Rehabilitation and Reconditioning chapter 12 Open vs. Closed Chain Exercises in Rehabilitation

Macrotrauma Macrotrauma is a specific, sudden episode of overload injury to a tissue, resulting in disrupted tissue integrity. Dislocation/subluxation: the complete/partial separation of surfaces within a joint Sprain: trauma to a ligament Strain: indirect musculotendinous trauma resulting in tearing of fibers Contusion: direct trauma to soft tissue resulting in an excess blood and fluid accumulation

Microtrauma Microtrauma results from repeated, abnormal stresses applied to a tissue by continuous training or training with too little recovery time; overuse injury Stress fracture: small bone breaks usually resulting from excessive training on hard surfaces Tendonitis: inflammation of a tendon Tendonosis: degeneration of the tendon caused by chronic inflammation

Table 20.1

Tissue Healing Inflammation Phase Inflammation is the body’s initial reaction to injury and is necessary for normal healing to occur. Pain, swelling, redness Decreased collagen synthesis Increased number of inflammatory cells Increased blood flow removes tissue debris Lasts approximately 2-3 days, longer if injury is severe or blood flow is poor

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. Reduction in inflammatory cells New tissue and scar tissue formed New capillaries form Collagen fibers laid out randomly as structure for repairs Not optimal for strength Begins as early as two days after injury and may last up to two months.

Tissue Healing Remodeling Phase The weakened tissue produced during the repair phase is strengthened during the remodeling phase of healing. Improved collagen alignment Usually never as strong as before injury Tissue remodeling can last up to two to four months after injury.

Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and Reconditioning Choose 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.

Loading During Rehabilitation Figure 20.3 (next slide) Loading during rehabilitation should neither overload nor underload the athlete’s healing tissue.

Figure 20.3

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.

Figure 20.4

Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and Reconditioning Inflammation Phase Treatment Goal Preventing disruption of new tissue Exercise Strategies General aerobic and anaerobic training and resistance training of uninjured extremities, with priority given to maximal protection of the injured area RICE: rest, ice, compression, elevation Cooling to re-warming ratio of 1:2 Also ultrasound and electrical stimulation Some passive movement of injured area if tolerable

Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and Reconditioning Repair Phase Treatment Goals Preventing excessive muscle atrophy and joint deterioration in the injured area; maintaining muscular and cardiovascular function in uninjured areas Avoid disruption of collagen mesh Non-movement can cause adhesions in the collagen mesh Exercise Strategies (after consultation with team physician, athletic trainer, or physical therapist) Submaximal isometric exercise Isokinetic exercise Specific exercises to improve neuromuscular control

Rehabilitation and Reconditioning Strategies Goals of Rehabilitation and Reconditioning Remodeling Phase Treatment Goal Optimizing tissue function by continuing and progressing the activities performed during the repair phase and adding more advanced, sport-specific exercises Apply progressive amounts of stress to injured area Helps collagen align and grow Exercise Strategies: progress from ones used in repair phase Transition from general exercises to sport-specific exercises Specificity of movement speed an important variable Velocity-specific strengthening exercises (velocities must progress to those used in the athlete’s sport)

Return-to-Activity Phase Return to normal activity should be based on therapist recommendations as well as testing ROM- equal to contralateral limb desirable Strength- at least 20% of contralateral limb Functional capacity tests- assess functional limitations in injured limb as a whole Several injury/sport specific rehab/return plans exists

Post-injury Programming Examine the goals of rehab to determine if athlete has satisfied all of them Ex. Back to a certain % of original strength or ROM Determine program based on athlete’s needs for sport Ex. Pulled hamstring in marathon runner vs. pulled hamstring in Olympic lifter Keep open communication w/therapists

Rotator Cuff Rehabilitation Figure 20.5 (next two slides) Exercises generally transition from (a, b) isolation exercises to (c, d) multijoint, sport-specific exercises.

Figure 20.5a and b

Figure 20.5c and d

Closed Kinetic Chain closed 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.

Closed Kinetic Chain Exercises Figure 20.6 (next slide) Closed kinetic chain exercises: (a) squat exercise (b) push-up exercise

Figure 20.6

Open Kinetic Chain open 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.

Open Kinetic Chain Exercise Figure 20.7 (next slide) Example of an open kinetic chain exercise—leg (knee) extension exercise

Figure 20.7

Kinetic Chain: Sprinting Figure 20.8 (next slide) Sprinting offers an example of open and closed kinetic chain movements occurring together.

Figure 20.8

Key Point Designing 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.