REHAB

Question 1

SPORTS INJURY

Answer 1

PHASE 1: acute management - pain relief

Phase 2:

• increase tissue load tolerance mechanotherapy
• address biomechanics unload injured tissue & alter risk factors
• maintain general condition alternative training

phase 3: replicate TASK-specific demands

> RETURN TO ACTIVITY

phase 4: prevent re-injury

Question 2

ANY INJURY

Answer 2

PHASE 1: acute management - pain relief

Phase 2:

• increase tissue load tolerance mechanotherapy
• address biomechanics unload injured tissue & alter risk factors
• maintain general condition alternative training

phase 3: replicate sport-specific demands

> rts

phase 4: prevent reinjury

Question 3

PHASE 1

Answer 3

ACUTE MANAGEMENT
ROM: regain active & passive range
MC: proprioception & motor output
M STRENGTH: voluntary activation 
EXERCISE PERSCRIPTION: controlled

+ ADDITIONAL USE OF ICE (10MINS, X4), INITIAL REST FROM ACTIVITY, SPLINT

Question 4

PHASE 1: PEACE & LOVE

Answer 4

P - protect - avoid activities that cause pain/symptoms
E - elevate injured limb higher than heart as much as poss.
A - avoid anti-inflams
C - compress to reduce sweel
E - educate: listen to body > avoid passive trtms and investigations
&
L - load - let pain guide your gradual return to activities
O - optimisim - be confident and positive
V - vasculariation - pain free CV exercises to increase blood flow
E - restore strength, endurance and prop by adopting active approach to recovery

Question 5

phase 2: restore adls

Answer 5

restore adls
ROM: cyclic, full ROM loading
MC: joint stability
strength: hypertrophy
- general strength -> functional strength -> eccentric control
ex. perscrip: extrinsic stim.

Question 6

phase 3 : replicate sport/task specific demands

Answer 6

restore adls
ROM: manual therapy if needed
MC: speed and agility
strength: generate strength - start to introduce power
ex. perscrip: complex mvmts
- incorporate mvmts involving whole kintetic chain - eg trunk rot.

Question 7

phase 4: prevent reinjury

Answer 7

restore adls
ROM: maintenance and recovery
MC: ingrain new patterns (repetition of new motot patterns)
strength: power and enduranc
ex. perscrip: sport-specific

Question 8

odema control

Answer 8

*Vital in the hand b/c it ensures maximal healing and return to daily function (must minimize swelling)

• Prx = gentle decline in elevation from hand to shoulder; early AROM and tendon gliding exercises; cold packs; compression (short bandages; tubular); manual edema mobilization WAYS TO CONTROL:
• Compression – coban bandage; lycra fingerstall; isotoner globes; pressure garments
• Chip Bag technique for Brawny Edema
• Contrast Bathing – warm, cold, warm
EFFLUEAGE.

Question 9

scar management

Answer 9

Management is important b/c scars can impede gliding and function of hand
• Scar Massage (from 21+ days)
• Thermal agents
• Electrotherapy
• Silicone Products – facilitate the realignment of collagen fibres

Question 10

WRIST Examination

Answer 10

• Skin temperature; sweating
• Scar tethering
• Hypersensitivity – presence & location
• Muscle spasm
• Tenderness over tendons; tendon sheath; joints

Question 11

IMMOBILIZATION - POSI OF WRIST

Answer 11

→ *POSI = position of safe immobilization
• Wrist = 30 ̊ Ext
• MCP = 60 ̊ Flx
• IP = max Ext
• Thumb = palmar ABD **Always in this position unless C/I (ie: after a nerve or tendon repair)
• During immobilization, structures tend to shorten (ie: MCP collateral ligament)
• Lumbrical duck position (tends to get tight in Flx)

Question 12

HAND HEALING

Answer 12

• Inflammation (0 – 48 hours) – vascular response; phagocytosis; negligible wound strength
o Mx = rest; elevation; edema control

• Proliferation of Fibroblasts (12hrs – 10days) – migrate and bridge wound edges
o Mx = rest; elevation; edema; light exercises

• Fibroplasia (4days – 28days) – collagen deposition (want this to be in a position that allows movement)
o Mx = exercise (want to get them moving!); edema control; function

• Remodelling (1 month – 2 years) – scar maturation (manipulate scar to gives us movement we want)
o Mx = exercise; MT; function

Question 13

GENERAL PRINCIPLES

Answer 13

1. Wound Management
2. Edema Control
3. Therapeutic Exercise / Manual Therapy
4. Splintage
5. Scar Management
6. Sensory Re-Education
7. Functional Use

Question 14

DESENSITIZATION:

Answer 14

teaching new skin receptors what normal touch is (through gradual exposure to diff stim)
• Gradually increase patients tolerance to tactile stimulation in an area of hypersensitivity
• Hyperalgesia is very common following hand trauma
• Mx = identify stimuli that provokes a response (textures, immersion particles, temp changes, pressure)
o Apply stimuli for 5-10 minutes; 3-4x/day
+ DO THIS WITH SENSORY RE-EDUCATION