1. Therapeutic exercises and modalities Lecture 20

2. The ultimate goal of rehabilitation is to return the injured athlete to activity, pain free and fully functional.
Therapeutic modalities, exercise and medications are used to create an optimal environment for injury repair

3. Controlling Inflammation
primary goal is to control inflammation by limiting hemorrhage, edema, muscle spasm and pain
PIER
maintain ROM , strength, flexibility and CV endurance in unaffected body parts

4. Restoration of Motion
goal here is to restore range of motion , flexibility to 80 % of unaffected limb
begin strengthening exercises
begin proprioceptive work
maintain other areas

5. Flexibility
Static – movement slow and deliberate
muscle stretched to point of mild tension and maintained for a time period
Ballistic – repetitive bouncing
may carry joint past point of comfort
not advisable to do

6. Developing Muscular Strength , Power and Endurance
focuses on developing muscular strength, endurance and power
restore full ROM and proprioception
initiate sport specific activity – on a controlled level

7. Strengthening
isometric contraction
muscle is at a constant tension
muscle length and joint angle remain the same
Isotonic contraction
muscle contraction generated a force to move a constant load through a ROM at a variable speed
free weights , tubing
allows for both concentric and eccentric strengthening

8. Isokinetic contraction
accommodating resistance
muscular overload and angular movement to rotate a lever arm at a controlled velocity
Cybex, Kin Con

9. Open vs Closed Chain Exercises
open or non weight bearing exercises are exercises in which the distal joints function independently of other joints
greater potential for joint shear
eg. quad extension machine , hamstring curls
closed or weight bearing exercises are ones in which movement at one joint will produce predictable motion at another joint

10. multiple joints are exercised through weight bearing
velocity and torque are more controlled
shear forces are reduced
proprioceptors better trained
eg. squats

11. Return to Sport continue to improve strength , endurance and power
restore co-ordination and balance
improve CV endurance
analyse skill performance and correct
increase sport related activities

12. Therapeutic Modalities

13. Indication
a condition that could benefit from a specific action or modality
Contraindication
a condition adversely affected by a specific action or modality
Modalities may be indicated or contraindicated for the same condition , depending on the phase of the therapy

14. Categories of Modalities

15. Cryotherapy
umbrella term that describes a multiple number of cold therapies
Primarily induces vasoconsctriction
immediate response to cold is a decrease in circulation and cell metabolism
cold can penetrate 1- 5 cms this does depend on subcutaneous insulation, temperature and duration of application

16. usually applied for 15 to 30 minutes , may be applied hourly during the first 24 to72 hours
ice, ice massage, ice tubs, cold whirlpools , gel packs , chemical packs , vapo-coolant sprays

17. Magnitude of temperature change depends on;
Type of cooling agent
Temperature difference between the cold object and the tissue
Amount of subcutaneous insulation (fat)
Thermal conductivity of the area being cooled
Limb circumference
Duration of application

19. 15-26

20. Thermotherapy or heat application
usually used after the acute phase to increase blood flow and promote healing
heat has an analgesic or sedative effect, it is used to decrease muscle spasm and pain
vasodilatation and increased circulation result in a influx of oxygen and nutrients to help promote healing

21. depth of penetration is generally 2 cm - warm whirlpools, hot pack , hot rubs , ultrasound

23. Electric modalities
electrical current refers to a string of electrons that pass along a conductor such as a wire.
depending on the electrical current parameters, you may be able to affect sensory , motor or pain fibres
used to relieve pain , reduce swelling, muscle spasm, increase blood flow muscle strength , re-educate muscle

24. TENS – used to produce analgesia and decrease acute and chronic pain
thought to work on gate therapy – overriding pain signals
or to stimulate release of endorphins
EMS – used to re-educate , increase muscular strength , reduce muscle spasm
IFC- used to decrease pain , muscle spasm and swelling helps increase circulation and wound healing

26. 15-14

27. Massage
soft tissue massage is a good means to increase cutaneous circulation , cell metabolism , venous and lymphatic flow in the removal of edema, stretch scar tissue

28. 15-15

29. Ultrasound
high frequency sound waves ( beyond the range of the human ear) to elicit thermal and non thermal effects in deep tissue
Chronic use- thermal effects elevate temperature and increase collagen tissue extensibility , blood flow and nerve conduction, as well as reduce muscle spasm, joint stiffness and pain

30. Acute injuries- nonthermal effects increase cell membrane permeability, tissue regeneration , protein synthesis and reduce edema
depth of penetration depends on frequency of the sound head
most common sound head is 1 MHz = 1 million cycles per sec
3.0 MHz more superficial