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Therapeutic exercises and modalitiesLecture 20
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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
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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
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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
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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
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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
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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
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Isokinetic contraction accommodating resistance muscular overload and angular movement
to rotate a lever arm at a controlled velocity
Cybex, Kin Con
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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
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multiple joints are exercised through weight bearing
velocity and torque are more controlled shear forces are reduced proprioceptors better trained eg. squats
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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
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Therapeutic Modalities
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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
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Categories of Modalities
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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
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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
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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
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15-26
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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
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depth of penetration is generally 2 cm - warm whirlpools, hot pack , hot rubs , ultrasound
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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
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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
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15-14
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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
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15-15
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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
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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
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