Rehabilitation Flashcards
What are the 3 phases?
Inflammation (1-7d)
Fibroblastic (up to 2wks)
Maturation (wks to months)
Cellular recovery in phase 1
Plasma exucation
Incr proliferation
Incr capillary permeability
Rehabilitation principles in phase 1
PRICE/ POLICE - Protect, Optimal Load, Ice, Compress, Elevate
Minimise movement for 1-3 d
Compress with caution
AVOID ANTI-INFLAMMATORIES (PEACE) !!!!
When can you move to phase 2?
Stabilisation of oedema
Define degree of severity; if oedema stabilised at 2cm then you can move on
Cellular recovery in Phase 2
Increase of fibroblast concentration
Increase of collagen formation
Done by mechanotransduction
Rehabilitation principles in phase 2
Physiomodalities - minimise swelling A-ROM - stretching exercises Aerobic - maintain 60-70% max aerobic capacity Strength Proprioception
Progression of strength exercises
NWB –> PWB –> FWB
Double leg –> Single leg
Isometric –> Concentric –> Eccentric/ Functional
Closed chain –> Closed chain
2-5 exercises, 10-15 reps, 1-3 sets
Exercise regime/prescription for proprioception
2-5 exercises, 10-15 reps, 1-3 sets
When can you move to phase 3?
HOP TEST - 20 consecutive hops on one leg without any pain or discomfort; repeat for other side
No swelling
Equal ROM
Cellular recovery in Phase 3
Remodelling
Functional Recovery
Rehabilitation principles in phase 3
Sport-specific training with plyometrics (explosive exercises for power); return to full training
Plyometric exercises involve both conc and ecc exercises
- Running, jumping, push ups + clap
- Eccentric training; 2 sets, 10-20 reps, 2x/day
- Trampoline training; 3-x20 forw-back + 3x20 sideways
Progression to land training –> run in a pattern
When can the athlete RTP?
No S&S
Aerobic and anaerobic capacity
Strength imbalance 20%
FASH (functional assessment scale of acute hamstring injuries)
Functional performance tests
- SL Triple jump, for distance
- SL Cross-over triple jump, for distance (difference should be <=5%)
- Full sprint 90% at max speed for 30m
What is the controversy with the use of ice?
Analgesic effect
BUT can disrupt inflammation, angiogenesis/ revascularisation, delay neutrophil and macrophage infiltration, increase immature myofibres
What is the positive effect of compression?
Reduces intra-articular oedema and tissue haemorrhage
Controls inflammatory exudate to reduce the fibrin and thus scar tissue produces
Optimal Loading
Mechanical stress should be applied to the area early on. The load should be gradual and varied according to the pain levels. If pain free, it promotes remodelling, building tissue tolerance, and increases capacity.
PEACE & LOVE
PEACE - Avoid anti-inflammatories
LOVE - Optimism (negative attitudes can interfere)
What are the risk factors for recurrence of injuries
Previous injury with inappropriate rehabilitation and earlier RTS
30% of athletes with ankle injury will be re-injured
What is phase 4?
Prevention of re-injury
Goal of Rehabilitation (definition)
A dynamic, structured process that aims to restore the injure athlete’s function and performance levels to above pre-injury level, return the athlete to sports in a safe and timely manner and prevent re-injury
What is the aim of rehabilitation exercises
Target local tissue level and CNS
- Increase tissue load tolerance - Mechanotherapy
- Alter biomechanics - Unload injured tissue via altered movement and muscle activation patterns
- Maintain general condition - Alternative training
Stages of Healing
- Bleeding and inflammation
- Proliferation
- Regeneration
- Remodelling
- Maturation
