Rehabilitation Flashcards
What conditions can physiotherapy exercise treat?
Arthritis sprains/strains fractures post surgert Non-specific LBP Tendinopathies pre and post-natal cardiac patients neuro patients COVID-19
What are the effects of Reduced Activity
on Muscle
Reduction in muscle size, mass and muscle
tension (tone)
• Loss of strength and endurance capability
• Atrophy of both type I and type II fibres. The
contractile ability of type I fibres is more
adversely affected than type II
• Changes in the mechanical properties of the
myo-tendinous junction – injury risk
• Increased fatigability
• Increased lactic acid production
What are the rehabilitation phases ?
Acute/Initial (pain management) • Intermediate (getting range back) • Advanced (strengthening) • Return to Sport/normal activity (conditioning/strength related to specific sport needs)
What is treatment in the acute phase of injury?
KEY - PAIN MANAGEMENT
PEACE and LOVE • Circulation exercises • ROM Exs • Maintain muscle activity • Consider stability program • Maintenance of other joints/muscles • Correct abnormal movement patterns
What is treatment in the Intermediate phase of injury?
Week 2 ish
• Starting to build strength • Continue ROM, Stretching • Stability, neuromuscular control • Impact/agility
What is treatment in the Advanced phase of injury?
• Strength especially power • Neuromuscular exercises • Agility • Functional exercises and sports specific exercises
Rehabilitation plan Considerations for acute conditions?
- Exercise is appropriate for stage of healing
• Not in first 48 hours – allow bleeding and
swelling to subside.
- Close monitoring of symptoms
- Static to dynamic
- Consider weight bearing status
- Consider level of injury
- Orthopaedic instructions / protocols
Benefits of exercise–
acute conditions
• Minimise muscle atrophy of other areas • Minimise loss of cardiac fitness • Maintain range of movement of other areas • Increase ROM • Increase muscle function • Reduced pain • Reduced swelling
Exercise Considerations–
chronic conditions
- Pathology
- Ability
- Cardiovascular fitness
- Comorbidities
- Exercise tolerance
- Motivation
- Yellow flags
Benefits of exercise–
chronic conditions
- Reduction in pain
- Increase muscle strength
- Improve flexibility
- Improve proprioception / balance
- Improve biomechanics
- Improve cardiovascular fitness
- Improvement in health status
- Reduce / prevent obesity (BMI >30) due to reduced mobility
- Psychosocial – improve mood and energy levels
- Increased functional ability
- Increased bone mineral density
Effects of immobilisation
Stiffness/reduced ROM • Atrophy – loss of cross sectional area of muscle • Weakness • Reduced coordination • Nervousness – Fear avoidance • Skin/hair changes • Sensation changes
Benefits of Joint Range of Motion (ROM)
• Enhance normal tissue healing • Load soft tissues in progressive way • Increase soft tissue extensibility • Maintain or increase joint ROM
Pathology - when would you use Joint Range of Motion (ROM)?
Post-op • Post fractures • Arthritis • Contractures • Adhesions • Pain/neural sensitivity
What is Passive ROM?
Absence of voluntary activity • Produced by extrinsic force • Therapist / CPM
What is active-assisted ROM?
Element of muscle activity
• Partially extrinsic with
element of intrinsic
What is active ROM?
Free active exercises • 100% of voluntary mm activity • Mobilising • Strengthening
Stretching types? (3)
Static stretching
• where a specific position is held with the muscle on
tension to a point of a stretching sensation
Dynamic stretching
• Active: moving a limb through its full range of motion
to the end ranges and repeating several times
• Ballistic: Bouncing at EOR. No longer recommended
Pre-contraction
• involves a contraction of the muscle being
stretched or its antagonist before stretching
Static stretching –
recommendations
For a general fitness program ACSM recommends: • Stretching should be preceded by a general warm up • Hold 15-30 secs, 2-4 repetitions • 2-4 times per week • Elderly population should hold for 60 secs
benefits of Resistance training
• Increase muscular strength and endurance • Increase bone mass • Reduce blood pressure • Increase muscle and soft tissue cross sectional area • Reduce body fat • Improve back pain, tendinopathy and other pathologies.
What happens during strength training?
• Muscle growth • hypertrophy • ? Hyperplasia • Muscle strength increases • High resistance, low reps and full recovery between sets • Type II fibres will increase more readily than type I • Normally takes a min of 4 weeks in untrained individuals
ACSM Guidance for Strength
Load:
60-70% 1RM novice/intermediate; 80-100 Advanced
Volume:
1-3 sets of 8-12 repetitions novice to intermediate;
2-6 sets of 1-8 repetitions for advanced
Rest period:
2-3 min for higher intense exercises that use heavier
loads; 1-2 minutes between the lower intense exercises with light loads
ACSM guidance for Muscle
Endurance
Load:
lower than 70% of 1RM
Volume:
2-4 sets of 10-25 repetitions
Rest period:
30 seconds to 1-minute between each
