Understanding the Basics of
Injury Rehabilitation
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• ______________________
– Exercise used as part of a rehabilitation
program
• _____________________
– Activities that are used to minimize injury
and maximize performance
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Basic Components and Goals of a
Rehabilitation Program
• Must address several basic components
• _____________ term goals
– Provide correct and immediate first aid to control
swelling
– Control ______________
– Restore full ______________
– Restore core stability
– Restore and increase strength, endurance and
power
– Re-establish _______________________ control
and balance
– Maintain levels of cardiorespiratory fitness
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Providing Correct First Aid and
Controlling Swelling
• Initial first aid is critical
• Should be directed towards
__________________ control
• Utilize the _______________ principle
– Each factor is critical in limiting swelling
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Controlling Pain
• Some degree of pain will be experienced
– Pain will be dependent on the severity of the
injury, athlete’s response, perception of pain
and the circumstances
• PRICE and additional modalities (electrical
stimulation, heat…etc.) can be used to
help modulate pain
• Pain can ______________ w/ rehab and
therefore must be addressed throughout
the rehab process
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Restoring Range of Motion
• Injury to a ________________ will always
be associated w/ some loss of
______________
– Due to contracture of connective tissue or
resistance to stretch of injured area
• Athlete will need to engage in dynamic,
static or PNF ______________ activities
to improve _________________
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Stretches
• _____________-bouncing, jerky movements
• ______________-controlled body movements
different from ballistic
• ______________- Static/maintained
• _____________-Someone else or something
helps hold the stretch
• ______________-static stretching without
motion
• __________-the fastest and most effective
way to increase static-passive flexibility
(combines passive and isometric stretching)
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
Restore ________ Stability
• Involves strengthening the _____________
region and is critical for dynamic functional
strength and movement
• Without proximal core stability, distal
extremity function become compromised
– Core strength & power must be emphasized
early in the strength training program
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
Restoring Muscular Strength,
Endurance, and Power
• Among the most essential factors
necessary when restoring function of a
body part to pre-injury status
• Variety of techniques can be utilized
–
–
–
–
_____________________
______________________
______________
______________
• Emphasize work through a full ROM
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• __________________
– Performed in early part of rehab following period
of immobilization
– Used when resistance through full range could
make injury worse
– Increase static strength, work to decrease/limit
atrophy, create a muscle pump to decrease
swelling
• _______________________________PRE)
– Can be performed using a variety of equipment
– Utilizes isotonic contractions to generate force
while muscle changes length
– Concentric and eccentric strengthening
exercises should be utilized
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Progressive Resistance
Exercises
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• _____________ Exercise
– Incorporated in later stage of
rehabilitation process
– Uses fixed speeds w/
accommodating resistance
to provide maximal
resistance throughout ROM
– Speed of movement can be
altered
– Commonly used as part of
the criteria for return to
functional activity
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•
______________Exercise
– Incorporated into later
stages of program
– Use quick stretch of
muscle to facilitate
subsequent concentric
contraction
– Useful in production of
dynamic movements
• Associated with
muscular power
• Generation of force
rapidly – key to
successful performance
in many activities
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Re-establishing _____________
Control
• Neuromuscular control is ___________ attempt to
teach the body conscious control of a specific
movement (_________________)
• Relies on CNS to interpret and integrate sensory and
movement information and then control
_______________ and ______________ to produce
coordinated movement
• Re-establishing neuromuscular control requires
repetition of same movement, step by step until it
becomes automatic (progression from simple to difficult
task)
