Principles for Treatment Selection & Exercise Prescription

Question 1

What are the principles for the acute phase?

Answer 1

• Guided by SIN
• Support, protect, maintain
• Manage pain & inflammation

Question 2

What are the principles for the subacute phase & onwards?

Answer 2

• Regain ROM
• Regain movement control
• Regain strength
• Regain function/participation

Question 3

What is SIN (Step 1)?

Answer 3

Severity
- Grade, pain score, degree of impairment

Irritability
- How much, how bad, how long

Nature of condition

• Outcomes good/bad?
• Healing capacity
• Mechanical or inflammatory
• Other complications

Question 4

What is step 2 of treatment?

Answer 4

Prioritise problems and causes

Question 5

What are some of the possible problems & causes?

Answer 5

• Tissue disruption // inversion sprain
• Pain // inflamm, tissue disruption
• Instability/laxity // tissue disruption
• Inflammation // tissue disruption
• Stiffness // inflammation, pain
• Weakness // pain, tissue disruption
• Activity limitations // pain inflamm, tissue disruption
• Other impairments // nerve compression, inflamm

Question 6

What should be maintained (i.e. support. protect, maintain)

Answer 6

• Undamaged tissues important for later function
• General fitness
• Patient psyche via education, info, reassurance

Question 7

How can you manage pain & inflammation?

Answer 7

• RICE
• No HARM
• Electrophysical agents
• Medication (as allowed)

Question 8

How can you regain ROM?

Answer 8

• Physiological movement (stretching, AROM, PROM, repeated, sustained)
• Passive accessory movement (joint mobilisation, manipulation)
• Combinations of above
• Soft tissue mobilisation

Question 9

What is the focus of regaining movement control?

Answer 9

Quality of movement, alignment of body & technique

Question 10

How can you regain movement control?

Answer 10

• Start in stable position, isolated joint
• Stable position, multiple joints
• Unstable position, isolated joint
• Unstable position, multiple joints

Question 11

What do you need to consider when regaining movement control?

Answer 11

• Neural adaptation
• Skill acquisition
• Effects of fatigue, concentration
• Cognition dependence
• Confidence

Question 12

What needs to be considered when regaining strength?

Answer 12

• Adaptive threshold
• Specificity principle (you get what you train for)
• Speed
• Joint position/muscle length
• Type of contraction
• Mode

Question 13

What are the principles for regaining strength in a rehab setting?

Answer 13

• Isolated to composite
• Inner/proximal ROM to outer/distal ROM
• Closed kinetic chain (CKC) to open kinetic chain (OKC)

Question 14

What does regaining function involve?

Answer 14

Integration of all systems

- ROM, control, strength, confidence

Question 15

What is involved in re-evaluation?

Answer 15

• Re-check diagnosis
• Establish SIN
• Re-prioritise problems & causes
• Select appropriate intervention
• Re-evaluate

Question 16

What is the difference between for exercise for normal fitness and rehabilitation?

Answer 16

• Stage of healing
• SIN
• Rate of progression
• Compromise
• Different phases (not just training for max load all the time)

Question 17

What normal principles of exercise can be used for rehabilitation?

Answer 17

• Progressive overload
• Training & recovery
• Skill before load
• Training specificity
• Goal-driven & outcome measures

Question 18

How can you achieve progressive overload?

Answer 18

Intensity
- Resistance
- Weight-bearing
- Impact duration
- Intensity of stretch
Frequency
ROM
Skill/complexity