Week 9 - Therapeutic Exercise Flashcards
ATs Role in therapeutic exercise?
Design, implement supervise rehab program
Ex prescription for rehab is different than for performance
Goals of TE?
Maintain fitness
Challenge athlete
Minimize time missed
Dont impede healing
Minimize immobilization
When does TE start?
Right after injury
- set up for success later
- POLICE
- W/in 2 days
Results of Immobilization?
Atrophy of T1 msc fibers
Decreased neuromsc efficiency
Reduced joint lubrication and cartilage degeneration
Lig./ bone weakness
Decreased Aerobic fitness (1/2 beat/ min for each day of immobilization) –> decreased SV, VO2max, Vital Capacity
Components of a Rehab Program?
Control swelling
REduce pain
Restore ROM
Establish core stability
Improve msc strength, power, endurance
Reestablish neuromsc control
Regain balance
Maintain cardiorespiratory
Controlling Swelling?
Swelling slows down rehab –> blocks ROM and stability and makes things more sore
POLICE
NSAIDs –> benefit pain/ function but may be detrimental for long term tissue healing if used in first few days
Reducing Pain?
Some pain is expected
- POLICE for acute injury
- Therapeutic modalities for Subacute injury
- keep calm and positive
- Splint or crutches if needed
- Don’t R2P if injured
- Avoid aggravating positions
Restoring full ROM?
Physiological Mvm
- osteokinematics
- active mvm
- Voluntary - flexion, extension, abduction, adduction, IR, ER
- Requires stretch/ foam roll
Accessory Mvm
- Arhrokinematics
- How articulating surfaces move relative to each other
- Limited due to joint capsule, lig., bone position (spine, glide, roll)
- Requires joint mobilization
Establishing Core Stability?
Location of COG - where all mvm begins
- Core stability = muscular based stability of the trunk
- Dynamic strengthening of the lumbar-pelvic-hip complex (29 mscs attach here) and or the shoulder/ scapula
- Improves neuromsc control (increased efficiency of while kinetic chain)
- Functional mvm stabilization
Improve msc strength, endurance, power step 1?
Isometrics
- contraction w/ no change in length
- used in early phase of rehab (especially if joint is immobilized)
- decreased atrophy
- can decrease swelling via msc pump
Improve msc strength, endurance, power step 2?
Isotonic (progressive resistance Exercise)
- Constant forces
- Eccentric
- Concentric
- Generally start w/ concentric mvm (except w/ tendonopathy)
- Start in Fibroblastic Repair Phase
Improve msc strength, endurance, power step 3?
Isokinetic
- constant speed
- most often used late in rehab for diagnostic purposes (criteria post ACL repair for R2P)
- Fixed speed w/ accommodating resistance to provide max resistance throughout ROM
- Not possible w/out Isokinetic Dynamometer
Improve msc strength, endurance, power step 4?
Plyometrics
- jumping –> eccentric contraction followed by concentric
- Start in maturation remodelling phase
* Useful to restore sport-specific skills
Reestablishing Neuromsc Control?
Regain ability to follow a previously established sensory pattern
Use Balance Exercises
Neuromuscular Training?
Repetitive, function moms to develop
- Kinesthetic awareness
- Proprioceptive awareness
- Dynamic stability
- Preparatory
Joint Mechanoreceptors?
Ruffini - joint capsule, ligaments, skin
* Position change/rate and direction of
joint movement
Pacinian, Merkels, Meissner’s - skin
* Deep pressure, light touch
Free nerve endings - skin
* Sensitive to extreme mechanical,
thermal, or chemical energy; tissue
damage
Msc Mechanoreceptors?
- Spindles - change in length
- Golgi Tendon Organs - change in
tension
Star Excursion Balance Test>
Reliable measure of dynamic lower
extremity stability
- Challenges athletes to balance on one
leg and reach as far as possible in eight
different directions - Set up:
- Four 120 cm lengths of tape, with
lines placed at 45 degree angles - Procedure:
- Reach as far as possible and touch
tape, before returning to start position - Administrator marks line with pencil
- Repeat three times with each leg,
then change legs
Regain Balance?
- Maintaining centre of mass within base of support
- AKA postural stability
- Failure to address balance can increase risk of reinjury
- Functional exercises
Maintaining Cardiorespiratory Fitness?
Maintain pre-injury fitness
* Whole body activity (when able)
* Ensure it does not result in
increased pain or swelling of
injured area
* Sport specific when possible
* Endurance is lost quickly
* Examples: arm ergometer, cycle
ergometer, elliptical, treadmill,
pool
Managing Psych Response?
- Setting goals
- Tracking progress
- Keeping log book
- Being involved with team
- Keeping active
Preventing Further/Re-injury?
- Brace, splint, or crutches if needed
- Do not return to play if injured
- Taping/bracing for exercise and gradual return to play
- Education about predisposing factors for injury
- Addressing faulty biomechanics
- Correcting muscle imbalances
Sports Specific Training?
- Functional progression
Component parts focused on:
* Slower speed
* Less impact
* Less distance
* Less repetition initially
Functional testing provides trainer with
objective data for review
More in the Maturation Remodelling Phase
R2P Decision Making?
- Has rehabilitation progressed to the later physiological stages of healing?
- Is pain at a tolerable level?
- Is swelling gone?
- Is ROM full?
- Are strength, endurance, and power sufficient to protect
athlete from reinjury? - Has the athlete relearned how to use the injured body
part? Can they sense where it is in space? - Is cardiorespiratory fitness at competition level?
- Can the athlete meet the demands of the sport?
- Are any additional supports necessary (braces, taping,
splints) to prevent reinjury? - Is the athlete capable of competing at a high level without
fear of reinjury? - Is this athlete prone to reinjury or new injury if not 100%?
- Does the athlete understand the importance of continuing
a conditioning program to reduce the chances of reinjury?
