Sports InjuriesSports Injuries

RehabilitationRehabilitation

A Progressive Model for A Progressive Model for RehabilitationRehabilitation

Adapted, by permission, from J. Hertel and C.R. Denegar, 1998, “A rehabilitation paradigm for Adapted, by permission, from J. Hertel and C.R. Denegar, 1998, “A rehabilitation paradigm for restoring neuromuscular control following athletic injury,” restoring neuromuscular control following athletic injury,” Athletic Therapy Today Athletic Therapy Today 3 (5): 13-14.3 (5): 13-14.

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Immediate TreatmentImmediate Treatment

The more immediate the treatment the The more immediate the treatment the better the outcome and the shorter the better the outcome and the shorter the recovery timerecovery time

Unfortunately many performers delay Unfortunately many performers delay seeking medical advice and continue to seeking medical advice and continue to train with an injurytrain with an injury

This then exacerbates the situation and This then exacerbates the situation and lengthens recovery timelengthens recovery time

RehabilitationRehabilitation

Used to return a performer Used to return a performer to their pre- injury fitnessto their pre- injury fitness

Time varies with injury typeTime varies with injury type

It usually comprises of 5 It usually comprises of 5 phases phases

Focusing on a progressive Focusing on a progressive approachapproach

RehabilitationRehabilitation

Phase 1Phase 1

Phase 2Phase 2

Phase 3 Phase 3

Phase 4Phase 4

Phase 5Phase 5

Medical management with the focus placed on pain relief, swelling reduction and protected mobilisation

Focus on restoring range of motion, non-weight bearing exercises

Flexibility and restoration of strength. Initially starts with isometric exercises, then isotonic with no load then onto proprioceptive exercises

Retain sport specific movement patterns and improve co-ordination and agility

Return to sport specific training

RehabilitationRehabilitation

Phase 1Phase 1

Phase 2Phase 2

Phase 3 Phase 3

Phase 4Phase 4

Phase 5Phase 5

Prevent swelling, Protect, Control bleeding, Relieve pain

Cold compression, elevation and rest

Control bleeding, Relieve pain, protect, Advise

PRICED

Absorbtion of swelling, removal of debris, growth of new vessels, development of scar tissue

Contrast bathing, elevation, massage, passive exercises

No swelling, No inflammation, some ROM, ability to undertake weight bearing

ROM, mobilisation and strength exercises, supports

Improve balance, coordination, skills and movement

TaskTask

Draw a diagram highlighting the 5 different Draw a diagram highlighting the 5 different phases showing the progression between phases showing the progression between each stage.each stage.

Include exercises you think would be Include exercises you think would be beneficial at each stage for a chosen injurybeneficial at each stage for a chosen injury

Hierarchy of Rehabilitation GoalsHierarchy of Rehabilitation Goals

Adapted, by permission, from J. Hertel and C.R. Denegar, 1998, “A rehabilitation paradigm for Adapted, by permission, from J. Hertel and C.R. Denegar, 1998, “A rehabilitation paradigm for restoring neuromuscular control following athletic injury,” restoring neuromuscular control following athletic injury,” Athletic Therapy Today Athletic Therapy Today 3 (5): 13–14.3 (5): 13–14.

RehabilitationRehabilitation

Patterns of motion that use multiple joints Patterns of motion that use multiple joints acting with various axes & in multiple acting with various axes & in multiple planesplanes– Essential part of rehab that places tissues Essential part of rehab that places tissues

under stresses that return tissues to levels of under stresses that return tissues to levels of full activityfull activity

– Places stresses & forces on each body systemPlaces stresses & forces on each body system

Traditional rehab techniques often stress Traditional rehab techniques often stress only single joints in single planes of motiononly single joints in single planes of motion

ProgressionProgressionFunctional progression = succession of Functional progression = succession of activities that simulate actual motor & sport activities that simulate actual motor & sport skillsskills– Enables the patient to acquire or reacquire the Enables the patient to acquire or reacquire the

skills needed to perform activityskills needed to perform activity– Must be able to adapt rehab to the sport-Must be able to adapt rehab to the sport-

specific demands & specific positionspecific demands & specific position

The clinician breaks down the activities into The clinician breaks down the activities into individual components.individual components.– The patient can focus on each specific part of The patient can focus on each specific part of

an activity.an activity.

Benefits for Using Functional Benefits for Using Functional ProgressionProgression

Helps patient reach goals of entire programHelps patient reach goals of entire program

Goals of functional progression:Goals of functional progression:– Restoration of joint ROMRestoration of joint ROM– Restoration of strengthRestoration of strength– Restoration of proprioceptionRestoration of proprioception– Restoration of agilityRestoration of agility– Restoration of confidenceRestoration of confidence

Provides both physiological & psychological Provides both physiological & psychological benefits to the patientbenefits to the patient

Full ReturnFull ReturnDecision requires full evaluation of athlete’s Decision requires full evaluation of athlete’s conditioncondition– Objective observation and subjective evaluationObjective observation and subjective evaluation

Athlete should feel readyAthlete should feel ready physically and physically and mentallymentallyControlled return Controlled return – Added stress to injury can slow healing and result long Added stress to injury can slow healing and result long

and painful recovery or re-injuryand painful recovery or re-injury

CriteriaCriteria– Physician’s releasePhysician’s release– Pain free, no swellingPain free, no swelling– Normal ROM, strengthNormal ROM, strength– Completion of functional testing minus adverse effectsCompletion of functional testing minus adverse effects