Chronic Phase of Healing

Question 1

Impairments

Answer 1

Soft tissue and/or joint contractures and adhesions that limit normal ROM or joint play
Decreased muscle performance, weakness, poor endurance, poor neuromuscular control
Decreased functional usage of involved part with inability to function normally in an expected activity

Question 2

Educate the patient

Answer 2

Safe progressions of ex. and stretching

How to avoid re-injury and safe body mechanics

Question 3

Increase soft tissue, muscle and/or joint mobility

Answer 3

Stretching techniques specific to tight tissue
joint and selected ligaments (mobilization)
ligaments, tendons, and soft tissue adhesions (CFM)
muscles (inhibition, passive stretch, massage, and flexibility exercises)

Question 4

Improve neuromuscular control, strength, muscle endurance

Answer 4

Progress exercises
submax to max resistance
specificity of exercise using resisted con/ecc, weight beating, and non weight bearing
Single plane to multiple plane and simple to complex motions
Controlled proximal stability, superimpose distal motion
Increase time at slow speed; progress complexity and time; progress speed and time

Question 5

Increase cardiovascular endurance

Answer 5

progress aerobic exercises using safe activities

Question 6

progress functional activities

Answer 6

Supportive/assistive devices until ROM is functional and strength of supporting muscles is adequate
Progress functional training with stimulated activities from protected and controlled to unprotected and variable
Continue with PRE and advanced training activities until muscles are strong enough and able to response to functional demands

Question 7

Precautions

Answer 7

No inflammation
Limited, short in time discomfort
Bad - joint swelling, pain >4 hours, decrease strength, easily fatigue