Chapter 22: Rehabilitation and Reconditioning Flashcards
Members of the sports medicine team
- Team physician
- Athletic trainer
- Physical therapist
- Strength and conditioning professional
- Exercise physiologist
- Nutritionist
- Counselor, psychologist, or psychiatrist
Roles of the Team Physician
- Preparticipation exams
- On-field emergency care
- Injury and illness evaluation and diagnosis
- Referral to other health care professionals
- Most often makes final determination of athlete readiness
- Medication prescription
Roles of Athletic Trainer
- Typically responsible for day-to-day health of the athlete
- Management and rehab of injuries
- Prevention of injuries through exercise prescription and application of prophylactic equipment
- Evaluate injury
- Treat injuries with therapeutic modalities
- Administrator for the sports medicine team
- Communication between members of the sports medicine time, the coach, and the athlete
Roles of Physical Therapist
- Develop specific treatment strategies
- Manage long-term rehab
- Many serve as athletic training and PT
Roles of Strength and Conditioning Professional
- Focuses on strength, power, and performance enhancement
- Develops a reconditioning program
Roles of Exercise Physiologist
- Assists with the design of conditioning program with metabolic response in mind
Roles of Nutritionist
Provide guidelines regarding proper food choices to optimize recovery
Roles of Counselor, Psychologist, or Psychiatrist
Provide strategies that help the injured athlete better cope with the mental stress of an injury
Indication
A form of treatment required by the rehabilitating athlete
Contraindication
An activity or practice that is inadvisable or prohibited due to the given injury
Types of Injury
- Macrotrauma
- Microtrauma
Macrotrauma
- A specific, sudden episode of overload injury to a given tissue
- Results in disrupted tissue integrity
Types of Macrotrauma
Trauma to:
- Bone
- Joint
- Ligamentous
- Musculotendinous
Types of trauma to bone
- Contusion (bruise)
- Fracture
Types of joint trauma
- Dislocation
- Subluxation
Dislocation
Complete displacement of the joint surfaces
Subluxation
Partial displacement of the joint surfaces
Types of ligamentous trauma
- First degree sprain
- Second degree sprain
- Third degree sprain
First Degree Sprain
Partial tear of the ligament without increase joint stabilty
Second Degree Sprain
Partial tear with minor joint instability
Third Degree Sprain
Complete tear with full joint instability
Types of musculotendinous trauma
- Contusion (direct trauma)
- Strain (indirect trauma)
Contusion
- An area of excess accumulation of blood and fluid in the tissues surrounding the injured muscle
- May severely limit the function of the injured muscle
Muscle Strain
- Tears of muscle fibers
- Assigned grades/degrees
Muscle Strain Degrees
- First degree
- Second degree
- Third degree
First Degree Muscle Strain
- A partial tear of individual fibers
- Characterized by strong but painful muscle activity
Second Degree Muscle Strain
- Partial tear with weak, painful muscle activity
Third Degree Muscle Strain
- A complete tear of the fibers
- Manifests a very weak, painless muscle activity
Tendon Rupture
- Rupture occurs if tensile load applied exceeds its limit
- Tendon fibers are usually stronger than muscle, so failure is more likely to occur in the muscle or at the attachment point
Microtrauma
- Overuse injury
- Results from repeated, abnormal stress applied to a tissue by continuous training or training with too little recovery time
Potential causes of microtrauma
- Training errors (poor program design, excessive volume)
- Suboptimal training surfaces (too hard or uneven)
- Faulty biomechanics or technique
- Insufficient motor control
- Decreased flexibility
- Skeletal malalignment and predisposition
Types of microtrauma
- Bone (stress fracture)
- Tendon (tendinitis/tendinopathy)
Stress Fracture
- Often the result of a rapid increase in training volume or excessive training volume on hard training surfaces
- Body type/structure, nutrition, and metabolic factors also play a role
Tendinitis
- Inflammation of a tendon
- If left untreated, chronic tendinitis or tendinopathy can occur
Tendinopathy
A degenerative condition characterized by minimal inflammation and neovascularization
General phases of tissue healing
Inflammatory response phase –> Fibroblastic repair phase –> Maturation-remodeling phase
Characteristics of the inflammatory response phase
- Pain, swelling, and redness
- Decreased collagen synthesis
- Increased number of inflammatory cells
- Typically lasts less than one week
Inflammation
The initial reaction to injury
Edema
- The escape of fluid into the surrounding tissues
- Inhibits contractile tissue
Characteristics of the fibroblastic repair phase
- Collagen fiber production
- Decreased collagen fiber organization
- Decreased number of inflammatory cells
- Catabolism and replacement of tissues that are no longer viable after injury
- Begins as early as two days after injury and may last up to 2 months
Characteristics of the maturation-remodeling phase
- Proper collagen fiber alignment
- Increased tissue strength
- Can last months to years after injury
Considerations for making goals in rehab and reconditioning
- Healing tissue MUST NOT be overstressed
- The athlete must meet specific objectives to progress from one phase of healing to the next
Primary treatment goal during the inflammatory response phase
Prevent disruption of new tissue
Exercise strategies for the inflammatory response phase
- Passive rest may be initially necessary
- Exercise directly involving or stressing the injured area is not recommended
- Exercise not directly involving these areas may be performed
Primary treatment goal during the fibroblastic repair phase
- Precent excessive muscle atrophy and joint deterioration of the injured area
- Low-load stresses are applied are introduced to promote collagen synthesis and prevent loss of ROM
Exercise strategies for the fibroblastic repair phase
- Isometric: may be performed, possibly at various joint angles
- Isokinetic: may be performed, but due to its small degree of functionality it may not be ideal
- Isotonic: can be used to increase strength and appropriately stress healing tissues
Neuromuscular Control
The ability of muscle to respond to afferent sensory information to maintain joint stability
Proprioception
- An awareness of afferent sensory information
- Contributes to the control of posture, balance, stability, and sense of position
Primary treatment goal during the maturation-remodeling phase
Optimize tissue function while transitioning to return to play or activity
What is so dangerous about doing “too much too soon”
While there may be less pain with activity, the injured tissues have not fully healed and require further treatment to recover completely
Exercise strategies for the maturation-remodeling phase
Exercises should increasingly reflect specificity
Kinetic Chain
The collective effort or involvement of two or more sequential joints to create movement
Closed Kinetic Chain
An exercise in which the terminal joint meets with considerable resistance that prohibits or restrains its free motion (the distal joint is stationary)
Advantages of closed chain exercises
- Increased joint stability
- Functional movement patterns
Open Kinetic Chain
- An exercise in which the terminal joint is free to move
- Allows for greater concentration on an isolated joint or muscle