• Functional exercises are critical for re-establishing
control
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Regaining ______________
• Ability to balance and maintain postural
stability is essential to reacquiring athletic
skills
• Program should incorporate
_____________________________that
involve balance training
• Failure to include balance training may
predispose the athlete to
_________________
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• When balance is challenged the response is
__________________ and __________________
• The primary mechanism for controlling balance
occurs in the joints of the lower extremity
• The ability to balance and maintain it is critical for
athletes
• If an athlete lacks balance or postural stability
following injury, they may also lack proprioceptive and
kinesthetic information or muscular strength which
may limit their ability to generate an adequate
response to disequilibrium
• A rehabilitation plan must incorporate functional
activities that incorporate balance and proprioceptive
training
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
Maintaining Cardiorespiratory
Fitness
• Single most ___________________component
of rehabilitation
• When injury occurs athlete is forced to miss
training time which results in decreased
cardiorespiratory endurance unless training
occurs to help maintain it
• __________________________ must be
substituted that allow athlete to maintain fitness
– Put into rehabilitation program as early as possible
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Functional Progressions
• Involves a series of gradually
__________________ activities designed to
prepare the individual for return to a specific
sport/activity
• Sport-specific skills are broken into separate
components
– Athlete works to reacquire skills over time
• Should be incorporated into treatment as early as
possible
– Athlete’s ________________________ must be
monitored
• If __________ and ________________ do not
arise, the activity can be advanced -- new
activities should be added as quickly as possible
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• Will gradually assist injured athlete in
achieving normal, pain-free ROM, strength
and neuromuscular control
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Functional Testing
– Uses functional progression drills for the
purpose of assessing the athlete’s ability to
perform a specific activity
– Entails a single maximal effort to gauge
how close the athlete is to full return
– Pre-season baseline testing for
comparison post injury
– Variety of tests
•
•
•
•
Shuttle runs
Agility runs
Figure 8’s
Cariocca tests
-Vertical jumps
-Balance
-Hopping for distance
-Co-contraction test
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
Using________________
• Incorporated into rehabilitation program as
adjuncts to exercise
– Cryotherapy and thermotherapy
– Ultrasound and electrical stimulation
– Massage and traction
• Require special instruction and supervised
clinical experience
• 3 types
– ________________-used to move heat into or out
of the body (heat & cold)
– __________________-ultrasound, massage,
traction
– _____________________-muscle stimulation
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Stages of Tissue Healing
• ___________________
– Injury just happened (bringing
in the positive
– Bleeding could last up to 6-8
hours depending on injury
– Typically 2-3 days
• _____________________
– Developing scar tissue
– Can last 2-3 weeks to several
months
• ______________________
– Turning the scar into usable
tissue
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
Cold Modality
• Types of cold use
– Ice pack (15-20 minutes)
– Ice massage (5-15 minutes)
– Cold whirlpool (15-20 minutes)
– Slush bucket (15-20 minutes)
– Cryokinetics (10 -15 minutes)
– Chemical cold packs (15 minutes??? Watch for
chemical burns)
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Physiological Effects of Cold
• Decrease tissue
temperature
• Decrease blood flow
• Decrease inflammation
• Decrease pain-analgesic
• Decrease muscle spasm
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Indications and Contraindications for
Cold Therapy
•
•
•
•
•
•
Indications
Acute injuries
Pain
Swelling
Inflammation
Soreness prevention
• Contraindications
• Open wounds
• Cold related allergy
Raynaud’s Phenomenon
• Areas with sensory or
circulatory deficits
(Diabetes?)
© 2010 McGraw-Hill Higher Education. All rights reserved.
Ice Packs (Bags)
• Used for minimizing swelling and
analgesia following injury
• Ice may be flaked or crushed and will be
encapsulated in wet towel or plastic bag
– Both are easily moldable to body
• Elastic wrap generally utilized to secure
pack in place for 20 minutes
• Compression and elevation are also
used in conjunction with ice
© 2010 McGraw-Hill Higher Education. All rights reserved.
