1. Unit 2: Rehabilitation
Sports Medicine 2

2. Rehab motivation…
6NO5sFU

3. Rehabilitation team
In order to give the patient the optimal care, their must be a team that works together to help the patient get better.
Patient: person receiving treatment and care from a clinician, physician, or other team member
Primary team members:
Physician
Athletic Trainer
Patient
Orthopedist
Psychologist
Physical therapist
Additional primary team members: ATS, parents/spouse, coach, school nurse

4. Rehabilitation team Secondary team members
Emergency care technicans
Orthoists
Pharmacists
Kinesiologist
Exercise physiologist
Nutritionist
Peers
Additional secondary team members: sports team members, teachers, AD

5. Athletic Trainer Skills needed as an ATC.. Interpersonal skills
Competent and energetic
Act professionally
Good active listening skills
Record keeping
Educator
What other skills do you think are important for an ATC to have?

6. Rehab…
With a partner, write down and discuss 10 elements you think would be important with rehab…

7. Why are we seeing more and more injuries?? Overuse?
2y_rFIA

8. Components of a Rehab Program
Principles of Rehab:
“ATC IS IT”
Avoid aggravation
Timing
Compliance
Individualization
Specific sequencing
Intensity
Total patient

9. Principles Avoid aggravation Don’t aggravate the injury during rehab
Rehab progression should be progressive and not worsen injury
Progress at right speed by knowing healing progress
Know the right exercises at the right timing
Know you athlete and how hard you can push them

10. Principles Timing Compliance Begin rehab ASAP, but not too quickly
Must get the necessary rest first
Sooner they can complete rehab, the sooner they can return to play
Compliance
Patient must do what they need to do to get better
Inform patient about the program and expected goals/progression
If program is carried out consistently, with progression and proper recovery, they will get back to play better and sooner

11. Principles Individualization Specific sequencing
Each person needs their own program
May have a template for an injury, but should be adjusted for every person
Must know patients response to injury and rehab
Specific sequencing
Sequence the progression based on how the patient is healing

12. Principles Intensity Total patient
You must challenge the patient and injured area, but also not aggravate the injury further
Knowing how much stress an exercise puts on an injury/person and when to back off
Total patient
Focus on the whole body, not just the injured area
Make sure you keep EVERYTHING strong

13. Objectives with Rehab Prevent deconditioning Rehabilitate injured part
Include cardio and target whole body
Rehabilitate injured part

14. Goals Set objective and measurable GOALS
Make sure you get the patient’s input on the goals
What do they want to achieve?
Should have short term and long term goals
Short term goals:
Progress towards long term goal
Give patient something concrete to work towards
Give patient a “boost”
Long term goals: final, desired outcome of the therapeutic program

15. Partner activity
You have basketball player who suffers from a MCL sprain. He will be out for at least 1 month.
Write down 5 short term goals and one long term goal

16. Examination and Assessment
An ATC must do an initial evaluation of the injury to determine the problem
Once they have established the problem, develop a program
The ATC must do continual evaluations to examine and assess how the injuries are doing
Helps determine when to progress
Helps determine when they can return to sport/playng

17. Basic components of therapeutic exercise
Flexibility
Range of motion (ROM)
Strength and muscle endurance
Proprioception
Coordination
Agility

18. Flexibility and Range of motion
Flexibility: the mobility of muscles and the length to which they can extend
If a body part is immobilized, they loose flexibility
May increase flexibility with stretching programs
Range of motion: the amount of movement possible at a joint
ROM is affect by flexibility
Decreased flexibility results in decreased ROM
May be affected mobility of capsule and ligaments, fascial restraints, scar tissue, and strength too

19. Range of motion and flexibility
Equipment for measuring ROM:
Goniometer: tool used to measure ROM
Protractor with a stationary and moveable arm
Different body parts have varying “norms” of ROM
Spine motion is usually measured with observing motions and comparing both sides
Harder to measure with a goniometer

20. How to improve ROM and flexibility in your therapeutic program
Stretching
Active stretching vs. passive stretching
Proprioceptive Neuromuscular Facilitation (PNF)
Two ways:
Hold-relax: muscle brought to end motion, isometric of tight muscle, relax, stretch via contraction of opposing muscle
Contract-relax: Muscle is brought to end-motion, isotonic contraction of tight muscle, relax, passive movement to end-range
Ballistic stretching

21. Practice it! We will go through the different techniques of stretching
Discuss as a group different ideas for stretching

22. Strength and endurance
Muscular strength:
Maximum force that a muscle or muscle group can exert
May be lost with injury
Muscular endurance:
The muscle’s ability to sustain a sub-maximal force in a static activity or repetitive activity over time
Muscular strength and endurance work hand in hand
If one improves, so does the other

23. Types of muscle activity
Static or “isometric” activity
Muscle tension is created without a change in the muscle’s length
Advantage: strengthen a muscle without imposing stress on injured or surgically repaired tissue
Disadvantage: strength gains are isolated to no more than 20 degs within the angle of the isometric contraction

