Presentation on theme: "Rehabilitation and Reconditioning"— Presentation transcript:
1 Rehabilitation and Reconditioning chapter 20Rehabilitation and ReconditioningDavid H. Potach, PT; MS; CSCS,*D; NSCA-CPT,*D Terry L. Grindstaff, DPT; ATC; SCS; CSCS,*D
2 Chapter ObjectivesIdentify members of the sports medicine team and their responsibilities during injury rehabilitation and reconditioning.Recognize types of injuries athletes sustain.Comprehend timing and events of tissue healing.Understand goals of each tissue healing phase.Describe the strength and conditioning profes-sional’s role during injury rehabilitation and reconditioning.
3 Rehabilitation and Reconditioning Principles of Rehabilitation and ReconditioningHealing tissues must not be overstressed.The athlete must fulfill specific criteria to progress from one phase to another during the rehabilitative process.The rehabilitation program must be based on current clinical and scientific research.The program must be adaptable to each individual and his or her specific requirements and goals.Rehabilitation is a team-oriented process requiring all the members of the sports medicine team to work together.
4 Section Outline Sports Medicine Team Sports Medicine Team Members Communication
5 Sports Medicine Team Sports Medicine Team Members All members of the sports medicine team are responsible for educating coaches and athletes regarding injury risks, precautions, and treatments.The sports medicine team also works to prevent injuries and rehabilitate injured athletes.Several different professionals play important roles in assisting an injured athlete’s return, so effective communication is necessary.
6 Key Termsteam physician: A person that provides med-ical care to an organization, school, or team.athletic trainer: A person typically responsible for the day-to-day physical health of the athlete; certified by the National Athletic Trainers’ Association Board of Certification as a Certified Athletic Trainer (ATC).
7 Key Termsphysical therapist: A person with a back-ground in orthopedics or sports medicine that can play a valuable role in reducing pain and restoring function to the injured athlete.
8 Key Termsstrength and conditioning professional: A person who plays a valuable role within the sports medicine team and is an integral part of the rehabilitation and reconditioning process. Ideally, this person should be certified by the National Strength and Conditioning Association (NSCA) Certification Commission as a Certified Strength and Conditioning Specialist (CSCS) to ensure that he or she has the knowledge and background to contribute to the rehabilitation process.
9 Key Termsexercise physiologist: A person who has a formal background in the study of the exercise sciences and uses his or her expertise to assist with the design of a conditioning program that carefully considers the body’s metabolic response to exercise and the ways in which that reaction aids the healing process.
10 Key Termsnutritionist: A person who has a background in sport nutrition may provide guidelines regard-ing proper food choices to optimize tissue recovery. Ideally, the nutritionist has been formally trained in food and nutrition sciences and is a Registered Dietitian (RD) recognized by the American Dietetic Association.
11 Key Termspsychologist or psychiatrist: A licensed professional with a background in sport may provide strategies that help the injured athlete better cope with the mental stress accom-panying an injury.
12 Sports Medicine Team Communication Strength and conditioning professionals must understand the following:The diagnosis of the injuryIndications—forms of treatment requiredContraindications—activity or practice prohibited due to the injuryThey must also inform the rest of the sports medicine team about the exercises performed by the athlete and the athlete’s response to the exercise.
13 Key PointThe sports medicine team includes a large number of professionals working together to provide an optimal rehabilitation and reconditioning environment. The relation-ship among members requires thoughtful communication to ensure a safe, harmoni-ous climate for the injured athlete.
15 Key PointMacrotrauma is a specific, sudden episode of overload injury to a tissue, resulting in disrupted tissue integrity. Microtrauma results from repeated, abnormal stresses applied to a tissue by continuous training or training with too little recovery time. Each injury requires specific rehabilitation strategies to allow return to function.
18 Tissue Healing Inflammation Phase Inflammation is the body’s initial reaction to injury and is necessary for normal healing to occur.
19 Tissue Healing Repair Phase Once the inflammatory phase has ended, tissue repair begins; this phase allows the replacement of tissues that are no longer viable following injury.This phase of tissue healing begins as early as two days after injury and may last up to two months.
20 Tissue Healing Remodeling Phase The weakened tissue produced during the repair phase is strengthened during the remodeling phase of healing.Tissue remodeling can last up to two to four months after injury.
