1. Rehabilitation Techniques Jenna Page, M.Ed., ATC November 2008

2. Objectives of Rehab Prevent De-conditioning Prevent De-conditioning Rehabilitate the Injury Rehabilitate the Injury Work to prevent repetitive injury Work to prevent repetitive injury

3. Principles of Rehab ATC IS IT ATC IS IT A: Avoid Aggravation A: Avoid Aggravation T: Timing T: Timing C: Compliance C: Compliance I: Individualization I: Individualization S: Specific Sequencing S: Specific Sequencing I: Intensity I: Intensity T: Total Patient T: Total Patient

4. Goals of Rehab These are the results one strives to achieve These are the results one strives to achieve Goals need to objective and measurable Goals need to objective and measurable Short-term and Long-term goals should be set Short-term and Long-term goals should be set Goals need to be realistic Goals need to be realistic

5. Goals What is the ultimate goal of rehab? What is the ultimate goal of rehab? What are objective/measurable goals? What are objective/measurable goals? What do short-term goals allow the patient to do? What do short-term goals allow the patient to do?

6. Components of Rehab Flexibility Flexibility ROM ROM Proprioception Proprioception Coordination Coordination Core Stability Core Stability Muscular Strength Muscular Strength Muscular Endurance Muscular Endurance Cardiovascular fitness Cardiovascular fitness Functional Exercises Functional Exercises

7. Phases of Rehab The phases of rehabilitation coincide with the phases of healing The phases of rehabilitation coincide with the phases of healing Prehab Prehab Phase I: Inflammation (Days 1 to 4) Phase I: Inflammation (Days 1 to 4) Phase II: Proliferation (Day 4 to Week 6) Phase II: Proliferation (Day 4 to Week 6) Phase III: Remodeling (Week 4 to 2-3 Years) Phase III: Remodeling (Week 4 to 2-3 Years)

8. Factors Affecting Healing 1. Modalities 2. Proper Medication 3. Surgical or Non-surgical 4. Age 5. Disease 6. Size and Location of Injury 7. Possible Infection 8. Nutrition 9. Swelling 10. Type of Tissue

9. Prehab Only when surgery is required Only when surgery is required The setup for SUCCESS! The setup for SUCCESS! The stronger you are going into surgery the easier the recovery. The stronger you are going into surgery the easier the recovery.

10. Phase I GOALS of PHASE I Control Swelling and Pain Control Swelling and Pain Limit Undue Stress Limit Undue Stress Range of Motion Range of Motion Progress out of assistive device (crutches, boot, sling, etc) Progress out of assistive device (crutches, boot, sling, etc)

11. Control Swelling RICE RICE By controlling swelling, pain is controlled as well. By controlling swelling, pain is controlled as well.

12. Limit Undue Stress Undue Stress – increases pain and impedes the healing process causing more harm Undue Stress – increases pain and impedes the healing process causing more harm

13. Range of Motion Early mobility is essential for returning the injured part to full ROM Early mobility is essential for returning the injured part to full ROM Follow the instructions given in rehab protocol or specific surgeon instructions Follow the instructions given in rehab protocol or specific surgeon instructions

14. What is going on now This is were scar tissue is laid down This is were scar tissue is laid down Scar is not as strong as the original tissue Scar is not as strong as the original tissue Tensile Strength = strength of the tissue Tensile Strength = strength of the tissue Tensile strength is related to the amount, type, and arrangement of collagen Tensile strength is related to the amount, type, and arrangement of collagen

15. What does this mean to the clinician? Collagen fibers are laid down originally in an unorganized manner Collagen fibers are laid down originally in an unorganized manner The fibers can be organized with exercise and stretching The fibers can be organized with exercise and stretching If not straightened out this means a mass of scar tissue If not straightened out this means a mass of scar tissue More Tensile Strength = less scar tissue More Tensile Strength = less scar tissue Elasticity of scar tissue is much less than normal muscle and ligamentous tissue Elasticity of scar tissue is much less than normal muscle and ligamentous tissue

16. Goals of Phase II 1. Strengthen the injured tissue 2. Strengthen the surrounding tissues 3. Continue ROM Remember the tissue is weak but improving Remember the tissue is weak but improving Important to work on stretching muscle and tendon tissue to help align collagen fibers. Important to work on stretching muscle and tendon tissue to help align collagen fibers.

17. Strengthening Progression: Progression: 1. Isotonic 2. Isometric 3. Isokinetic 4. Plyometric Weight should be challenging but not irritating Weight should be challenging but not irritating How many repetitions and sets for rehab exercises? How many repetitions and sets for rehab exercises?

18. Range of Motion Progression: Progression: 1.AAROM 2.AROM 3.PROM

19. What’s going on in the healing process? Phase III is called Remodeling Phase III is called Remodeling Tensile strength is continuing to increase Tensile strength is continuing to increase As tensile strength continues to increase in the tissue the patient is able to increase the stress they can apply to the tissue (usually with exercise) As tensile strength continues to increase in the tissue the patient is able to increase the stress they can apply to the tissue (usually with exercise)

20. Goals of Phase III Building confidence in athlete’s ability Building confidence in athlete’s ability Start with multi-functional rehab Start with multi-functional rehab Move onto Sport Specific Rehab Move onto Sport Specific Rehab Complete Functional Rehab Complete Functional Rehab End of this Phase = Return to Play End of this Phase = Return to Play How do you know when athlete is ready to return to play and when to stop coming in for rehab? How do you know when athlete is ready to return to play and when to stop coming in for rehab?

21. How aggressive can you be? If your rehab program is too aggressive then athlete may experience: If your rehab program is too aggressive then athlete may experience: – ↑ pain – ↑ swelling – ↓ performance –Inability to progress If there is Sx of further injury, then play it safe and be cautious If there is Sx of further injury, then play it safe and be cautious

22. Tools to Use in Rehab Foam Roller Foam Roller Theraband Theraband Swiss Ball Swiss Ball Cuff Weights Cuff Weights Airex Pad Airex Pad AND MANY MANY more... AND MANY MANY more...