1. Therapeutic Exercise in Rehabilitation

2. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Establishing or Enhancing Core Stability
Important component of all strengthening and comprehensive injury prevention program
Core is defined as the lumbo-pelvic complex, area where center of gravity (CoG) is located

3. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Establishing or Enhancing Core Stability
Body’s stabilization system has to function optimally to effectively utilize the strength of prime movers

4. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Establishing or Enhancing Core Stability
A weak core is a fundamental problem of inefficient movements which leads to injury

5. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Establishing or Enhancing Core Stability
Program should be safe, challenging, stress multiple planes and incorporate a variety of resistance equipment; be derived from fundamental movement skills, and be activity specific
Program should be systematic, progressive and functional

6. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining or Improving Range of Motion
Physiological versus Accessory Movements
Both occur simultaneously and ultimately work together
Physiological movement results from active voluntary muscle contraction - moving an extremity through a ROM

7. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining or Improving Range of Motion
Accessory motion refers to the manner in which one articulating surface moves relative to another

8. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining or Improving Range of Motion
If physiological movement is restricted, a stretching program designed to increase flexibility should be engaged

9. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Must work through a full pain free range of motion when working on strength

10. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Isometrics
Increase static strength, work to decrease/limit atrophy, create a muscle pump to decrease swelling

11. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Isometrics
Difficult to motivate and measure force being applied

12. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Progressive Resistance Exercise (PRE)
Can be performed using a variety of equipment
Utilizes isotonic contractions to generate force while muscle changes length
Concentric and eccentric muscle contractions
Traditionally focus on concentric exercises
Eccentrics involved in deceleration of limbs

13. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Concentric and eccentric muscle contractions
Traditionally focus on concentric exercises
Eccentrics involved in deceleration of limbs
Machines tend to limit movement in functional planes
Machines and free weights are difficult to operate at functional speeds w/out injury

14. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Isokinetic Exercise
Uses fixed speeds w/ accommodating resistance to provide maximal resistance throughout ROM

15. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Isokinetic Exercise
Allows for work at more functional speeds

16. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Restoring or Increasing Muscular Strength & Endurance
Isokinetic Exercise
Work at higher speeds tends to reduce joint compressive forces
Can be used to develop neuromuscular pattern for functional speed and movements

17. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining Balance
Involves complex integration of muscular forces, neurological sensory information from mechanoreceptors and biomechanical information

18. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining Balance
Center of gravity (CoG): the point at which the entire weight of a body may be considered as concentrated so that if supported at this point the body would remain in equilibrium in any position

19. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining Balance
If center of gravity extends beyond this base, the limits of stability have been exceeded and a corrective step or stumble will be necessary to prevent

20. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining Balance
Even when “motionless” body is constantly undergoing constant postural sway with reflexive muscle contractions which correct and maintain dynamic equilibrium in an upright posture

21. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining Balance
When balanced is challenged the response is reflexive and automatic
The primary mechanism for controlling balance occurs in the joints of the lower extremity

22. Therapeutic Exercise in Rehabilitation
Major Components of a Rehab Program
Regaining Balance
The ability to balance and maintain it is critical for patients
A rehabilitation plan must incorporate functional activities that incorporate balance and proprioceptive training

23. Therapeutic Exercise in Rehabilitation
Maintaining Cardiorespiratory Fitness
When injury occurs an athlete is forced to miss training time which results in decreased cardiorespiratory endurance unless training occurs to help maintain it
Alternative activities must be substituted that allow athlete to maintain fitness

24. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Involves a series of gradually progressive activities designed to prepare the individual for return to a specific sport/activity

25. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Adequate program will gradually assist athlete regain pain free ROM, restoration of strength, and neuromuscular control
Progression moves from simple to complex, slow to fast, short to long, light to heavy

26. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
New activities must be monitored closely to assure proper mechanics and form

27. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
As progress is made, the athlete should be returned to sports specific activity
The optimal functional progression would be designed to allow opportunity for practice of every skill that is required for the sport
This program will minimize the normal anxiety and apprehension experienced by the athlete upon return to the competitive environment

28. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Functional progression activities should be done during team practice - integrate athlete with team and coaches

29. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Functional Testing
Uses functional progression drills for the purpose of assessing the athlete’s ability to perform a specific activity

30. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Functional Testing
Can be used to determine risk of injury due to limb asymmetry, provide objective measures of progress, and determine level of activity tolerance

31. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Functional Testing
Validity and reliability must be considered
Should assess unilateral and bilateral function
Validity- producing the desired result
Reliability- the extent to which an experiment, test, or measuring procedure yields the same results on repeated trials.

32. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Functional Testing
Other factors to consider
Subjective injury evaluation
Performance of functional tests successfully
Relative to pre-injury status if available
Presence of other signs and symptoms
Stage of healing

33. Therapeutic Exercise in Rehabilitation
Incorporating Functional Progressions
Functional Testing
Other factors to consider
Appropriate rest time
Self-evaluation
Findings from other clinical tests
Physician approval