1. Basic Components of therapeutic exercise

2. Therapeutic exercise  Parameters must be restored to at least preinjury level if patient is to return to sport or normal activity  1- flexibility- ROM  2-strength, muscle endurance  3 – proprioception, coordination and agility  Parameters are base on previous ones – much like a pyramid

3. Flexibility and ROM  Flexibility – mobility of muscles and length they can be extended  ROM- refers to the amounts of movements possible at a joint  Normal ROM  Flexibility may affect full ROM  ROM also affected by joint capsule, ligaments, fascia and scar tissue  ROM also affected by strength ( active – passive ROM)  Priority is placed on regaining ROM /flexibility – lacking ROM effects performance even if strength good – pitcher, runner  ROM- must minimize scar tissue

4. Strength and muscular endurance  Strength – refers to max force a muscle or group of muscles can exert  Endurance – the muscle abilities to sustain a sub maximal force in a static or repetitive activity  When strength improves so does endurance and vice versa

5. Proprioception, Coordination and Agility  Impaired balance,coordination and or agility – from an injury or from lack of use may effect return to play, and increase risk of re-injury  factors affecting these elements muscular power, skill and execution  Flexibility and strength must first be achieved  Coordination and agility based on patient having the flexibility to perform the skill through the appropriate ROM, strength, endurance and power to repeat skill rapidly and correctly  These factors need foundations to build on  Sport specific activities -

6. Return to Play Criteria  Patients ability to withstand the demands of the sport  Patients readiness to return to competition  Injured area – no pain, swelling, or atrophy and full ROM, strength, and endurance to perform the skills needed  Physician often has final word - based on therapists communications

7. Psychological Considerations Stages of Grief  Denial  Injury not severe- feels will be back in day or two  Anger  Reality of severity and consequences sets in  Frustration, helplessness  Not usually able to help them at this time – they want to be angry  Depression  Realizes the severity of the situation  Not participating with the team – feelings of isolation – self doubt, worthlessness  Acceptance  Begins battle of physical limitations and emotional ones