21 Key PointFollowing injury, all damaged tissues go through the same general phases of heal-ing: inflammation, repair, and remodeling. Characteristic events define each phase and separate one phase from another.
22 Section Outline Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and ReconditioningInflammation PhaseTreatment GoalExercise StrategiesRepair PhaseRemodeling PhaseExercise Strategies (continued)
23 Section Outline (continued) Rehabilitation and Reconditioning StrategiesProgram DesignResistance TrainingAerobic and Anaerobic Training
24 Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and ReconditioningChoose a level of loading that neither overloads nor underloads healing tissue.Healing tissue must never be overstressed.But, controlled therapeutic stress is needed to optimize collagen matrix formation.The athlete must meet specific objectives (established by the physician, athletic trainer, physical therapist, or a combination of these) to progress from one phase of healing to the next.
25 Loading During Rehabilitation Figure 20.3 (next slide)Loading during rehabilitation should neither overload nor underload the athlete’s healing tissue.
27 Soft Tissue Injury Response Figure 20.4 (next slide)Pain is often used as a guide for tissue health.Pain levels often decrease well before tissue healing is complete, which may lead athletes to believe they can return to competition before the body is actually ready.
28 Figure 20.4Reprinted, by permission, from Leadbetter, 1992.
29 Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and ReconditioningInflammation PhaseTreatment GoalPreventing disruption of new tissueExercise StrategiesGeneral aerobic and anaerobic training and resistance training of uninjured extremities, with priority given to maximal protection of the injured area
30 Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and ReconditioningRepair PhaseTreatment GoalPreventing excessive muscle atrophy and joint deterioration in the injured area; maintaining muscular and cardiovascular function in uninjured areasExercise Strategies (after consultation with team physician, athletic trainer, or physical therapist)Submaximal isometric exerciseIsokinetic exerciseSpecific exercises to improve neuromuscular control
31 Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and ReconditioningRemodeling PhaseTreatment GoalOptimizing tissue function by continuing and progressing the activities performed during the repair phase and adding more advanced, sport-specific exercisesExercise StrategiesTransition from general exercises to sport-specific exercisesSpecificity of movement speed an important variableVelocity-specific strengthening exercises (velocities must progress to those used in the athlete’s sport)
32 Rotator Cuff Rehabilitation Figure 20.5 (next two slides)Exercises generally transition from(a, b) isolation exercises to(c, d) multijoint, sport-specific exercises.
35 Key Termclosed kinetic chain: An exercise in which the terminal joint meets with considerable resistance that prohibits or restrains its free motion; that is, the distal joint segment is stationary.
38 Key Termopen kinetic chain: An exercise that uses a combination of successively arranged joints in which the terminal joint is free to move; open kinetic chain exercises allow for greater concentration on an isolated joint or muscle.
39 Open Kinetic Chain Exercise Figure 20.7 (next slide)Example of an open kinetic chain exercise—leg (knee) extension exercise
43 Rehabilitation and Reconditioning Strategies Program DesignResistance TrainingSeveral programs have been developed to assist with the design of resistance training programs for injured athletes, including the De Lorme and Oxford programs and Knight’s DAPRE program.DAPRE allows more manipulation of intensity and volume.The demands of the athlete’s sport determine the training goal, which should dictate the design of the resistance training program during the remodeling phase.
44 Rehabilitation and Reconditioning Strategies Program DesignResistance TrainingDaily adjustable progressive resistive exercise (DAPRE) systemFirst set requires 10 repetitions of 50% of the estimated 1RM.Second set requires six repetitions of 75% of the estimated 1RM.Third set requires the maximum number of repetitions of 100% of the estimated 1RM.The number of repetitions performed during the third set determines the adjustment to be made in resistance for the fourth set.
46 Rehabilitation and Reconditioning Strategies Program DesignAerobic and Anaerobic TrainingAlthough research has yet to determine an optimal aerobic training program for use in the rehabilitation setting, the program should mimic specific sport and metabolic demands.
47 Key PointDesigning strength and conditioning programs for injured athletes requires the strength and conditioning professional to examine the rehabilitation and recondi-tioning goals to determine what type of program will allow the quickest return to competition.