Lecture 5 - Treatment, Rehabilitation, and RTS Flashcards
What are the elements of diagnosis?
- History
- Physical examination
- Imaging
In terms of diagnosis, what are some parts of the history element?
- age, sex
- details of injury
- training history
- diet
- injury history
- general health
- work/leisure activities
- other predisposing factors
In terms of diagnosing, what are some parts of the physical examination element?
- inspection
- palpation
-ROM testing - ligament testing
- Strength testing
- Neural testing
- Spinal examination
- Biomechanical examination
What are the 3 stages of treatment and rehab?
- Acute
- Rehab
- Training: Sport specific
What do we do in the acute stage for acute vs. overuse injuries?
Acute: PEACE/PRICE/POLICE (no ice)
Overuse:
- partial unloading
- loading pattern must be altered
- no protection, no elevation, yes pain meds
- Compression - right time, right place, yes ice
What are the goals of the rehabilitation stage?
- monitor pain and swelling
- Ensure normal ROM
- Ensure normal strength
- Ensure Normal neuromuscular function
- ensure normal aerobic capacity
What is alternative training?
maintaining generals strength and endurance, but does not use injured area
What is specific training?
Training that affects injured structures
Why is NMT important during rehab?
- painful conditions may result in reflex inhibitions, which can lead to change in movement patterns and unfavourable loading which increases the risk of injury
- acute ligament injuries may also result in reduced joint position sense and coordination which increases risk of re-injury
- need NMT for proprioceptive training and progressive strength training
What are some other therapies for treatment and rehab?
- Manual treatments (massage, dry needling etc.)
- Taping/bracing
- electrophysical agents (therapeutic ultrasound)
- medication (NSAIDS, corticosteroids)
- dietary supplements (vitamin D)
What are the goals of the training stage?
- gradual transition from controlled rehab exercises to sport specific training
- function and sport specific testing
85-90% of original strength is regained before being allowed to compete again
What should RTS process be according to?
To the sport, the participant, and the level of participation
What are the 3 elements of the RTS continuum?
- return to participation
- return to sport
- return to performance
What 2 tests should be tested to asses and athletes readiness to RTS?
- closed open skills (controlled skills like single leg jumps)
- Open skills (reactive element to execute motor task, react to something than direction change)
What tests should we do to asses acute knee injuries for RTS?
direction change and reactive agility tests
What tests should we do to asses acute hamstring injuries for RTS?
- symmetrical hopping performance
- sport specific functional field testing
- sprints
- ballistic hamstring test
- minimal ROM and/or strength deficits
What tests should we do to asses groin injuries for RTS?
hip adduction strength
What tests should we do to asses achilles tendon injuries for RTS?
Tendinopathy: pain should not be greater than 5/10 during activity and pain should subside by next morning
Tendon rupture: no milestone based criteria
What tests should we do to asses shoulder injuries for RTS?
- look for 10% increased rotator cuff strength in dominant throwing side
- internal/external ratios from 65% to 100%
- functional tests not fully explored
What is the most common groin injuriy?
Adductor-related
What guideline is used for chronic groin pain?
Holmich Exercise Program
What guideline is sued for Acute groin injury?
progressive groin exercise
What is considered chronic groin pain?
pain for more than 2 months
What are the 2 modules of the Holmich Exercise program?
Module 1: Isometric exercises
- isometric and dynamic exercises to reactivate adductor
Module 2: Isotonic
- heavier resistance training, balance, coordination
What is not allowed during the Homich Exercise program?
Stretching of the adductor muscle (jogging is allowed after 6 weeks)
What is included the the exercise program for acute groin injury?
Strength training and balance
(9 groin exercises)
What are the high risk sports for adductor-related groin injury and what are the risk factors?
Sport: hockey, floorball, soccer
Factors: rapid direction changes
What are the 3 milestone of RTS?
- Clinically pain free
- Controlled sports training
- Full team training (RTS)