Heat
• Types of heat modalities
– Hydrocollator pack (moist heat) (10-15 minutes)
– Electrical heat pack (15-20 minutes)
– Warm whirl pool (10-15 minutes)
– Paraffin bath (dip several times--10-15 minutes)
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Physiological Effects of Heat
• Physiological effects
– Increase tissue temperature
– Increase blood flow
– Increase tissue extensibility
– Increase ROM
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Indications and Contraindications for
Heat
• Indications:
– Chronic inflammatory
conditions
– Tight tissue—connective,
muscle, tendon ,
ligament
– Chronic pain
– Chronic muscle spasm
• Contraindications:
– Acute injuries
– Areas with sensory
deficits
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Ultrasound
• ____________ or ____________
modality that stimulates blood flow
– Continuous or pulsed
• _____________ waves pass through
crystal in sound head to create
mechanical energy
• Mechanical energy cause vibration of
tissue cells which create heat
• Heat can reach depth of
______________ centimeters
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Therapeutic Ultrasound
• Sound Wave Technology
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Ultrasound Applications
• Application
– Must use a coupling agent
• Conductive gel, lotion, water
– Keep sound head _____________
with even pressure over the area
being treated
– Area shouldn’t be larger than 3-4
inches
– Treatment time 3-8 minutes
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Indications and Contraindications for
Ultrasound
• Indications:
– Chronic injuries
– Acute injuries (nonthermal setting)
– Strains
– Sprains
– Tendonitis
– Contusions
– Tight tissue
• Contraindications:
– Heart, eyes, ears, brain,
spinal cord, genitals
– Epiphyseal plates
– Acute injuries
– Areas with poor
circulation
– Stress fractures
– Open wounds
– Infected areas
– Tumors
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Traction
• Pulling force that deliberately
__________________ joints of the
body that have been compressed
together or are stiff
• Commonly used at cervical or
lumbar area
• Can be done mechanically or
manually
• Separates bones
• Puts ______________ stretch on
area
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Indications and Contraindications for
Traction
• Indications:
– Disc
herniation/protrusion
– Degenerative disc
disease
– Degenerative joint
disease
– Soft tissue compression
– Nerve root compression
– Muscle spasm
• Contraindications:
–
–
–
–
Osteoporosis
Fractured vertebrae
Spinal hypermobility
Infections of spine
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Electrical Muscle Stimulation
• The application of electrical current to the
surface of the skin
• Types
– Premodulated stimulation
– TENS
– Interferential
– Combo (US & e-stim)
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Electrical Stimulation
• Used generally for _____________
management sometimes
muscle _____________________
– ____________________
• 2 pads generating a linear electrical pathway
– ___________________
• 4 pads creating a cross current electrical
pathway
– _______________________
•Used primarily in rehabilitation for muscle strengthening (postoperatively)
–5 sec on 5 sec off or 10 sec on 10 sec off
–_____________________
–_______________________________
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
Premodulated Stim
• Used for treatment of
– Contusions
– Sprains
– Strains
– Acute edema
– Muscle re-education
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Premodulated stim
• Physiological response of body depends on
the _____________ of the current
• _____________ current: vasoconstriction,
hardens tissues, local analgesic, decreases
nerve excitability
• ______________ current: vasodilatation,
softens tissue, increases nerve excitability,
increases venous and lymphatic return
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Premodulated stim
• Place electrodes so pain is
“_________________” the pads
• Place electrodes at either end of the muscle
being treated
• Can be used in conjunction with heat or cold
• Treatment time is 10-20 minutes
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E-Stim
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Interferential Stimulation
• Uses __________________ electrical currents
to regulate blood flow, reduce pain, decrease
edema, relieve muscle spasm, strengthen
muscle tissue
• Used to treat: contusions, sprains, strains, etc.
• Should feel slight vibration
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Inferential
• Uses 4 electrodes set at a
__________________ pattern
• Covers “larger” area
• Electrical currents “interfere” with each other
to create a bigger surface areas
• Can be used with heat or cold
• Treatment time is 10-20 minutes
© 2010 McGraw-Hill Higher Education. All rights reserved.
TENS
(transcutaneous electrical muscle stimulation)
• Used primarily for ______________ control
• Electrodes are placed on skin over painful area
to “______________” the sensation of chronic
or acute pain
• Cause a muscle ________________
• Used for 30 minutes to 1 hour treatment time
• Can be used so patient can exercise without
pain
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TENS
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Ultrasound/muscle stim combo
• US combined with muscle stim
• Electricity comes through the US head
• Combine deep heating with benefits of muscle
contraction
• Used for treating strains, muscle spasms,
trigger points, tight muscles
• Treatment time is 5-15 minutes
© 2010 McGraw-Hill Higher Education. All rights reserved.
Combo
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Criteria for Full Return to Activity
• _____________ plan must determine what is
meant by complete recovery
– Athlete is fully reconditioned, achieved full ROM,
strength, neuromuscular control, cardiovascular
fitness and sports specific functional skills
– Athlete is _______________ prepared
• The decision to return to play should be a
__________________ decision (sports
medicine team)
– Team physician is ultimately responsible
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