Therapeutic Exercises

Therapeutic Exercises Chapter 7

Therapeutic Exercises • Goal is to return injured athlete to pain-free full function participation. • Areas of Focus: • Pain Modulation Muscular Strength • Normal ROM Endurance • Kinematics Coordination • Flexibility Power

Rehabilitation Areas • Psychological • Physical • Emotional • Social • Performance

Personal Factors Performance Anxiety Self-esteem/motivation Extroversion/ Introversion Psychological Investment Coping resources History with stress Previous intervention Cognitive Responses Outcome of the Situational Factors Type of Sport Relationship with coach and team Timing of the injury Level and intensity of the player Point in athletes career Role on the team Emotional Responses Behavioral Responses Rehabilitation Cognitive Model

Kubler-Ross Emotional Stages • Denial • Isolation • Anger • Bargaining • Depression • Acceptance

Specific and measurable Positive rather than negative Challenging yet realistic Established time table for completion Integration of short- intermediate- and long term goals Personalized and internalized Monitored and evaluated LINKED TO LIFE GOALS!!! Goal Setting

Factors that Inhibit Progress • Lack of Knowledge • Lack of Skill • Lack of Risk-Taking Ability • Lack of Social Support

Psychological Influences • Confidence • Motivation • Anxiety • Focus • Management of Pain

Confidence • Program Confidence • Adherence Confidence • Physical Confidence • Return-to-sport Confidence

Poor Attendance Incomplete Exercises Low Effort Low Intensity Lack of Attentiveness to Instructions Undefined Goals Using Pain to Avoid Exercise Unsupportable Excuses Motivation

Anxiety • Caused by pain, slow healing, low confidence, pressure, lack of familiarity, predictability, and control • Signs: • Physical • Cognitive • Emotional • Social • Performance

Focus • Ability to perceive and address various internal and external cues. • Athlete should focus on: • Positive attributes • Present time • The Process of their rehabilitation • Their individual Progress

Pain • Benign pain • Harmful pain • Use a variety of methods to deal with pain.

The Rehabilitation ProcessPhase I • Assess the Patient • Interpret the Assessment • Establish Goals • Develop and Supervise the Treatment Plan • Reassess the Progress of the Program

Inflammation Control • CRIPES • ROM • Cardiovascular Fitness • Affects on: • Muscle • Articular cartilage • Ligaments • Bone

RemobilizationPhase II • Wolff’s Law • Affects on: • Muscle • Articular Cartilage • Ligaments • Bone

Restoration of Motion • Cryokinetics • PROM • AROM • Joint Mobilization • Grade I • Grade II • Grade III • Grade IV • Grade V

Flexibility • Agonist • Antagonist • Ballistic Stretching • Static Stretching • Proprioceptive Neuromuscular Facilitation (PNF) • Active Inhibition • Contract-Relax • Reciprocal Inhibition

Muscle/Movement Re-education • AAROM • AROM • RROM • Proprioception • Closed kinetic chain exercises (CKC) • Open kinetic chain exercises (OKC)

Muscular Strength, Endurance and PowerPhase III • Muscular Strength • Isotonic • Isokinetic • Muscular Endurance • Muscular Power • Functional Exercise

Rehabilitation Guidelines • Intensity • Duration • Frequency • Specificity • Speed • Progression

Sport Specific FunctioningPhase IV • Coordination • Sport Specific Skill Conditioning • Cardiovascular Endurance

Therapeutic Exercises