Lower Limb Rehabilitation Revision Flashcards
What are some principles of rehabilitation?
Specificity
- target area you want to, including structure or capacity - now what you’re doing and why
Progression
- increasing the demand placed on body to ensure continued improvement
Overload
- ensuring the load is sufficient to create a response from the tissue
Reversibility
- when rehab stops, body will reverse if a higher level of activity is not maintained
What is the general rehabilitation blueprint to follow?
ROM Motor Control Strength Power Speed Sport specific
Why and how do you increase ROM?
Good indicator for progress
Use exercises and manual techniques (active and passive)
Check with other limb
Why and how do you improve motor control in rehabilitation?
Overcome muscle pain and inhibition
Retrain optimal movement pathways
High repetition, low load ➡️ neural biased training benefit
THis must be at the start of the workout, as muscles need to be fresh in order to train muscles back to functional position
Why is improving strength important in rehab and how is it achieved?
Primary goal is to increase cross-sectional area of the muscle by inducing Hypertrophy
Using high load, low reps
Correct technique is essential to ensure distributed loading patterns are retrained
Check progress with other limb (within 10%)
Why is improving power important in rehabilitation and how is it achieved?
Need to ensure the explosive capacity of the musculotendinous unit is restored Plyometrics - work on eccentrics before Quality of movement essential Does not require working to fatigue
How do adductor muscle strains present?
Sport: sudden changes of direction, kicking, twisting
Acute onset, pain well localised
Clinical: localised tenderness, pain on passive/resisted Adduction
How to rehab adductors strains
RICE Gentle stretching Gradually increase stretching Gradually increase strengthening - active abduction and Adduction - Adduction and flexion against resistance - stabilising exercises Functional strengthening Sport specific skills
What is the presentation and rehabilitation programme for trochanteric bursitis?
Presentation:
- pain in lateral aspect of the hip
- aggravated by hip movements
- often with gluteus medius pathologies
- often overuse - long distance runners
Rehabilitation
- initially ➡️ rest from aggravating activities, glut med stretch
- later ➡️ gluteus medius stretching and strengthening, pelvic tilt correction
- correct the biomechanics, abnormalities
▶️ high rep low load
How does Osteitis pubis present and how should it be rehabilitated?
True joint Pathology of pubic bone/symphysis
Gradual onset of groin pain/lower abdomen
Aggravated by exercise, twisting, turning, kicking
Noted decrease of sports performance
Rehabilitation:
- Undefined period of rest
- gradual return to activity - based on physical signs and response to activity
What in important in EARLY stages of rehabilitation?
Pain management
Restoring normal gait
Swelling management - stabilises joint but reduces ROM
Prevent atrophy
Manage:
▶️ RICE, Analgesia, crutches, electro therapy, bracing
What are the important stages of MIDDLE stage rehabilitation?
Indicators guiding progress
- pain
- function
- observation of gait
Primary goals of phase
- full ROM
- improve proprioception
- good strength
- correct biomechanics
- more confidence
What are he primary goals of MIDDLE stage rehabilitation for the ankle?
- Range of motion
▶️ subtalar joint and talocalcaneal joint mechanics - Strength and Conditioning
▶️ locally and globally
▶️ conditioning needs to be maintained, consider non-weight-bearing activities - Proprioception
▶️ both feed-forward and back mechanism are affected post ankle injury - Address intrinsic and extrinsic factors
▶️ biomechanics, training errors
What is necessary in the LATE stage of rehabilitation?
Sport specific retraining
- considering playing surface, multidirectional nature of sport
- create game environment
- non-contact➡️contact➡️game
What are the tissue repair phases of rehabilitation?
- Bleeding
- influx of inflammatory cells
- big swelling in high vascularised (eg ACL after injury)
- control pain and swelling and stabilise ankle - Inflammation
- attracts inflammatory markers
- no NSAIDs in first 48hrs - Proliferation
- rebuilding ➡️ stretching to direct remodelling - Remodelling
- gradually introducing higher and higher loads
