1. Rehabilitation and Reconditioning
chapter 12
Open vs. Closed Chain Exercises in Rehabilitation

2. Macrotrauma
Macrotrauma is a specific, sudden episode of overload injury to a tissue, resulting in disrupted tissue integrity.
Dislocation/subluxation: the complete/partial separation of surfaces within a joint
Sprain: trauma to a ligament
Strain: indirect musculotendinous trauma resulting in tearing of fibers
Contusion: direct trauma to soft tissue resulting in an excess blood and fluid accumulation

3. Microtrauma
Microtrauma results from repeated, abnormal stresses applied to a tissue by continuous training or training with too little recovery time; overuse injury
Stress fracture: small bone breaks usually resulting from excessive training on hard surfaces
Tendonitis: inflammation of a tendon
Tendonosis: degeneration of the tendon caused by chronic inflammation

4. Table 20.1

5. Tissue Healing Inflammation Phase
Inflammation is the body’s initial reaction to injury and is necessary for normal healing to occur.
Pain, swelling, redness
Decreased collagen synthesis
Increased number of inflammatory cells
Increased blood flow removes tissue debris
Lasts approximately 2-3 days, longer if injury is severe or blood flow is poor

6. Tissue Healing 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.
Reduction in inflammatory cells
New tissue and scar tissue formed
New capillaries form
Collagen fibers laid out randomly as structure for repairs
Not optimal for strength
Begins as early as two days after injury and may last up to two months.

7. Tissue Healing Remodeling Phase
The weakened tissue produced during the repair phase is strengthened during the remodeling phase of healing.
Improved collagen alignment
Usually never as strong as before injury
Tissue remodeling can last up to two to four months after injury.

8. Rehabilitation and Reconditioning Strategies
Goals of Rehabilitation and Reconditioning
Choose a level of loading that neither overloads nor underloads healing tissue.
Healing tissue must never be overstressed.
But, controlled therapeutic stress is needed to optimize collagen matrix formation.
The athlete must meet specific objectives (established by the physician, athletic trainer, physical therapist, or a combination of these) to progress from one phase of healing to the next.

9. Loading During Rehabilitation
Figure 20.3 (next slide)
Loading during rehabilitation should neither overload nor underload the athlete’s healing tissue.

10. Figure 20.3

11. Soft Tissue Injury Response
Figure 20.4 (next slide)
Pain is often used as a guide for tissue health.
Pain levels often decrease well before tissue healing is complete, which may lead athletes to believe they can return to competition before the body is actually ready.

12. Figure 20.4

13. Rehabilitation and Reconditioning Strategies
Goals of Rehabilitation and Reconditioning
Inflammation 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
RICE: rest, ice, compression, elevation
Cooling to re-warming ratio of 1:2
Also ultrasound and electrical stimulation
Some passive movement of injured area if tolerable

14. Rehabilitation and Reconditioning Strategies
Goals of Rehabilitation and Reconditioning
Repair Phase
Treatment Goals
Preventing excessive muscle atrophy and joint deterioration in the injured area; maintaining muscular and cardiovascular function in uninjured areas
Avoid disruption of collagen mesh
Non-movement can cause adhesions in the collagen mesh
Exercise Strategies (after consultation with team physician, athletic trainer, or physical therapist)
Submaximal isometric exercise
Isokinetic exercise
Specific exercises to improve neuromuscular control

15. Rehabilitation and Reconditioning Strategies
Goals of Rehabilitation and Reconditioning
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
Apply progressive amounts of stress to injured area
Helps collagen align and grow
Exercise Strategies: progress from ones used in repair phase
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)

16. Return-to-Activity Phase
Return to normal activity should be based on therapist recommendations as well as testing
ROM- equal to contralateral limb desirable
Strength- at least 20% of contralateral limb
Functional capacity tests- assess functional limitations in injured limb as a whole
Several injury/sport specific rehab/return plans exists

17. Post-injury Programming
Examine the goals of rehab to determine if athlete has satisfied all of them
Ex. Back to a certain % of original strength or ROM
Determine program based on athlete’s needs for sport
Ex. Pulled hamstring in marathon runner vs. pulled hamstring in Olympic lifter
Keep open communication w/therapists

18. Rotator Cuff Rehabilitation
Figure 20.5 (next two slides)
Exercises generally transition from
(a, b) isolation exercises to
(c, d) multijoint, sport-specific exercises.

19. Figure 20.5a and b

20. Figure 20.5c and d

21. Closed Kinetic Chain
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.

22. Closed Kinetic Chain Exercises
Figure 20.6 (next slide)
Closed kinetic chain exercises:
(a) squat exercise
(b) push-up exercise

23. Figure 20.6

24. Open Kinetic Chain
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.

25. Open Kinetic Chain Exercise
Figure 20.7 (next slide)
Example of an open kinetic chain exercise—leg (knee) extension exercise

26. Figure 20.7

27. Kinetic Chain: Sprinting
Figure 20.8 (next slide)
Sprinting offers an example of open and closed kinetic chain movements occurring together.

28. Figure 20.8

29. 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.