1. © 2010 McGraw-Hill Higher Education. All rights reserved. Understanding the Basics of Injury Rehabilitation

2. © 2010 McGraw-Hill Higher Education. All rights reserved. ______________________ –Exercise used as part of a rehabilitation program _____________________ –Activities that are used to minimize injury and maximize performance

3. © 2010 McGraw-Hill Higher Education. All rights reserved. Basic Components and Goals of a Rehabilitation Program Must address several basic components _____________ term goals –Provide correct and immediate first aid to control swelling –Control ______________ –Restore full ______________ –Restore core stability –Restore and increase strength, endurance and power –Re-establish _______________________ control and balance –Maintain levels of cardiorespiratory fitness

4. © 2010 McGraw-Hill Higher Education. All rights reserved. Providing Correct First Aid and Controlling Swelling Initial first aid is critical Should be directed towards __________________ control Utilize the _______________ principle –Each factor is critical in limiting swelling

5. © 2010 McGraw-Hill Higher Education. All rights reserved. Controlling Pain Some degree of pain will be experienced –Pain will be dependent on the severity of the injury, athlete’s response, perception of pain and the circumstances PRICE and additional modalities (electrical stimulation, heat…etc.) can be used to help modulate pain Pain can ______________ w/ rehab and therefore must be addressed throughout the rehab process

6. © 2010 McGraw-Hill Higher Education. All rights reserved. Restoring Range of Motion Injury to a ________________ will always be associated w/ some loss of ______________ –Due to contracture of connective tissue or resistance to stretch of injured area Athlete will need to engage in dynamic, static or PNF ______________ activities to improve _________________

7. © 2010 McGraw-Hill Higher Education. All rights reserved. Stretches _____________-bouncing, jerky movements ______________-controlled body movements different from ballistic ______________- Static/maintained _____________-Someone else or something helps hold the stretch ______________-static stretching without motion __________-the fastest and most effective way to increase static-passive flexibility (combines passive and isometric stretching)

8. © 2010 McGraw-Hill Higher Education. All rights reserved.

10. Restore ________ Stability Involves strengthening the _____________ region and is critical for dynamic functional strength and movement Without proximal core stability, distal extremity function become compromised –Core strength & power must be emphasized early in the strength training program

11. © 2010 McGraw-Hill Higher Education. All rights reserved.

12. Restoring Muscular Strength, Endurance, and Power Among the most essential factors necessary when restoring function of a body part to pre-injury status Variety of techniques can be utilized –_____________________ –______________________ –______________ Emphasize work through a full ROM

13. © 2010 McGraw-Hill Higher Education. All rights reserved. __________________ –Performed in early part of rehab following period of immobilization –Used when resistance through full range could make injury worse –Increase static strength, work to decrease/limit atrophy, create a muscle pump to decrease swelling _______________________________PRE) –Can be performed using a variety of equipment –Utilizes isotonic contractions to generate force while muscle changes length –Concentric and eccentric strengthening exercises should be utilized

14. © 2010 McGraw-Hill Higher Education. All rights reserved. Progressive Resistance Exercises

15. © 2010 McGraw-Hill Higher Education. All rights reserved. _____________ Exercise –Incorporated in later stage of rehabilitation process –Uses fixed speeds w/ accommodating resistance to provide maximal resistance throughout ROM –Speed of movement can be altered –Commonly used as part of the criteria for return to functional activity

16. © 2010 McGraw-Hill Higher Education. All rights reserved. ______________Exercise –Incorporated into later stages of program –Use quick stretch of muscle to facilitate subsequent concentric contraction –Useful in production of dynamic movements Associated with muscular power Generation of force rapidly – key to successful performance in many activities

17. © 2010 McGraw-Hill Higher Education. All rights reserved. Re-establishing _____________ Control Neuromuscular control is ___________ attempt to teach the body conscious control of a specific movement (_________________) Relies on CNS to interpret and integrate sensory and movement information and then control _______________ and ______________ to produce coordinated movement Re-establishing neuromuscular control requires repetition of same movement, step by step until it becomes automatic (progression from simple to difficult task) Functional exercises are critical for re-establishing control

18. © 2010 McGraw-Hill Higher Education. All rights reserved. Regaining ______________ Ability to balance and maintain postural stability is essential to reacquiring athletic skills Program should incorporate _____________________________that involve balance training Failure to include balance training may predispose the athlete to _________________

19. © 2010 McGraw-Hill Higher Education. All rights reserved. When balance is challenged the response is __________________ and __________________ The primary mechanism for controlling balance occurs in the joints of the lower extremity The ability to balance and maintain it is critical for athletes If an athlete lacks balance or postural stability following injury, they may also lack proprioceptive and kinesthetic information or muscular strength which may limit their ability to generate an adequate response to disequilibrium A rehabilitation plan must incorporate functional activities that incorporate balance and proprioceptive training

20. © 2010 McGraw-Hill Higher Education. All rights reserved.

