1. Rehabilitation and Reconditioning
chapter 22
Rehabilitation and Reconditioning
David H. Potach, PT, and Terry L. Grindstaff, PhD, PT, ATC

2. Chapter Objectives
Identify members of the sports medicine team and their responsibilities during injury rehabilitation and reconditioning
Recognize types of injuries athletes sustain
Comprehend timing and events of tissue healing
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3. Chapter Objectives (continued)
Understand goals of each tissue healing phase
Describe the strength and conditioning professional’s role during injury rehabilitation and reconditioning

4. Rehabilitation and Reconditioning
Principles of rehabilitation and reconditioning
Healing tissues must not be overstressed.
The athlete must fulfill specific criteria to progress from one phase to another during the rehabilitative process.
The rehabilitation program must be based on current clinical and scientific research.
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5. Rehabilitation and Reconditioning (continued)
Principles of rehabilitation and reconditioning
The program must be adaptable to each individual and his or her specific requirements and goals.
Rehabilitation is a team-oriented process requiring all the members of the sports medicine team to work together.

6. Sports Medicine Team Sports medicine team members
All members of the sports medicine team are responsible for educating coaches and athletes regarding injury risks, precautions, and treatments.
The sports medicine team also works to prevent injuries and rehabilitate injured athletes.
Several different professionals play important roles in assisting an injured athlete’s return, so effective communication is necessary.

7. Key Terms
team physician: A person who provides med-ical care to an organization, school, or team.
athletic trainer: A person typically responsible for the day-to-day physical health of the athlete; certified by the National Athletic Trainers’ Association Board of Certification as a Certified Athletic Trainer (ATC).
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8. Key Terms (continued)
physical therapist: A person with a back-ground in orthopedics or sports medicine who can play a valuable role in reducing pain and restoring function to the injured athlete.
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9. Key Terms (continued)
strength and conditioning professional: A person who focuses on strength, power, and performance enhancement and is an integral part of the rehabilitation and reconditioning process. Ideally, this person should be certified by the National Strength and Conditioning Association (NSCA) as a Certified Strength and Conditioning Specialist (CSCS) to ensure that he or she has the knowledge and background to contribute to the rehabilitation process.
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10. Key Terms (continued)
exercise physiologist: A person who has a formal background in the study of the exercise sciences and uses his or her expertise to assist with the design of a conditioning program that carefully considers the body’s metabolic response to exercise, as well as the ways in which that reaction aids the healing process.
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11. Key Terms (continued)
nutritionist: A person who has a background in sports nutrition and can provide guidelines regarding proper food choices to optimize tissue recovery. Ideally, the nutritionist has been formally trained in food and nutrition sciences and is a Registered Dietitian recognized by the American Dietetic Association.
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12. Key Terms (continued)
psychologist or psychiatrist: A licensed professional with a background in sport may provide strategies that help the injured athlete better cope with the mental stress accom-panying an injury.

13. Sports Medicine Team Communication
Strength and conditioning professionals must understand the following:
The diagnosis of the injury
Indications—forms of treatment required
Contraindications—activity or practice prohibited due to the injury
They must also inform the rest of the sports medicine team about the exercises performed by the athlete and the athlete’s response to the exercise.

14. Key Point
The sports medicine team includes a large number of professionals working together to provide an optimal rehabilitation and reconditioning environment. The relation-ship between members requires thoughtful communication to ensure a safe, harmoni-ous climate for the injured athlete.

15. Types of Injury
Macrotrauma: A specific, sudden episode of overload injury to a given tissue
Dislocation: A complete displacement of the joint surfaces
Subluxation: A partial displacement of the joint surfaces
Sprain: Trauma to a ligament, classified as 1st, 2nd, or 3rd degree depending on severity
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16. Types of Injury (continued)
Contusion: A musculotendinous injury caused by direct trauma
Strain: Tears in the muscle fibers caused by indirect trauma that are classified into 1st, 2nd, or 3rd degree based on severity
Microtrauma: An overuse injury caused by repeated, abnormal stress applied to a tissue by continuous training or training with too little recovery time
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17. Types of Injury (continued)
Stress fracture: The most common type of overuse injury that occurs in bones
Tendinitis: An overuse injury that results in inflammation of a tendon

