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Rehabilitation Rehabilitation TechniquesTechniques
Jenna Page, M.Ed., ATCJenna Page, M.Ed., ATC
November 2008November 2008
Objectives of RehabObjectives of Rehab
Prevent De-conditioningPrevent De-conditioning Rehabilitate the InjuryRehabilitate the Injury Work to prevent repetitive injuryWork to prevent repetitive injury
Principles of RehabPrinciples of Rehab
ATC IS ITATC IS IT A: Avoid AggravationA: Avoid Aggravation T: TimingT: Timing C: ComplianceC: Compliance I: IndividualizationI: Individualization S: Specific SequencingS: Specific Sequencing I: IntensityI: Intensity T: Total PatientT: Total Patient
Goals of RehabGoals of Rehab
These are the results one strives These are the results one strives to achieveto achieve
Goals need to objective and Goals need to objective and measurablemeasurable
Short-term and Long-term goals Short-term and Long-term goals should be setshould be set
Goals need to be realisticGoals need to be realistic
GoalsGoals
What is the ultimate goal of What is the ultimate goal of rehab?rehab?
What are objective/measurable What are objective/measurable goals?goals?
What do short-term goals allow What do short-term goals allow the patient to do?the patient to do?
Components of RehabComponents of Rehab
FlexibilityFlexibility ROMROM ProprioceptionProprioception CoordinationCoordination Core StabilityCore Stability Muscular StrengthMuscular Strength Muscular EnduranceMuscular Endurance Cardiovascular fitnessCardiovascular fitness Functional ExercisesFunctional Exercises
Phases of RehabPhases of Rehab
The phases of rehabilitation coincide The phases of rehabilitation coincide with the phases of healingwith 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 Phase II: Proliferation (Day 4 to Week
6)6) Phase III: Remodeling (Week 4 to 2-3 Phase III: Remodeling (Week 4 to 2-3
Years)Years)
Factors Affecting Factors Affecting HealingHealing1.1. ModalitiesModalities2.2. Proper MedicationProper Medication3.3. Surgical or Non-surgical Surgical or Non-surgical 4.4. AgeAge5.5. DiseaseDisease6.6. Size and Location of InjurySize and Location of Injury7.7. Possible InfectionPossible Infection8.8. NutritionNutrition9.9. SwellingSwelling10.10. Type of Tissue Type of Tissue
PrehabPrehab
Only when surgery is requiredOnly when surgery is required The setup for SUCCESS!The setup for SUCCESS! The stronger you are going into The stronger you are going into
surgery the easier the recovery.surgery the easier the recovery.
Phase IPhase I
GOALS of PHASE IGOALS of PHASE I Control Swelling and PainControl Swelling and Pain Limit Undue StressLimit Undue Stress Range of MotionRange of Motion Progress out of assistive device Progress out of assistive device
(crutches, boot, sling, etc)(crutches, boot, sling, etc)
Control SwellingControl Swelling
RICERICE By controlling swelling, pain is By controlling swelling, pain is
controlled as well.controlled as well.
Limit Undue StressLimit Undue Stress
Undue Stress – increases pain and Undue Stress – increases pain and impedes the healing process impedes the healing process causing more harmcausing more harm
Range of MotionRange of Motion
Early mobility is essential for Early mobility is essential for returning the injured part to full returning the injured part to full ROMROM
Follow the instructions given in Follow the instructions given in rehab protocol or specific surgeon rehab protocol or specific surgeon instructions instructions
What is going on now What is going on now
This is were scar tissue is laid downThis is were scar tissue is laid down Scar is not as strong as the original Scar is not as strong as the original
tissuetissue Tensile Strength = strength of the Tensile Strength = strength of the
tissuetissue Tensile strength is related to the Tensile strength is related to the
amount, type, and arrangement of amount, type, and arrangement of collagencollagen
What does this mean to What does this mean to the clinician?the clinician?
Collagen fibers are laid down originally Collagen fibers are laid down originally in an unorganized manner in an unorganized manner
The fibers can be organized with The fibers can be organized with exercise and stretchingexercise and stretching
If not straightened out this means a If not straightened out this means a mass of scar tissuemass of scar tissue
More Tensile Strength = less scar tissueMore Tensile Strength = less scar tissue Elasticity of scar tissue is much less than Elasticity of scar tissue is much less than
normal muscle and ligamentous tissuenormal muscle and ligamentous tissue
Goals of Phase IIGoals of Phase II
1.1. Strengthen the injured tissueStrengthen the injured tissue
2.2. Strengthen the surrounding tissuesStrengthen the surrounding tissues
3.3. Continue ROMContinue ROM• Remember the tissue is weak but Remember the tissue is weak but
improvingimproving• Important to work on stretching Important to work on stretching
muscle and tendon tissue to help muscle and tendon tissue to help align collagen fibers.align collagen fibers.
StrengtheningStrengthening
Progression:Progression:
1.1. IsotonicIsotonic
2.2. IsometricIsometric
3.3. IsokineticIsokinetic
4.4. PlyometricPlyometric Weight should be challenging but not Weight should be challenging but not
irritatingirritating How many repetitions and sets for How many repetitions and sets for
rehab exercises?rehab exercises?
What’s going on in the What’s going on in the healing process?healing process?
Phase III is called RemodelingPhase III is called Remodeling Tensile strength is continuing to Tensile strength is continuing to
increaseincrease As tensile strength continues to As tensile strength continues to
increase in the tissue the patient increase in the tissue the patient is able to increase the stress they is able to increase the stress they can apply to the tissue (usually can apply to the tissue (usually with exercise)with exercise)
Goals of Phase IIIGoals of Phase III
Building confidence in athlete’s abilityBuilding confidence in athlete’s ability Start with multi-functional rehabStart with multi-functional rehab Move onto Sport Specific RehabMove onto Sport Specific Rehab Complete Functional RehabComplete Functional Rehab End of this Phase = Return to PlayEnd of this Phase = Return to Play How do you know when athlete is How do you know when athlete is
ready to return to play and when to ready to return to play and when to stop coming in for rehab?stop coming in for rehab?
How aggressive can you How aggressive can you be?be?
If your rehab program is too If your rehab program is too aggressive then athlete may aggressive then athlete may experience:experience:– ↑ ↑ painpain– ↑ ↑ swellingswelling– ↓ ↓ performanceperformance– Inability to progressInability to progress
If there is Sx of further injury, then If there is Sx of further injury, then play it safe and be cautiousplay it safe and be cautious