1. Functional Progressions and Functional Testing in Rehabilitation
Rehabilitation Techniques for Sports Medicine and Athletic Training
William E. Prentice

2. Introduction
To reduce lasting effects of injury, athletic trainer should direct rehabilitation toward improving neuromuscular coordination and agility as well as strength and endurance
Return athlete to pre-injury activity levels
Function refers to patterns of motion that use multiple joints acting with various axes and multiple planes
Focus on functional rehabilitation will ready patient for activity and competition

3. Role of Functional Progressions in Rehabilitation
A.T. must adapt rehabilitation to the sports specific demands of each individual sport and position
Functional Progression
Succession of activities that simulate actual motor and sport skills
Enable patient to acquire or reacquire skills needed to perform athletic endeavors safely and effectively
Places stresses and forces on each body system in a well-planned positive and progression fashion
Improves patients overall ability to meet the demands of daily activities as well as sport competition

4. Role of Functional Role of Functional Progressions in Rehabilitation
A.T. breaks down activities involved in a given sport into individual components
Patient concentrates on components in a controlled environment before combining them together in an uncontrolled environment
Essential in the rehabilitation process
Tissues not placed under performance level stresses do not adapt to the sudden return of such stresses when full activity is resumed

6. Benefits of using Functional Progressions
Assist patient and A.T. in reaching the goals of the entire program
Restoration of joint ROM
Strength
Proprioception
Agility
Confidence
Allow patient to reach desired level of activity safely and effectively

7. Physical Benefits Improving functional stability Muscle strength
Maintained by neuromuscular control mechanisms involved in proprioception and kinesthesia
Performance during functional task can be evaluated and corrected
Functional testing can be used to provide objective measure of ability
Muscle strength
Muscles involved will be strengthened dynamically under stresses similar to those encountered in competition
Using SAID and Overload Principles
Endurance
Muscular and cardiorespirtaory endurance can be enhanced with functional progressions
Through repetition of of individual activities and their combination into one general activity

8. Physical Benefits Flexibility
Injured area stressed within a controlled range during functional progression
Improved mobility and flexibility crucial to patient return to activity
Strength and endurance do not mean much if injured area cannot move through normal ROM
Muscle relaxation
Functional progression can teach an individual to recognize muscle tension and eventually control or remove it by relaxing muscles after exercise
Relieve muscle guarding that may inhibit normal ROM

9. Physical Benefits Motor Skills
Coordination, agility and motor skills are complex aspects of normal function
Needed to transform strength, flexibility and endurance into full-speed performance
Repetition and practice are are important to learning motor skills
Rehabilitation exercises must stress neuromuscular coordination and agility to increase performance and decrease chance of reinjury
Develop automatic reactions needed during activity

10. Psychological Benefits
Functional progression can help reduce common emotions found after injury
Anxiety
Athlete gradually placed into more demanding situations.
Experience success and not be as concerned with failure
Deprivation
Athlete can engage in activity during practice to remain close in proximity and socially feel little loss in team cohesion
Apprehension
Enable patient to adapt to imposed demands of their sport in a controlled environment
Restore confidence

12. Components of a functional progression
Four principles
Individuality of the patient, sport and the injury
Activities should be positive not negative; no increase in signs or symptoms
Orderly progressive program
Program should be varied to avoid monotony
Vary exercise techniques
Alter the program at regular intervals
Maintain fitness base
Set achievable goals , reevaluate, and modify regularly
Use clinical, home and on field programs
Use sport specific activities to enhance patients return to activity

13. Designing a Functional Progression
No cookbook, be creative and specific to athletes goals and injury status
Progressions should start early in rehab
Start with low impact and progress to high impact
Assess athlete periodically to determine ability to progress to next exercise
Achieving a certain skill level occurs when a the skill can be completed at functional speed with high repetition without increase in pain, swelling or a decrease in ROM

14. Functional Testing
Patient performs certain tasks appropriate to their stage in rehab
Isolate specific deficits
A.T. able to determine current functional level and set functional goals
Indirect measure of muscular strength and power
Uses maximal performance of an activity
Provide A.T. with objective data

15. Functional Testing Three purposes
Determine risk of injury due to limb asymmetry
Provide objective measure of progress during rehab plan
Measure the ability of the individual to tolerate forces

16. Functional Testing A.T. must evaluate what test will be used
Validity : test should measure what it intends to measure
Reliability: Test should consistently provide similar results regardless of evaluator
Observe unilateral and bilateral function to determine compensation patterns
A.T. should also consider stage of healing, strength, patients ability and physician approval

17. Functional Testing
Preseason baseline measurements are preferred so A.T. has data to compare post injury activity levels
Not always obtained by A.T., however individual sports may do baseline testing
With or without baseline measurements a score of 85% or better compared to noninjured side is recognized as standard for limb symmetry scores

18. Functional Testing
Uses functional progression drills for the purpose of assessing the athlete’s ability to perform a specific activity
Entails a single maximal effort to gauge how close the athlete is to full return
Pre-season baseline testing for comparison post injury
Variety of tests
Shuttle runs -Vertical jumps
Agility runs -Balance
Figure 8’s -Hopping for distance
Carioca tests -Co-contraction test

19. Lower Extremity Functional Progression
Walking: Normal Gait
Walking: Heels walks
Walking: Toe walks
Side step/Shuffle
Lunge 90° to Lunge 180°
Step ups forward to lateral step ups
Increase speeds

20. Jogging Sprint Box Runs Carioca
Begin straight ahead, gradually increase intensity 50%- 100%
Introduce curves: Oval,“S” course, figure “8” course, “Z” course
Sprint
Straight ahead varying intensities
Add acceleration/deceleration drills
Box Runs
Carioca

21. Speed and Agility drills:
Hopping:
Double Leg to Single Leg to Alternate
Jumping:
Plyometrics
Progress intensities
Sport specific
Speed and Agility drills:
Ladder drills
Cutting, jumping on command
Position specific activities

27. Upper Extremity Functional Progression
Assisted PNF techniques
T-band exercises simulating specific sport/position motions
Strength and endurance
Closed chain exercises: Push up progression
Upper Body Plyometrics

28. Interval throwing program
Focus on mechanics and biomechanical dysfunctions
Begin with general warm up
Step 1: 45 ft. phase
Warm up throwing
25 throws
Rest 10 minutes

29. Step 2: 45 ft. phase Warm up throwing’ 25 throws 15 minute rest
Rest 10 minutes

30. Repeat steps 1 & 2 for 60, 90, 120, 150, 180 ft.
Only progress if pain free and no signs or symptoms develop
When program completed move to position specific throwing
For example: pitcher throw off mound

31. Designing a Functional Progression
Full Return to Play
Physicians release
Pain free
No Swelling
Normal ROM
Normal strength (in reference to contralateral limb)
Appropriate functional testing completed with no adverse reactions