dr. Nilla Mayasari,Mkes, SpKFR Instalasi Rehabilitasi Medik RSUP.Wahidin Sudirohusodo

 Rehabilitation involves reconditioning injured tissue.  If the healing tissue is mature the emphasis to more aggressive conditioning for the athlete to re-enter the sports.  Rehabilitation programs are specifically tailored to an injury or surgical intervention.

 The effectiveness of rehabilitation during the recovery period usually determines the degree and success of future athletic competition  Optimize the tissue healing and return the athlete to competition as soon as possible without compromising the healing process.

Incomplete rehabilitation and premature sports re-entry predispose the athlete to re- injury.

Healing Process Depends on the athlete’s age, health, and nutritional status and the magnitude of injury

Parameters should be monitored:  Pain  Tenderness  Range of Motion  Swelling  Heat  Redness  Ability to perform exercises and functional activities

Include :  Progression of tissue healing where the tissue is healed or sufficiently stabilized for active motion  Passive range of motion to 75% of the opposite side  Minimal pain or tenderness  Manual muscle test strength in non pathologic area 4+ to 5  Control of the particular regions  Continued kinetic chain function

Include:  Full, non painful active and passive range of motion of the joint  No pain on tenderness  Strength at 80% of the opposite site with good force couple balance  A normal kinetic chain

 Normal arthrokinetics and multiple-plane activities  Isokinetic strength balance and work at 90% of normal  Completion of functional progressions and satisfactory clinical examinations

 Time constraints for soft tissue healing have been observed  Pain-free full range of movement  No persistent swelling  Adequate strength and endurance  Good flexibility  Good proprioception

 Adequate cardiovascular fitness  Good regional skill  No persistent biomechanical abnormality  Athlete physiologically ready  Coach satisfied with training form

Propioceptive training on lower limb

After Injury altered joint position sense Change to motor control Altered latency onset of muscle contraction, Inadequate sequencing / Patterning

Sport Skill :  Agility training  Sports specific drills Functional rehabilitation and return to training and competition

 Persistent recurrent swelling  Joint instability  Loss of joint range of motion  Lack of full muscle strength

The factors that effect Rehabilitation:  Type of injury  Circumstances of the injury  External pressure (eq : fear of losing position on the team)  Pain tolerance  Psychological attributes of the player  Player-player and coach-player support system

1. Be reasonable in demands on time, energy & enthusiasm 2. Children participate for fun & enjoyment & that winning is only part of their motivation 3. Ensure that equipment and facilities meet safety standards & appropriate to the age & ability 4. Consider maturity level of the children when scheduling and determining the length of practice times & competition

5. Follow the advice of a sport medicine practitioner when determining when a injured player is ready to recommence training or competition. 6. Remain informed the principles of growth & development of children.

 As age increases this leads to a decline in functional status, and an increase risk of injury, joint stiffness, and reduced independence (Buckwalter and Lane 1997)  Divided into three groups :  Who has exercised throughout life, either at a recreational or competitive level  Who has active during his on her youth and is now resuming athletic activity  Who has never been physically active but commences activity anticipating certain benefits

 Rehabilitation of the injured athlete requires carefull assessment and subsequent correction of the athlete’s deficit  The rehabilitation program should be individualized for the athlete’s need such as in younger athletes and older athletes  Functional and sport-specific activities should form a major part of the program  The injured athlete should be able to return to sport without functional deficit and with any predisposing factors to injury corrected