21. Maintaining Cardiorespiratory Fitness Single most ___________________component of rehabilitation When injury occurs athlete is forced to miss training time which results in decreased cardiorespiratory endurance unless training occurs to help maintain it __________________________ must be substituted that allow athlete to maintain fitness –Put into rehabilitation program as early as possible

22. © 2010 McGraw-Hill Higher Education. All rights reserved. Functional Progressions Involves a series of gradually __________________ activities designed to prepare the individual for return to a specific sport/activity Sport-specific skills are broken into separate components –Athlete works to reacquire skills over time Should be incorporated into treatment as early as possible –Athlete’s ________________________ must be monitored If __________ and ________________ do not arise, the activity can be advanced -- new activities should be added as quickly as possible

23. © 2010 McGraw-Hill Higher Education. All rights reserved. Will gradually assist injured athlete in achieving normal, pain-free ROM, strength and neuromuscular control

24. © 2010 McGraw-Hill Higher Education. All rights reserved. Functional Testing –Uses functional progression drills for the purpose of assessing the athlete’s ability to perform a specific activity –Entails a single maximal effort to gauge how close the athlete is to full return –Pre-season baseline testing for comparison post injury –Variety of tests Shuttle runs-Vertical jumps Agility runs-Balance Figure 8’s-Hopping for distance Cariocca tests-Co-contraction test

25. © 2010 McGraw-Hill Higher Education. All rights reserved.

26. Using________________ Incorporated into rehabilitation program as adjuncts to exercise –Cryotherapy and thermotherapy –Ultrasound and electrical stimulation –Massage and traction Require special instruction and supervised clinical experience 3 types –________________-used to move heat into or out of the body (heat & cold) –__________________-ultrasound, massage, traction –_____________________-muscle stimulation

27. © 2010 McGraw-Hill Higher Education. All rights reserved. Stages of Tissue Healing ___________________ – Injury just happened (bringing in the positive – Bleeding could last up to 6-8 hours depending on injury – Typically 2-3 days _____________________ – Developing scar tissue – Can last 2-3 weeks to several months ______________________ – Turning the scar into usable tissue

28. © 2010 McGraw-Hill Higher Education. All rights reserved.

30. Cold Modality Types of cold use – Ice pack (15-20 minutes) – Ice massage (5-15 minutes) – Cold whirlpool (15-20 minutes) – Slush bucket (15-20 minutes) – Cryokinetics (10 -15 minutes) – Chemical cold packs (15 minutes??? Watch for chemical burns)

31. © 2010 McGraw-Hill Higher Education. All rights reserved. Physiological Effects of Cold Decrease tissue temperature Decrease blood flow Decrease inflammation Decrease pain-analgesic Decrease muscle spasm

32. © 2010 McGraw-Hill Higher Education. All rights reserved. Indications and Contraindications for Cold Therapy Indications Acute injuries Pain Swelling Inflammation Soreness prevention Contraindications Open wounds Cold related allergy Raynaud’s Phenomenon Areas with sensory or circulatory deficits (Diabetes?)

33. © 2010 McGraw-Hill Higher Education. All rights reserved. Ice Packs (Bags) Used for minimizing swelling and analgesia following injury Ice may be flaked or crushed and will be encapsulated in wet towel or plastic bag –Both are easily moldable to body Elastic wrap generally utilized to secure pack in place for 20 minutes Compression and elevation are also used in conjunction with ice

34. © 2010 McGraw-Hill Higher Education. All rights reserved. Heat Types of heat modalities – Hydrocollator pack (moist heat) (10-15 minutes) – Electrical heat pack (15-20 minutes) – Warm whirl pool (10-15 minutes) – Paraffin bath (dip several times--10-15 minutes)

35. © 2010 McGraw-Hill Higher Education. All rights reserved. Physiological Effects of Heat Physiological effects – Increase tissue temperature – Increase blood flow – Increase tissue extensibility – Increase ROM

36. © 2010 McGraw-Hill Higher Education. All rights reserved. Indications and Contraindications for Heat Indications: – Chronic inflammatory conditions – Tight tissue—connective, muscle, tendon, ligament – Chronic pain – Chronic muscle spasm Contraindications: – Acute injuries – Areas with sensory deficits

37. © 2010 McGraw-Hill Higher Education. All rights reserved. Ultrasound ____________ or ____________ modality that stimulates blood flow – Continuous or pulsed _____________ waves pass through crystal in sound head to create mechanical energy Mechanical energy cause vibration of tissue cells which create heat Heat can reach depth of ______________ centimeters

