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William E. Prentice Rehabilitation Techniques for Sports Medicine and Athletic Training.

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Presentation on theme: "William E. Prentice Rehabilitation Techniques for Sports Medicine and Athletic Training."— Presentation transcript:

1 William E. Prentice Rehabilitation Techniques for Sports Medicine and Athletic Training

2  Majority of injuries in athletics are non-life threatening  Will require treatment and rehabilitation for a timely, but safe return to activity  Athletic Trainer will assume primary responsibility for the design, implementation and supervision of the rehab. program  Must have as complete understanding of the injury as possible  Knowledge of mechanism of injury  Major anatomical structures affected  Degree or grade of trauma  Stage or phase of injury’s tissue healing

3  Rehabilitation in athletic setting requires a group effort to be most effective  Athletic Trainer and A.T. students  Team Physician  Coach  Athlete and athletes family  Strength and conditioning coach  Other specialist  A.T. will direct athlete and facilitate communication

4  A.T. is the one individual who will deal directly with the patient/athlete throughout the entire period of rehabilitation  From time of injury to return to unrestricted return to activity  A.T. works closely with and under direct supervision of team physician  Develop and design rehabilitation and reconditioning protocols  Appropriate therapeutic exercise, rehab. Equipment, manual therapy techniques, and therapeutic modalities

5  Communication  Athlete must always be informed and made aware of the why, when and how factors of their rehab. program  Relationship takes time to develop  Must build trust and rapport with athletes  Must involve coach in discussions of athletes progression and athletes return to activity  Can help determine what and athlete can and cant do during practice.  Failure to communicate may cause misunderstanding between those involved and possibly exacerbating the athletes injury or symptoms

6  Approach in athletic setting is considerably different than in most other rehab. settings  Competitive nature of athletics necessitates an aggressive approach to rehabilitation  Competitive season is relatively short and athlete does not have the luxury of time  Goal is to return the athlete to activity as soon and as safely as possible  A.T. tends to play games with healing process and return athletes before complete healing has occurred  “Balancing act” between not pushing athlete enough and being too aggressive  Mistake in judgment may hinder the athletes return to activity

7  Progression of rehab program must be based on the process of injury/tissue healing  A.T. Must have a sound understanding of the different phases of tissue healing and apply appropriate treatment/rehab  Failure to do so may interfere with tissue healing and increase the length of time required for rehabilitation, thus slowing the athletes return to activity  Little can be done to speed the healing process physiologically, but many things can be done to impede healing

8  Exercise intensity  SAID Principle: Specific Adaptations to Imposed Demands  When an injured structure is subjected to stresses and overloads of varying intensities, it will gradually adapt over time to whatever demands are placed on it  Exercises must not be too great that they will exacerbate the injury before it has had time to adapt  Exercise that is too intense can be detrimental to the rehab program  Indications include an increase in swelling, pain, loss or plateau in strength and range of motion.

9  Exercise intensity must be commensurate with tissue healing  Submaximal exercise in short bouts initially, several times a day  As recovery increases, the intensity of exercise increases

10  Psychological aspects of how athlete deals with injury are critical and often neglected factor  Wide range of emotional reactions  A.T. needs to develop an understanding of the psyche of each individual and adjust rehab accordingly  Pain threshold, cooperation and compliance, competitiveness, denial, intrinsic and extrinsic motivation, anger, fear, guilt and ability to adjust to injury are all factors  Sports psychology can also be used to improve total athletic performance

11  When joint or anatomical structures are injured, normal biomechanical function is compromised  A.T. must have solid foundation in biomechanics and human anatomy to design effective rehab program  Must be able to identify and correct postural and biomechanical dysfunctions in order to appropriately design rehab plan

12  Entire body is a kinetic chain that operates as an integrated functional unit  Composed of muscular systems (muscles, tendons, fascia), articular systems and neural systems  All systems function simultaneously with the others for structural and functional efficiency  CNS sorts info. from these systems for neuromuscular control.  If any system in kinetic chain is not working effectively, other systems are forced to adapt and compensate  Can lead to tissue overload, decreased performance, and predictable patterns of injury

13  Movements in everyday activity require dynamic and postural control through multiple planes of motion and different speeds of motion  Rehabilitation should focus on functional movements that integrate all components necessary to achieve optimal movement performance  Concepts of muscle imbalances, myofascial adhesions, altered arthrokinematics, and abnormal neuromuscular control need to be addressed

14  Function: Integrated, multiplanar movement that requires acceleration, deceleration and stabilization  Rehab. must address all links of the kinetic chain to develop functional strength and neuromuscular efficiency  Functional Strength: ability of neuromuscular system to reduce force, produce force, and dynamically stabilize the kinetic chain during functional movement in a smooth coordinated fashion

15  Neuromuscular Efficiency: ability of CNS to allow agonist, antagonist, synergist, stabilizers and neutralizers to work efficiently and interdependently during dynamic kinetic chain movements  Rehab may begin with isolated strengthening in single planes of motion, but progress to multi-plane functional movement that mimic sport activity

16  Tool Belt  A.T. have many tools in their tool belt  Manual therapy techniques  Therapeutic modalities  Aquatic Therapy  Physician prescribed medications  Therapeutic Exercise  How A.T. utilizes tools is often a matter of individual preference and experience  Patients differ in their responses to various treatment techniques  A.T. should avoid “cookbook" rehabilitation protocols  A.T. should develop broad theoretical knowledge from which specific techniques can be selected and practically applied to each individual case