24. Types of muscle activity
Dynamic- a change in the position of the muscle occurs
Two types: isotonic and isokinetic
Isotonic: change in muscle length
Concentric- the muscle shortens
Eccentric- the muscle is lengthening
Produces 20-40% more force than concentric
Takes more energy than concentric
Isokinetic: dynamic activity involving motion
Velocity is controlled and maintained at a specific speed of movement
The amount of resistance provided to the muscle varies as the muscle goes through its range

25. Open vs. closed kinetic chain activity
Open kinetic chain (OKC): distal segment is moving freely in space
Produce high velocity motions
Examples: kicking or throwing a ball
Closed kinetic chaing (CKC): distal segment is weight bearing and the body moves over the hand or foot
Functional activities putting less force on the joints
Beneficial for rehab purposes
Examples: running, squats

26. Partner activity
Come up with examples of CKC and OKC activities (10 each)
Write down the pros and cons of each
What is an injury you may use CKC?
What is an injury you may use OKC?

27. Open vs. closed kinetic chain activities continued…
Lower-extremity sports mostly CKC
How will that effect rehab?
CKC
Improve strength, power, stability, balance, coordination, and agility
Can generate large forces with low velocity
So how could you incorporate CKC into your rehab activities?
OKC – move freely, higher velocity
Not delayed until weight bearing
Can isolate weak muscles

28. Evaluating muscle strength
Evaluation equipment:
Isokinetic machines
Manual muscle test
Assessment of the muscle’s ability to move a joint through its normal ROM in strength
Performed by a clinician
Clinician resists a patient through a motion
Example: resisted knee extension
Break test: the patient holds in a position while the clinician provides resistance

29. Grades of MMT Grade Quality of movement Definition 5 Normal
Full ROM against gravity and able to tolerate full resistance 4
Good
Full ROM against gravity and able to tolerate moderate resistance 3
Fair
Full ROM against gravity. Muscle unable to go through its full ROM if resistance is provided 2
Poor
Full ROM with gravity eliminated. 1
Trace
There is evidence of muscle contraction but no joint motion occurs

30. Strength equipment Manual resistance: provided by ATC Body weight
Advantage: no equipment required but a clinician, hands-on technique that builds trust between clinician and patient
Body weight
Advantage: no equipment required, own body weight provides the resistance
Examples: body weight squats, lunges, push ups, pull ups
Rubber band and tubing
Advantage: provides resistance, bands are cheap, they can do the exercise on their own, may progress with harder tubing
Disadvantage: compliance, bands may wear out

31. Strength equipment Free weights Isotonic machines Isokinetic machines
Cuff weights, barbells, and dumbbells
Advantages:
Variety of sizes and weights, easy to progress, common equipment in gyms
Important to use proper technique
Weight safety could be a disadvantage
Isotonic machines
Provide constant load during exercise
Examples: cable machines, leg press, etc.
Isokinetic machines

32. Strengthening principles
“SNAP” principles
Specific exercises
Exercises should be geared towards specific goals
No pain
Shouldn’t have pain during strengthening exercises
If patient has pain following rehab, identify the site of pain and type of pain
Soreness is OKAY
Attainable goals
Goals should be challenging but attainable
Progressive Overload
In order to progress you have to continually adapt the resistance and overload it

33. Examples of exercises

34. Proprioception
Proprioception is the body’s ability to transmit position sense, interpret the information, and respond consciously/unconsciously to stimulation through appropriate execution of posture and movement
Fundamental to correct performance
Three main components:
Good agility
Balance
Coordination

35. Balance
The body’s ability to maintain equilibrium by controlling the body’s center of gravity over its base of support
Required to perform the simplest activities like standing
Poor balance can increase your chances of injury
May be affected by visual, auditory, and proprioceptive systems
Tests: Romberg

36. Examples of exercises for balance
Changes in stances
Double legged vs. single legged vs. tandem
Eyes open vs. eyes closed
Flat surface vs. unstable surface (foam pad)

37. Coordination
The complex process by which a smooth pattern of activity is production through a combo of muscles acting together with appropriate intensity and timing
Muscles work together to provide accurate response in timing and intensity
Improve by starting with simple exercises and improving to more complex ones

38. Examples of coordination
SL balance with cup taps or stacking cups

39. Agility
The ability to control the direction of a body or segment during rapid movement
Requires several elements:
Flexibility, strength, power, speed, balance, and coordination
Involves rapid change in direction and sudden starting and stopping
Most sports require good agility skills

40. Examples of agility exercises
Cutting drills
Ladder drills
Line drills
Sports specific drills
Basketball- running through plays, defensive drills
Football- catching drills
Soccer- passing and shooting drills

41. Psychological considerations
Stages of grief
1. Denial
2. Anger
3. Depression
4. Acceptance