Understanding the Basics of Injury Rehabilitation

Athletic Injury Rehab AT is responsible for design, implementation, and supervision of rehab program Healthcare providers should be in charge of rehab, not coaches ANYONE IS ABLE TO HELP CONTROL SWELLING AND DECREASE PAIN BY USING FIRST AID TECHNIQUES.

Long Term Goal of Rehab Return the injured athlete to practice and play as soon as it is safely possible.

8 Short-Term Goals of Rehab (don’t write just read, we will discuss each) Provide first aid and limit swelling Reduce pain Restore full ROM Restore muscular strength, endurance, power Re-establish neuromuscular control Regain balance Maintain cardiovascular endurance Include functional progression exercises

1. Control Swelling Less swelling = faster RTP Main goal of immediate care is to limit swelling PRICE Protect, Rest, Ice, Compress, Elevation

2. Controlling Pain All injuries have some degree of pain Pain is determined by: Severity Individual perception and response Circumstances of the injury PRICE Therapeutic modalities

3. Restore Full ROM All joint injuries lose some ROM Stretching Muscle & tendon resistance, joint capsule and ligament contracture, swelling, or a combination Stretching Static, dynamic, PNF, foam rollers

4. Restore Muscular Strength Muscular strength, endurance, & power Most essential factor in restoring function to pre-injury status Exercise through a full, pain free ROM Isometric Isotonic – Progressive Resistance Exercises (PREs) Isokinetic Plyometrics

Strength Techniques Isometric Isotonic No change in muscle length Early in rehab Contraction (muscle pump) can reduce swelling Isotonic Progressive Resistance Exercises (PREs) Muscle length changes Most common training technique Free weights, tubes, machine, body weight

Progressive Resistance Exercises (PREs)

Strength Techniques Isokinetic Plyometrics Muscle length changes at constant speed Used in rehab to measure strength Machine set at specific speed Plyometrics Jumping and hops Quick stretch of muscle followed by a contraction Improves power

Plyometric Exercises

5. Reestablish Neuromuscular Control Produces coordinated movements Mind teaches the body conscious control of specific movements Body “forgets” how to move after an injury

6. Regain Balance Improve whole body balance Balance = postural stability Balance problems will increase the chance of reinjury

7. Maintain Cardiovascular Endurance Most often neglected part of rehab Cardio endurance decreases quickly Start cardio training ASAP Bike, swimming, arm bike, eliptical

8. Functional Progression Incorporate sport specific skills in rehab Gradual progression to sport skills Helps with ROM, strength, balance, and neuromuscular control

Functional Testing Uses functional progression drills to assess the athlete’s ability to perform Timed agility runs, vertical jump, Compare to baseline or pre-injury test Compare to uninjured side Way to determine if the athlete is ready to RTP

Therapeutic Modalities An intervention used to help with healing Cold (cryotherapy) Heat (thermotherapy) Ultrasound (deep heat, not pictures) Electric stimulation (stim) Massage Traction Anyone can use basic modalities, but not everyone can use advanced modalities like stim, ultrasound, & traction

Cold (cryotherapy) Ice bags, ice massage, cold whirlpool Decrease pain and decrease swelling Ice 20 min – off 1 hour; repeat Can place a wet towel between skin & ice Wrap with elastic wrap and elevate to help decrease swelling 4 phases: Stinging Burning Aching Numbness

Heat (thermotherapy) Not used with an acute injury Wait until swelling has stopped; do not use for at least 72 hrs after a new injury Increases blood and lymphatic flow and helps the body reabsorb injury by-products Increases relaxation Use hot pack for 7-10 minutes

Ice vs. Heat What do you use immediately after an injury to decrease swelling and pain? What should be used for at least the first 72 hours after an injury? What increases blood flow to an area? What could increase swelling? Which is safer to use if you are not sure?

It is safe to switch from ice to heat when… There is little to no chance of additional swelling. The injury is not point tender (sore to touch). Any discoloration or bruising from the injury is starting to disappear.

Massage Is systematic manipulation of the soft tissues of the body. Movements include: Gliding, compressing, stretching, percussing, and vibrating to produce a specific response Has mechanical, physiological, and psychological responses

Criteria for Full Recovery Must determine what full recovery is for each injury Physical ROM, strength, NM control, cardio, functional Must pass functional testing Psychological (mental) Confidence RTP decision made by full sports med team Doctor, AT, coach, and athlete