C H A P T E R Rehabilitation and Reconditioning

Chapter Outline  Sports medicine team  Rehabilitation and reconditioning strategies  Types of injury  Tissue healing

Principles of Rehabilitation and Reconditioning  Healing tissues must never be overstressed.  Rehabilitation is a team-oriented process.  Athlete must fulfill criteria.  Program must be based on current research.  Program must be adaptable to each individual.

Sports Medicine Team Members  Team physician  Athletic trainer  Physical therapist  Strength and conditioning professional  Exercise physiologist  Nutritionist  Psychologist or psychiatrist

T he sports medicine team includes a large number of professionals working together to provide an optimal rehabilitation and reconditioning environment. The relationship among members requires thoughtful communication to ensure a safe, harmonious climate for the injured athlete. 

Types of Injury  Macrotrauma: caused by a specific, sudden episode of overload injury to a tissue; results in disrupted tissue integrity  Microtrauma: caused by repeated, abnormal stresses applied to a tissue through continuous training or training with too little recovery time

Tissue Healing: Inflammation Phase  Pain, swelling, and redness  Increased number of inflammatory cells  Decreased collagen synthesis

Tissue Healing: Repair Phase  Collagen fiber production  Decreased number of inflammatory cells  Decreased collagen fiber organization

Tissue Healing: Remodeling Phase  Proper collagen fiber alignment  Increased tissue strength

Rehabilitation and Reconditioning Goals and Strategies: Inflammation  Prevention of new tissue disruption and prolonged inflammation.  No active exercise for injured area.  Function of cardiorespiratory and surrounding neuromusculoskeletal systems must be maintained.

Rehabilitation and Reconditioning Goals and Strategies: Repair  Prevention of excessive muscle atrophy and joint deterioration.  Function of neuromusculoskeletal and cardiorespiratory systems must be maintained.  Possible exercises include -submaximal isometric, isokinetic and isotonic exercise and -balance and proprioceptive training activities.

Rehabilitation and Reconditioning Goals and Strategies: Remodeling  Optimization of tissue function  Progressive loading of neuromusculoskeletal and cardiorespiratory systems  Possible exercise options: -joint-angle specific strengthening -velocity-specific muscle activity -closed and open kinetic chain exercises -proprioceptive training activities

D esigning strength and conditioning programs for injured athletes requires the strength and conditioning professional to examine the rehabilitation and reconditioning goals to determine what type of program allows the quickest return to competition. 

Resistance Training Techniques Used in Rehabilitation DeLorme’s method –Based on repetition maximum of 10 –Designed for early rehab –Designed for beginning rehab –Introduced PRE – “progressive loading” –Builds in warm-up period MacQueen’s method –Utilizes varying sets for beginning/intermediate & advanced –Set of 10 RM Oxford method –Used during early, intermediate & advanced levels of rehabilitation –Percentages of 10 RM –Diminishes resistance as muscle fatigues – “regressive load” Sander’s program –Utilized in advanced stages of rehabilitation –Utilizes percentages of body weight

Knight (DAPRE) –Daily Adjustable Progressive Resistive Exercise –Adjusted based on individual’s progress –Based on 6 RM working weight Berger –Adjusts within individual’s limitations –Should allow for 6-8 RM repetitions on seconds –Must be able to achieve 3 sets of at least 6 RM and no more than 8 RM –Increases occur in 10% increments For rehabilitation –Base program on pain and healing process –Should be performed daily early on –Reduce workout to every other day as progress is made

Isokinetic Exercise Involves muscle contractions where length change of muscle is set at a constant velocity Maximal resistance throughout the range of motion Variety of machines/manufacturers are available Can be used with eccentrics & concentric exercise

Isokinetics as a Conditioning Tool –Maximal effort for maximal strength gains –Dynamometer will move at a set speed whether maximal or half of maximal effort is put forth Athlete can cheat with machine and not put forth the effort –Not cost effective Isokinetics in Rehabilitation –Gained popularity in rehabilitation during the 1980’s –Provide objective means of athlete/patient evaluation –Training at fast vs. slow speeds –Functional speeds

De Lorme Program Uses 3 sets of 10 repetitions 1 st set: 10 reps of 50% of 10RM 2 nd set: 10 reps of 75% of 10RM 3 rd set: 10 reps of 100% of 10RM The Oxford system is the reverse of De Lorme, it progresses from heavy to light

Daily Adjustable Progressive Resistance Exercise (DAPRE by Ken Knight) DAPRE involves four sets with repetitions ranging from 10 to possibly 1 during the final set. 1 st set: 10 reps of 50% of 1RM 2 nd set: 6 reps of 75% of 1RM 3 rd set: maximum number of reps of 100% of 1RM The number of repetitions performed in the 3 rd set determines the adjustments to be made in the fourth set. (Table 23.2, p 542).