration of joint ROM Restoration of strength Restoration of proprioception Restoration of agility Restoration of confidence Provides both physiological & psychological benefits to the patient

Full Return Decision requires full evaluation of athlete’s condition Objective observation and subjective evaluation Athlete should feel ready physically and mentally Controlled return Added stress to injury can slow healing and result long and painful recovery or re-injury Criteria Physician’s release Pain free, no swelling Normal ROM, strength Completion of functional testing minus adverse effects