18. Tissue Healing All tissues follow the same basic pattern of healing:
Inflammation
Repair
Remodeling
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19. Tissue Healing (continued)
The timing of events within each phase of tissue healing differs for each tissue type and is affected by a variety of factors:
Age
Lifestyle
Degree of injury
The structure that has been damaged

20. Key Point
The process of returning to competition following injury involves
Healing of the injured tissues
Preparation of these tissues for the return to function
Use of proper techniques to maximize rehabilitation and reconditioning

21. Table 22.1

22. Tissue Healing Inflammatory response phase Fibroblastic repair phase
Inflammation is the body’s initial reaction to injury and is necessary for normal healing to occur.
The injured area will become red and swollen.
Fibroblastic 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.
This phase of tissue healing begins as early as 2 days after injury and may last up to 2 months.
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23. Tissue Healing (continued)
Maturation–remodeling phase
The weakened tissue produced during the repair phase is strengthened during the remodeling phase of healing.
Tissue remodeling can last up to 2 to 4 months after injury.

24. Key Point
Healing tissue must not be overstressed, but controlled therapeutic stress is necessary to optimize collagen matrix formation. The athlete must meet specific objectives to progress from one phase of healing to the next.

25. Goals of Rehabilitation and Reconditioning
Inflammatory response 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
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26. Goals of Rehabilitation and Reconditioning (continued)
Fibroblastic repair phase
Treatment goal
Preventing excessive muscle atrophy and joint deterioration in the injured area; maintaining muscular and cardiovascular function in uninjured areas
Exercise strategies (after consultation with team physician, athletic trainer, or physical therapist)
Submaximal isometric exercise
Isokinetic exercise
Specific exercises to improve neuromuscular control
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27. Goals of Rehabilitation and Reconditioning (continued)
Maturation–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
Exercise strategies
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)

28. Rotator Cuff Rehabilitation
Figure 22.4 (next slide)
Sample progression of exercises that could be used for basketball players recovering from ankle sprains.
Exercises progress from general to basketball specific.

29. Figure 22.4

30. Key Term
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.

31. Kinetic Chain Figure 22.5 (next slide) Closed kinetic chain exercises
(a) Squat exercise (downward movement)
(b) Push-up exercise

32. Figure 22.5

33. Key Term
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.

34. Kinetic Chain Figure 22.6 (next slide)
Example of an open kinetic chain exercise—leg (knee) extension exercise

35. Figure 22.6

36. Kinetic Chain Figure 22.7 (next slide)
Sprinting offers an example of open and closed kinetic chain movements occurring together.

37. Figure 22.7

38. Program Design Resistance training
Several programs have been developed to assist with the design of resistance training programs for injured athletes, including the De Lorme and Oxford programs and Knight’s DAPRE program.
DAPRE allows more manipulation of intensity and volume.
The demands of the athlete’s sport determine the training goal, which should dictate the design of the resistance training program during the remodeling phase.
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39. Program Design (continued)
Resistance training
Daily adjustable progressive resistive exercise (DAPRE) system
First set requires 10 repetitions of 50% of the estimated 1RM.
Second set requires 6 repetitions of 75% of the estimated 1RM.
Third set requires the maximum number of repetitions of 100% of the estimated 1RM.
The number of repetitions performed during the third set determines the adjustment to be made in resistance for the fourth set.

40. Table 22.2

41. Program Design Aerobic and anaerobic training
Research has yet to determine an optimal aerobic training program for use in the rehabilitation setting.
The program should mimic specific sport and metabolic demands.

42. 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.

43. Reducing Risk of Injury and Reinjury
Previous injury is the most substantial risk factor for future injury in active individuals.
Risk factors for upper extremity injury
Decreased glenohumeral ROM
Scapular dyskinesis
Decreased shoulder strength
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44. Reducing Risk of Injury and Reinjury (continued)
Risk factors for lower extremity injury
Decreased balance
Decreased neuromuscular control during jump landing
Decreased lower extremity muscle strength
Structured programs should be specific to sport demands.