basis of rehab Flashcards
Rehabilitate the injury consists
Knowledge of injury
Evaluation
Examination
Healing process
List 5 signs of inflammation
Edema Pain Function Redness Heat
Phase of healing
Hemostasis
Inflammation
Proliferation
Remodeling
Hemostasis
Inflammation
Proliferation
Remodeling
Hemostasis phase alongside treatment modalities
RICE
POLICE
Inflammation phase alongside treatment modalities
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Proliferation phase alongside treatment modalities
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isometric exercises
Remodeling phase alongside treatment modalities
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Providing a comprehensive rehabilitation program for an injured patient starts with
Patient assessment
Treatment selection
Implementation
Functional exercises and return to play
When rehabilitating an injured patient, AT, coach, and physician must take the time to
explain and inform the patient’s parents about the course of injury rehab process.
Exercise intensity in rehab
It will gradually adapt over time. During rehab, the stresses of reconditioning exercises must not be so great as to exacerbate the injury before the injured structure has had a chance to adapt specifically to the increased demands.
Engaging in exercise that is too intense or too prolonged can be detrimental
If baseball player recently underwent surgery for a few tears in shoulder region and wanted to know why he cannot start throwing right away. What’s your reason for why he must progress slowly?
Swelling and limited ROM. All starts with early exercise in short bouts that are repeated several times daily. It begins with local modalities to re-educate muscle and extensibility of collagen fibers. Understanding the healing process is the key. Primary goal is to minimize edema and improve ROM.
Massage: safety concerns
Bruising
Soreness
Traction is designated for what use
Decreased back and neck pain
Stretch connective tissue
establishing short goals in a rehab program in the following steps
- Providing correct immediate first aid and management following injury to limit or control swelling
- Reducing or minimizing pain
- Establishing core stability
- Reestablishing neuromuscular control
- Improving postural stability and balance
- Restoring full ROM
- Restoring or increasing muscular strength, endurance, and power
- Maintaining cardiorespiratory fitness
- Incorporating appropriate functional progression
Establishing long term goals in rehab program
Return athlete to practice or competition as quickly and safely as possible
Importance of controlling swelling beings with
POLICE
Compression: wrap directly over the injury from distal to proximal.
basis of re-establishing neuromuscular control
Relies on central nervous system to interpret and integrate proprioceptive and kinesthetic information and then control individual muscles and joints to produce coordinated movements.
Example: following injury, subsequent rest and immobilization, CNS “forgets” how to put together
Requires many repetitions of same movement, progressing step by step from simple to more complex movements.
basis of restoring range of motion
musculotendinous unit: muscle, tendon, fascia to stretch
contracture of connective tissues: ligaments, joint capsule, or both
basis of restoring muscular strength, endurance, and power
Isometric, progressive resistive (isotonic), Isokinetic, and plyometric exercises
main goal in performing strengthening exercises is to work through a full, pain free ROM
Isometric: increasing static strength and decrease amount of atrophy. Lessen the swelling by causing a muscle pump to remove fluid and edema.
PRE: free weights, exercise machines, or rubber tubing. It uses isotonic contraction (concentric and eccentric).
Isokinetic: used later in phase of rehab program. Commonly used as a criteria for RTF activity following injury
Plyos: reactive neuromuscular training which is often incorporated into later stage of rehab program. It is a quick eccentric stretch to facilitate a subsequent concentric contraction. It is useful in restoring or developing the patient’s ability to produce dynamic movements associated with muscular power. The ability to generate force rapidly is a key to successful performance in many sports activities.
ligament sprains
physiological characteristics
Grade 1: some stretching or tearing of ligamentous fibers, with little or no joint instability. Mild pain, little swelling, and joint stiffness.
Grade 2: some tearing and separation of ligamentous fibers and moderate instability of joint. Moderate to severe pain, swelling, and joint stiffness.
Grade 3: total rupture aka gross laxity. Severe pain might be present initially followed by little or no pain because of total disruption of nerve fibers.
Phase 1 the acute injury phase - incorporating therapeutic exercises
Injury occurs and can last as long as 4 days following injury.
Control swelling and modulate pain by using POLICE. Immobility during the first 24-48 hours following injury is necessary to control inflammation.
Acutely, that loss can be attributed primarily to pain; thus, modalities (ice and electrical stimulation) that modulate pain should be routinely incorporated into each treatment session.
At this point, patient should begin active mobility exercises working through a pain free ROM. Importantly, regaining ROM.
NSAIDs to help control swelling and inflammation.
Phase 2: repair phase (fibroblastic)
incorporating therapeutic exercises
As soon as inflammation is controlled, incorporating activities into rehab program that can maintain levels of cardiorespiratory fitness, restore full ROM, restore or increase strength and reestablish neuromuscular control.
As neuromuscular control improves, strength will also improve.
Cryotherapy and Electrical stimulation can help with controlling pain and improving strength and ROM.
Phase 3: remodeling phase incorporating therapeutic exercises
Maturation stage of healing process is return to activity. The injury is no longer painful to the touch. The collagen fibers must be re-aligned according to tensile stresses and strains placed upon them during functional exercises.
Focus: regaining functional skills. It involves repeated performance of movement or skill for the purpose of perfecting that skill.
Plyo strengthening exercises can be used to improve muscle power and explosiveness. Functional testing should be done to determine specific skill weaknesses that need to be addressed prior to normal activity return.
Deep heating modalities - ultrasound or diathermy should be used to increase circulation to deeper tissues.
Massage used to reduce guarding, increase circulation, and reduce pain. Increased blood flow delivers the essential nutrients to the injured area to promote healing.
medications to affect the healing process
aspirin (salicylate)
common for analgesic, anti-inflammatory, and antipyretic capabilities.
Tylenol (acetaminophen)
naproxen sodium
ketoprofen
ibuprofen