1. Sports Injuries
Rehabilitation

2. 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):

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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.

11. 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

12. 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