Chapter 1: Essential Considerations in Designing a Rehabilitation Program for the Injured Athlete

1. Chapter 1: Essential Considerations in Designing a Rehabilitation Program for the Injured Athlete

2. The Rehabilitation Team • Group Effort • Athletic trainer • Athlete • Physician • Coaches • Strength and Conditioning specialists • Athlete’s family

3. Treatment philosophy • There must be an understanding tempered by flexibility • Variations occur athlete to athlete and physician to physician • Communication is critical on all levels • Trust and confidence involved in the working relationship must evolve • Goal directed approach • All parties must be involved in the rehabilitation process and must communicate effectively at every level of athletic participation

4. Philosophy of Sports Medicine Rehabilitation • Aggressive Rehabilitation • Competitive nature of athletics necessitates aggressive approach • Quick, safe, effective rehabilitation and return to play • Is the injury completely healed? • Pushing too hard or not hard enough may have negative impact on athlete’s return to play

5. Exercise Intensity • SAID principle – Specific Adaptations to Imposed Demands • Ability of the body to adapt to stress and overload imposed on it • Critical to consider during rehabilitation • Indications of having applied too much stress: • Pain, swelling, loss or plateau in strength or range of motion, increased laxity in healing ligaments • As healing progresses exercise intensity should increase

6. Understanding the Concept of the Kinetic Chain • The kinetic chain is an integrated functional unit • Each system works to provide structural and functional efficiency • Kinetic chain injury rarely involves one structure • Comprehensive rehabilitation must examine • Muscle imbalances • Myofascial adhesions • Altered arthrokinematics • Neuromuscular control • Goal is to restore optimal kinetic chain functioning • Modality use in rehab • Medication use in rehab • Conditioning in rehab

7. Understanding the Psychological Aspect of Rehabilitation • Critical factor that is often neglected and overlooked • Injury/illness produce a variety of emotional responses • Athlete’s vary on: • pain threshold • competitiveness cooperation • compliance • depression • Anger • Fear • guilt • The psychological aspect can also play an important role in performance enhancement

8. Establishing Goals • Short term goals • Provide immediate first aid and care • Reduce/minimize pain • Re-establish neuromuscular control • Restore full range of motion • What are some others??? • Long term goal = return to play • Goals should be reasonable and attainable • Integrate specific activities to achieve goals • Program should have progressive steps • Avoid exact time frames or dates • The athlete should be actively engaged in the rehabilitation process

9. Goals of rehabilitation • Control swelling and pain • It may interfere with the rehabilitation process • Pain will dictate the rate of progression • Neuromuscular control • Range of motion • Muscle or postural imbalances • Resistance of musculotendinous units • Restore strength • Important to return to pre-injury status • Full pain free range of motion emphasized • Needs to incorporate single and triplanar motions

10. Types of Exercises • Isometrics • Initial stage • Used when full range of motion is contraindicated • Increase strength, decrease atrophy, reduce edema • Progressive Resistive Exercise (PRE) • Uses free weights, machines, and tubing • Uses isotonic contractions • Isokinetic • Later stages • Fixed speed with accommodating resistance • Used as criteria to return to functional activity

11. Types of Exercise con… • Plyometric • Later stages • Quick bursts; Encourages dynamic movements • Core Stabilization • Essential for functional strength • Stabilizes kinetic chain • Allows distal segments to function optimally and efficiently

12. Open vs. Closed Kinetic Chain Exercises • Deals with the functional relationship in upper and lower extremities • Open kinetic chain = foot or hand operating in space • Closed kinetic chain = foot or hand are weight-bearing

13. Maintaining Cardiorespiratory Fitness • Most neglected aspect of rehabilitation • Cardiorespiratory fitness decreases rapidly during periods of inactivity • Alternative activities should be substituted to minimize the decrements in fitness levels

14. Functional Progression • Gradually progressive activities designed to prepare the athlete for return to play • Skill progression and reacquisition within limitation of injury and rehabilitation • Progression based on injury response • Functional progression will help injured athlete return to normal pain-free range of motion, strength and neuromuscular control

15. Functional Testing • Drills used to assess athletes ability to perform a specific activity • Commonly used tests • Agility runs • Sidestepping • Vertical jump • Hops for distance/time • Co-contraction test

16. Criteria for Full Recovery • What is complete recovery? • Restoration to normal function – all aspects • Determined by nature of injury and philosophy of physician and athletic trainer • Based on objective and subjective criteria • Strength testing and questionnaires • Functional tests • Physician has the final say in return to play

17. Physiological healing constraints Pain status Swelling Range of motion Strength Neuromuscular control Cardiorespiratory fitness Sports-specific demands Functional testing Prophylactic strapping and bracing Responsibility of athlete Predisposition to injury Psychological factors Athlete education and preventative maintenance Factors to Consider Prior to Return to Play

18. Documentation in Rehabilitation • Detailed records must be maintained • Injury evaluations • Treatment records • Progress notes • Lawsuits and malpractice • In clinical setting record keeping is critical for third-party billing • While time consuming it can not be neglected

19. Legal Considerations in Supervising a Rehabilitation Program • Educational backgrounds, licensure, and certification are controversial when considering patient care • Laws vary state to state with regard to an athletic trainers ability to conduct rehabilitation programs • Athletic trainers should be sure to operate within the limitations of their respective state laws