Chapter 1: Essential
Considerations in Designing a
Rehabilitation Program for the
Injured Athlete
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
The Rehabilitation Team
• Group Effort
– Athletic trainer
– Athlete
– Physician
– Coaches
– Strength and Conditioning specialists
– Athlete’s family
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
• Treatment philosophy
– There must be an understanding tempered by flexibility
– Variations occur athlete to athlete and physician to
physician
• Communication is critical on all levels
• Trust and confidence involved in the working relationship must
evolve
– Goal directed approach
• All parties must be involved in the rehabilitation process and
must communicate effectively at every level of athletic
participation
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Philosophy of Sports Medicine Rehabilitation
• Aggressive Rehabilitation
– Competitive nature of athletics necessitates aggressive
approach
– Quick, safe, effective rehabilitation and return to play
– Is the injury completely healed?
– Pushing too hard or not hard enough may have negative
impact on athlete’s return to play
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
• Exercise Intensity
– SAID principle – Specific Adaptations to Imposed Demands
• Ability of the body to adapt to stress and overload
imposed on it
• Critical to consider during rehabilitation
• Indications of having applied too much stress:
– Pain, swelling, loss or plateau in strength or range of
motion, increased laxity in healing ligaments
• As healing progresses exercise intensity should
increase
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Understanding the Concept of the Kinetic Chain
• The kinetic chain is an integrated functional unit
• Each system works to provide structural and functional
efficiency
• Kinetic chain injury rarely involves one structure
• Comprehensive rehabilitation must examine
– Muscle imbalances
– Myofascial adhesions
– Altered arthrokinematics
– Neuromuscular control
• Goal is to restore optimal kinetic chain functioning
• Modality use in rehab
• Medication use in rehab
• Conditioning in rehab
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Understanding the Psychological Aspect of
Rehabilitation
• Critical factor that is often neglected and overlooked
• Injury/illness produce a variety of emotional responses
• Athlete’s vary on:
– pain threshold
– competitiveness cooperation
– compliance
– depression
– Anger
– Fear
– guilt
• The psychological aspect can also play an important role in
performance enhancement
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Establishing Goals
• Short term goals
– Provide immediate first aid and care
– Reduce/minimize pain
– Re-establish neuromuscular control
– Restore full range of motion
– What are some others???
• Long term goal = return to play
• Goals should be reasonable and attainable
• Integrate specific activities to achieve goals
• Program should have progressive steps
• Avoid exact time frames or dates
• The athlete should be actively engaged in the
rehabilitation process
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Goals of rehabilitation
• Control swelling and pain
– It may interfere with the rehabilitation process
– Pain will dictate the rate of progression
• Neuromuscular control
• Range of motion
– Muscle or postural imbalances
– Resistance of musculotendinous units
• Restore strength
– Important to return to pre-injury status
– Full pain free range of motion emphasized
– Needs to incorporate single and triplanar motions
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Types of Exercises
• Isometrics
– Initial stage
– Used when full range of motion is contraindicated
– Increase strength, decrease atrophy, reduce edema
• Progressive Resistive Exercise (PRE)
– Uses free weights, machines, and tubing
– Uses isotonic contractions
• Isokinetic
– Later stages
– Fixed speed with accommodating resistance
– Used as criteria to return to functional activity
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Types of Exercise con…
• Plyometric
– Later stages
– Quick bursts; Encourages dynamic movements
• Core Stabilization
– Essential for functional strength
– Stabilizes kinetic chain
– Allows distal segments to function optimally and
efficiently
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
• Open vs. Closed Kinetic Chain Exercises
– Deals with the functional relationship in upper and lower
extremities
– Open kinetic chain = foot or hand operating in space
– Closed kinetic chain = foot or hand are weight-bearing
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Maintaining Cardiorespiratory Fitness
• Most neglected aspect of
rehabilitation
• Cardiorespiratory fitness
decreases rapidly during
periods of inactivity
• Alternative activities should
be substituted to minimize
the decrements in fitness
levels
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Functional Progression
• Gradually progressive activities designed to prepare the athlete
for return to play
• Skill progression and reacquisition within limitation of injury
and rehabilitation
• Progression based on injury response
• Functional progression will help injured athlete return to
normal pain-free range of motion, strength and neuromuscular
control
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Functional Testing
• Drills used to assess
athletes ability to perform a
specific activity
• Commonly used tests
– Agility runs
– Sidestepping
– Vertical jump
– Hops for distance/time
– Co-contraction test
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Criteria for Full Recovery
• What is complete recovery?
• Restoration to normal function – all aspects
• Determined by nature of injury and philosophy of physician and
athletic trainer
• Based on objective and subjective criteria
– Strength testing and questionnaires
– Functional tests
• Physician has the final say in return to play
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Factors to Consider Prior to Return to Play
• Physiological healing
constraints
• Pain status
• Swelling
• Range of motion
• Strength
• Neuromuscular control
• Cardiorespiratory fitness
• Sports-specific demands
• Functional testing
• Prophylactic strapping and
bracing
• Responsibility of athlete
• Predisposition to injury
• Psychological factors
• Athlete education and
preventative maintenance
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Documentation in Rehabilitation
• Detailed records must be maintained
– Injury evaluations
– Treatment records
– Progress notes
• Lawsuits and malpractice
• In clinical setting record keeping is critical for third-party billing
• While time consuming it can not be neglected
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Legal Considerations in Supervising a
Rehabilitation Program
• Educational backgrounds, licensure, and certification are
controversial when considering patient care
• Laws vary state to state with regard to an athletic trainers
ability to conduct rehabilitation programs
• Athletic trainers should be sure to operate within the limitations
of their respective state laws
(c) 2004 The McGraw-Hill Companies, Inc. All rights reserved
Download

Chapter 1: Essential Considerations in Designing a Rehabilitation