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• Group Effort
– Athletic trainer
– Athlete
– Physician
– Coaches
– Strength and Conditioning specialists
– Athlete’s family
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• 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
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• 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
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• 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
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• 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
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• 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
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• 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
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• 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
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• 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
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• 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
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• 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
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• 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
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• 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
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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
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• 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
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• 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
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• 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
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• 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