38. © 2010 McGraw-Hill Higher Education. All rights reserved. Therapeutic Ultrasound Sound Wave Technology

39. © 2010 McGraw-Hill Higher Education. All rights reserved. Ultrasound Applications Application – Must use a coupling agent Conductive gel, lotion, water – Keep sound head _____________ with even pressure over the area being treated – Area shouldn’t be larger than 3-4 inches – Treatment time 3-8 minutes

40. © 2010 McGraw-Hill Higher Education. All rights reserved. Indications and Contraindications for Ultrasound Indications: – Chronic injuries – Acute injuries (non- thermal setting) – Strains – Sprains – Tendonitis – Contusions – Tight tissue Contraindications: – Heart, eyes, ears, brain, spinal cord, genitals – Epiphyseal plates – Acute injuries – Areas with poor circulation – Stress fractures – Open wounds – Infected areas – Tumors

41. © 2010 McGraw-Hill Higher Education. All rights reserved. Traction Pulling force that deliberately __________________ joints of the body that have been compressed together or are stiff Commonly used at cervical or lumbar area Can be done mechanically or manually Separates bones Puts ______________ stretch on area

42. © 2010 McGraw-Hill Higher Education. All rights reserved. Indications and Contraindications for Traction Indications: – Disc herniation/protrusion – Degenerative disc disease – Degenerative joint disease – Soft tissue compression – Nerve root compression – Muscle spasm Contraindications: – Osteoporosis – Fractured vertebrae – Spinal hypermobility – Infections of spine

43. © 2010 McGraw-Hill Higher Education. All rights reserved. Electrical Muscle Stimulation The application of electrical current to the surface of the skin Types – Premodulated stimulation – TENS – Interferential – Combo (US & e-stim)

44. © 2010 McGraw-Hill Higher Education. All rights reserved. Electrical Stimulation Used generally for _____________ management sometimes muscle _____________________ – ____________________ 2 pads generating a linear electrical pathway – ___________________ 4 pads creating a cross current electrical pathway – _______________________ Used primarily in rehabilitation for muscle strengthening (post- operatively) – 5 sec on 5 sec off or 10 sec on 10 sec off – _____________________ – _______________________________

45. © 2010 McGraw-Hill Higher Education. All rights reserved.

46. Premodulated Stim Used for treatment of – Contusions – Sprains – Strains – Acute edema – Muscle re-education

47. © 2010 McGraw-Hill Higher Education. All rights reserved. Premodulated stim Physiological response of body depends on the _____________ of the current _____________ current: vasoconstriction, hardens tissues, local analgesic, decreases nerve excitability ______________ current: vasodilatation, softens tissue, increases nerve excitability, increases venous and lymphatic return

48. © 2010 McGraw-Hill Higher Education. All rights reserved. Premodulated stim Place electrodes so pain is “_________________” the pads Place electrodes at either end of the muscle being treated Can be used in conjunction with heat or cold Treatment time is 10-20 minutes

49. © 2010 McGraw-Hill Higher Education. All rights reserved. E-Stim

50. © 2010 McGraw-Hill Higher Education. All rights reserved. Interferential Stimulation Uses __________________ electrical currents to regulate blood flow, reduce pain, decrease edema, relieve muscle spasm, strengthen muscle tissue Used to treat: contusions, sprains, strains, etc. Should feel slight vibration

51. © 2010 McGraw-Hill Higher Education. All rights reserved. Inferential Uses 4 electrodes set at a __________________ pattern Covers “larger” area Electrical currents “interfere” with each other to create a bigger surface areas Can be used with heat or cold Treatment time is 10-20 minutes

52. © 2010 McGraw-Hill Higher Education. All rights reserved. TENS (transcutaneous electrical muscle stimulation) Used primarily for ______________ control Electrodes are placed on skin over painful area to “______________” the sensation of chronic or acute pain Cause a muscle ________________ Used for 30 minutes to 1 hour treatment time Can be used so patient can exercise without pain

53. © 2010 McGraw-Hill Higher Education. All rights reserved. TENS

54. © 2010 McGraw-Hill Higher Education. All rights reserved. Ultrasound/muscle stim combo US combined with muscle stim Electricity comes through the US head Combine deep heating with benefits of muscle contraction Used for treating strains, muscle spasms, trigger points, tight muscles Treatment time is 5-15 minutes

55. © 2010 McGraw-Hill Higher Education. All rights reserved. Combo

56. © 2010 McGraw-Hill Higher Education. All rights reserved. Criteria for Full Return to Activity _____________ plan must determine what is meant by complete recovery –Athlete is fully reconditioned, achieved full ROM, strength, neuromuscular control, cardiovascular fitness and sports specific functional skills –Athlete is _______________ prepared The decision to return to play should be a __________________ decision (sports medicine team) –Team physician is ultimately responsible