17  Therapeutic Modalities  Useful tools in injury rehabilitation  When used appropriately can greatly enhance the patients chance for safe and rapid return to full activity  A.T. should have knowledge of scientific basis of various modalities and their physiological effects.  Therapeutic Exercise however, is more critical than the use of modalities

18  Therapeutic Exercise:  Exercises that force the injured anatomical structure to perform its normal function  Key to successful rehabilitation  AROM, PROM, RROM and functional exercises

19  Medications to facilitate Healing  Prescription and over the counter (OTC) medications can effectively aid the healing process during rehabilitation  A.T. must have some knowledge of the effects of medications and make decisions on appropriate use with guidance from team physician

20  Short Term Goals  Provide correct immediate care and management following injury to limit or control swelling  Reduce or minimize pain  Establishing core stability  Re-establishing neuromuscular control  Improving postural stability and balance  Restoring full range of motion  Restoring or increasing muscular strength, endurance and power  Maintaining cardiorespiratory fitness  Incorporating functional progressions

21  Long Term Goals  To return to athlete to practice or competition as quickly and as safely as possible  Establishing reasonable and attainable goals and integrating specific exercises or activities to address these goals is critical to rehab. plan.  Can be difficult knowing when and how to progress, change, or alter rehab program to most effectively accomplish short and long term goal

22  Important not to give exact time frame or date  May discourage athlete if time frame not met  Set series of progressions or successes to keep athlete motivated  Keep athlete involved in goal setting and planning the processes of their rehab plan.

23  Initial first aid and management techniques may be the most critical part of any rehab program  Has significant impact on the course of the rehabilitation process  One major factor is the presence of swelling  Swelling caused by bleeding, production of synovial fluid, accumulation of inflammatory by-products, edema or combination of these factors  Produces increased pressure that causes increased pain  Can also cause neuromuscular inhibition, thus weak muscular contractions  Usually occurs in first 72 hours after injury

24  If swelling can be controlled initially in acute stage of injury, the time required for rehab is likely to be significantly reduced  Follow P.R.I.C.E acronym  Protection  Rest  Ice  Compression  Elevation

25  Protection:  Injury protected from further injury  Splints, braces, pads or other immobilization devices  Lower Extremity: Non weight bearing or limited weight bearing until acute inflammatory response has subsided

26  Rest (Restricted Activity):  Critical component  Healing process begins immediately after injury occurs  If interrupted will delay healing or not allow healing process to begin and lengthen time of rehab  Controlled mobility vs. immobilization better for scar formation, revascularization, muscle regeneration and reorientation of muscle fibers  Severity of injury determines length of rest time, but usually 24 to 48 hours  Involve athlete in core, cardio respiratory and exercises for un-affected parts of body

27  Ice  Most commonly used immediately after injury and for 72 hours after to decrease pain and controlling hemorrhage and edema  Through local vasoconstriction  Decrease secondary cell death by hypoxia by lowering metabolism and tissue need for oxygen  Reduce muscle spasm and guarding that accompany pain  Analgesic effect through decreased velocity of nerve conduction and bombarding sensory nerves with cold so pain impulses are lost  Times for icing vary for different areas of body

28  Compression  Single most important technique for controlling swelling  Mechanically decrease amount of space available for swelling by applying pressure around injured area  Applied distally to proximally  Kept in place despite pain because of importance for swelling  Worn for 72 hours or until swelling is eliminated

29  Elevation:  Eliminate the effects of gravity on blood pooling in the extremities  Assist venous and lymphatic drainage of blood and other fluids from the injured area back to central circulatory system  Greater the degree of elevation the more effective  As much as possible for first 72 hours

30  Pain will interfere with progression of rehab.  Assess pain on a daily basis and with exercises  Persistent pain will make range of motion and strengthening exercises more difficult  Manage with medication, modalities and P.R.I.C.E.

31  Essential to every aspect of rehab process  Include in all phases of rehab program  Muscles of lumbo-pelvic-hip complex  Functions to dynamically stabilize entire kinetic chain during functional movement  Train proximally or locally to distally or globally

32  Re-establishing Neuromuscular Control  Ability to sense he position of a joint in space  Altered after injury  Re-establishing postural control and balance  Restoring Range of Motion  Restoring muscular strength, Endurance and Power  Maintaining Cardio-respiratory Fitness  Functional Progressions and Testing

33  Decision to release a patient recovering from injury to a full return to activity is the final stage of rehabilitation process  Should be carefully considered by all members of sports medicine team  Ultimately team physicians decision, however it should be based on input from A.T.. Coach and the patient

34  Is athlete pain free?  Do they have full non restricted pain free range of motion?  Is their strength equal to non injured side or enough to protect from re-injury?  Do they have neuromuscular control and balance?  Are they reconditioned for their sport, cardio- respiratory fitness and functional testing?  Is the athlete psychologically ready for full return without fear or hesitation?

35  A.T. should be proficient in record keeping  Initial injury report  Rehab progression Reports, treatment logs and S.O.A.P. Notes  Should be accurate and detailed  Important for appropriate progressions of rehab, consistency among different practioners, third party re- imbursement, and defense in a malpractice suit

36  States vary considerably in their laws governing what an A.T. may and may not do in supervising a program  A.T. should not act outside their scope of knowledge and practice and within the laws of their state


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