1. Daily adjustable progressive resistance exercise technique D.A.P.R.E.

2. D.A.P.R.E. To Develop Strength
The athlete must perform some progressive resistive exercises on a regular basis if an increase of strength is desired
The D.A.P.R.E. technique takes advantage of the fact that strength can be redeveloped much more quickly than it was developed initially.
Patients perform maximal repetitions during their third and fourth sets, with the number or repetitions performed used as a basis for adjusting the resistance for the fourth set and next day, respectively.
Each side of the body should be worked independently
Prevents the injured limb from depending on the non-injured one
It establishes a functional strength-development goal for the injured side.

3. Portion of working weight used
D.A.P.R.E.
Set
Portion of working weight used
Number of repetitions 1
1/2 10 2
3/4 6 3
Full
Maximum* 4
Adjusted
Maximum**
*The number of repetitions performed during the third set is used to
determine the adjusted working weight for the fourth set, according
to the guidelines in the next table
**The number of repetitions performed during the fourth set is used to
determine the adjusted working weight for the next day, according to
the guidelines in the next table

4. Adjustment of Working Weight
Number or repetitions performed during set
Fourth set*
Next day**
0-2
Decrease 5-10 lb. and perform the set over
Keep the same
3-4
Decrease 0-5 lb.
Increase 5-10 lb.
5-7
Increase 5-15 lb.
8-12
Increase lb.
13 to…
Increase lb.

5. Number or repetitions performed during set Fourth set* Next day** 0-2
Portion of working weight used
Number of repetitions 1
1/2 10 2
3/4 6 3
Full
Maximum* 4
Adjusted
Maximum**
Number or repetitions performed during set
Fourth set*
Next day**
0-2
Decrease 5-10 lb. and perform the set over
Keep the same
3-4
Decrease 0-5 lb.
Increase 5-10 lb.
5-7
Increase 5-15 lb.
8-12
Increase lb.
13 to…
Increase lb.

6. Cryokinetics in Rehabilitation of Joint Sprains

7. Cryokinetics Effects Cold decreases pain Exercise increases blood flow
Exercise reestablishes neuromuscular function

8. Cryokinetics Advantages
Cryokinetics allows exercise much sooner than normally would be the case.
Cryokinetics retards muscular atrophy and neural inhibitions.
Cryokinetics reduces swelling dramatically through muscular “milking action”
You can progress at the patient’s speed

9. Cryokinetics Disadvantages
Ice is very painful during the initial ice immersion.

10. Cryokinetics Indications Ankle sprains Finger sprains Shoulder sprains
Other joint sprains

11. Cryokinetics Contraindications
Do not perform any exercise or activity that causes pain
Do not use ice on a person who is hypersensitive to cold.

12. Cryokinetics Precautions Pain must be used as a guideline
With lower extremity injuries, patients may limp if not frequently reminded to refrain from limping.
There may be an increase in pain 4 to 8 hours after treatment.

13. Cryokinetics
Equipment Needed
Slush bucket or ice packs
Toe cap
Towel

14. Application Procedures
Numb the Body Part
Use ice immersion, ice massage, or cold-pack application
Numbing generally takes min.
The patients sensation is more significant than the time of application
Use a toe cap

15. Application Procedures
Exercise the numbed body part
All exercise should be
Active
Progressive
Pain-free
Exercise should last 2 to 3 minutes, the duration of the numbness
Renumbing takes 3 to 5 min.
Begin with simple rang-of-motion activities and progress through full-sport activity.
With some injuries, progression through full-sport activity will take place in a single treatment session, while with others it may take weeks.

16. Exercise Progression For an Ankle Strain
Non-weight-bearing range of motion
Weight-bearing
Weight-bearing range of motion
Walking
Strengthening the ankle musculature
Jogging
Hopping and jumping
Sprints
Hopping and sprinting without ice application
Team drills

17. Relieving Acute Muscle Spasm: Cryostretch

18. Cryostretch Combines three techniques for reducing muscle spasm:
Cold application
Static stretching
The hold-relax technique of PNF
Its purpose is to decrease muscle spasm, thereby allowing increased flexibility.
Is similar to cryokinetics in that exercise is performed while the body part is numbed.

19. Cryostretch Effects Ice diminishes pain and muscle spasm
Static stretching overcomes the stretch reflex, decreasing muscle spasm.
Relaxation is often greater after a near-maximal muscular contraction than it was before the contraction.

20. Cryostretch Advantages
The combination of the three components into one procedure is more effective than any of the parts independently.
Ice is relatively inexpensive; exercise is free.

21. Cryostretch Disadvantages Ice is painful to some people
Melting ice can be messy.

22. Cryostretch Indications Any muscle with residual muscle spasm
First-degree muscle strain
A muscle that is stiff from prolonged disuse (immobilized)

23. Cryostretch Contraindications
Do not perform any exercise or activity that causes pain.
Do not use ice on a person who is hypersensitive to cold.

24. Cryostretch Precautions
Pain must be used as a guideline. The patient should not attempt to consciously or willfully overcome pain.
There may be an increase in pain 4 to 8 hours after treatment.
Muscles may tear or pull if the static exercise begins too quickly or suddenly. There must be a gradual build-up to a maximal conatraction.

25. Summary Of Cryostretch Technique
ICE - Until numb (20 minutes maximum)
Exercise Bout
First Stretch Total of 65 sec.
Static stretch sec.
Isometric contraction sec.
Static stretch sec.
Rest - 20 seconds
Second Stretch (Same as first stretch)
Renumb with 3 to 5 minutes ice application
Two stretches (65 sec.) with a 20 sec. rest between stretches