Principles of Rehabilitation.pptx

This presentation simplifies the various principles specific to sports rehabilitation in an attempt to make them concise and easy to understand.

1. PRINCIPLES OF REHABILITATION APOORVA BALODHI 06211202616

2. By definition, rehabilitation is the ‘restoration to a former capacity or standing, or to rank, rights, and privileges lost or forfeited’. It enables a athlete to return to sport with full function in the shortest time period possible.

3. WHAT MAKES A REHABILITATION PROGRAM SUCCESSFUL? Explain the program to the patient Provide a precise prescription Use the facilities available to the utmost Begin rehabilitation early

4. COMPONENTS OF A REHABILITATION PROGRAM Muscle conditioning Flexibility Neuromuscular control Functional exercises Sport skills Correction of abnormal biomechanics Maintenance of cardiovascular fitness P sychology

5. Progression of treatment

6. RESPONSE OF SOFT TISSUE TO INJURY

7. PARAMETERS FOR PROGRESSION OF REHABILITATION Type of activity Duration of activity Frequency of activity/Rest Intensity of activity Complexity of activity

8. STAGES OF REHABILITATION The rehabilitation process is divided into four stages each comprising of three subcategories: modalities, exercises, and cardiorespiratory maintenance. Progression is made based on the athlete’s level of function. The four stages are: Initial Stage Intermediate Stage Advanced Stage Return to Sport

9. STAGE 1: INITIAL STAGE (poor functional level) It is marked from the time of injury to the point of pain-free range of motion. It is also called the immobilization phase . This stage corresponds to the acute phase of tissue healing.

10. GOALS: Reduce pain Improve soft tissue extensibility Improve joint ROM Minimize inflammation Increase muscle strength Maintain cardiorespiratory capacity Improve endurance Improve stability Motor re-education Improve proprioception and balance *The healing of the injured tissue should not be hampered or symptoms worsened. Avoid excessive force on the injured area.

11. Gentle, pain-free ROM (active and passive) exercises SHOULDER ACTIVE ROM EXERCISE SHOULDER PASSIVE ROM EXERCISE

12. Gentle passive mobilization for pain relief and to improve mobility SHOULDER MOBILIZATION

13. Muscle conditioning-initially isolated movements are performed followed by more functional movements Muscle activation Maximal isometric exercises Multiple angle exercises Short arc exercises *Light weights may be introduced.

14. Agility type exercises SIDE STEPPING GRAPEVINE STEPPING

15. Proprioception and balance exercises (as tolerated) SIMPLE STANDING STANDING ON WOBBLE BOARD

16. Stationary bicycle, upper limb ergometer or other to maintain cardiorespiratory capacity STATIONARY BICYCLE UPPER LIMB ERGOMETER

17. Heat (to relieve muscle tightness), ice (to reduce pain and swelling) a nd other electrotherapeutic modalities before or after exercise

18. STAGE 2: INTERMEDIATE STAGE ( g ood functional level) This stage is entered when the athlete gains good ROM and reasonable strength. It corresponds to the repair/proliferation phase of tissue repair.

19. GOALS: Functional rehabilitation Improve soft tissue extensibility Improve joint ROM Increase muscle strength Maintain cardiorespiratory capacity Improve endurance Improve stability Improve proprioception and balance *Progressions to all of the above are introduced.

20. Flexibility exercises for injured part, adjacent areas, or any other tight structure PASSIVE HAMSTRINGS STRETCHING

21. Joint mobilization exercises for restricted ROM Massage therapy Electrotherapeutic modalities Active (by patient) and passive (by therapist) ROM exercises

22. *Progressed according to general principle of overload. Increased resistance and number of repetitions to increase strength and increase in volume of work to increase endurance. Strengthening exercises (isotonic and isokinetic exercises introduced) ISOTONIC EXERCISE ISOKINETIC EXERCISE

23. Closed kinetic chain exercises SQUAT LEG PRESS STAIR CLIMBING

24. Functional exercises (prepare for return to sport) JOGGING WALKING

25. Balance and proprioception exercises SKIPPING HOPPING

26. STAGE 3: ADVANCED STAGE ( g ood functional level) The athlete enters this stage when he/she has good strength and endurance, flexibility, ROM, can tolerate a reasonable volume of work, and the cardiovascular fitness is maintained. The athlete should be able to perform exercises without adverse effects. This stage corresponds to the remodelling /maturation phase of healing.

27. GOALS: Increase strength Enhance power Progressive functional rehabilitation Re-learning of correct technique (correction of biomechanics) Improve soft tissue extensibility Maintain cardiorespiratory capacity Improve endurance Improve stability Improve proprioception and balance Restore athlete’s confidence *Progressions to all of the above are introduced.

28. Muscle conditioning specific to required activity (example: CKC exercises for weight lifters) Progress strength enhancement with high load and low repetition, and maintain endurance with low load, high repetition. This is decided based on athlete’s sport of participation.

29. Enhance power with high speed isotonic and plyometric exercises JUMPS DEPTH JUMPS BOUNDING

30. Functional activities, initially in isolation and then in a more realistic sports environment (progress to team drills)

31. Advanced balance and proprioception exercises specific to sport

32. STAGE 4: RETURN TO SPORT ( g ood functional level) WHEN CAN THE ATHLETE RETURN TO SPORT? Tissue healing complete Pain-free full ROM No swelling Adequate strength and endurance Good flexibility Good balance and proprioception Adequate cardiovascular fitness Skills regained No biomechanical abnormality Athlete psychologically ready Coach satisfied with training form

33. CONTRAINDICATIONS TO RETURN TO SPORT Recurrent swelling Joint instability Loss of joint ROM Lack of full muscle strength *The rehabilitation does not stop after return to sport.

34. REGULAR ASSESSMENT AND MONITORING

35. REFERENCES Bomgardner Rich. Rehabilitation Phases and Program Design for the Injured Athlete. Strength and Conditioning Journal. Vol 23, Number 6, Pages 24-25. December 2001 Brukner and Khan. Clinical Sports Medicine, 3E, McGraw-Hill Professional. Chapter 12: Principles of Rehabilitation, Pages 174-196