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

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.

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

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 10-20 lb. 13 to… Increase 10-15 lb.

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 10-20 lb. 13 to… Increase 10-15 lb.

Cryokinetics in Rehabilitation of Joint Sprains

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

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

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

Cryokinetics Indications Ankle sprains Finger sprains Shoulder sprains Other joint sprains

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

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.

Cryokinetics Equipment Needed Slush bucket or ice packs Toe cap Towel

Application Procedures Numb the Body Part Use ice immersion, ice massage, or cold-pack application Numbing generally takes 12-20 min. The patients sensation is more significant than the time of application Use a toe cap

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.

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

Relieving Acute Muscle Spasm: Cryostretch

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.

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.

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.

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

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

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

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.

Summary Of Cryostretch Technique ICE - Until numb (20 minutes maximum) Exercise Bout First Stretch Total of 65 sec. Static stretch 20 sec. Isometric contraction 5 sec. Static stretch 10 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