Essential Considerations in Designing a rehabilitation Program for the Injured Patient

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Essential Considerations in Designing a rehabilitation Program for the Injured Patient. William E. Prentice Rehabilitation Techniques for Sports Medicine and Athletic Training. Introduction. Majority of injuries in athletics are non-life threatening - PowerPoint PPT Presentation

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Essential Considerations in Designing a rehabilitation Program for the Injured Patient

Essential Considerations in Designing a rehabilitation Program for the Injured PatientWilliam E. PrenticeRehabilitation Techniques for Sports Medicine and Athletic TrainingIntroductionMajority of injuries in athletics are non-life threateningWill require treatment and rehabilitation for a timely, but safe return to activityAthletic Trainer will assume primary responsibility for the design, implementation and supervision of the rehab. programMust have as complete understanding of the injury as possibleKnowledge of mechanism of injuryMajor anatomical structures affectedDegree or grade of traumaStage or phase of injurys tissue healing

Rehabilitation TeamRehabilitation in athletic setting requires a group effort to be most effectiveAthletic Trainer and A.T. studentsTeam PhysicianCoachAthlete and athletes familyStrength and conditioning coachOther specialistA.T. will direct athlete and facilitate communicationRehabilitation TeamA.T. is the one individual who will deal directly with the patient/athlete throughout the entire period of rehabilitationFrom time of injury to return to unrestricted return to activityA.T. works closely with and under direct supervision of team physicianDevelop and design rehabilitation and reconditioning protocolsAppropriate therapeutic exercise, rehab. Equipment, manual therapy techniques, and therapeutic modalitiesRehabilitation TeamCommunicationAthlete must always be informed and made aware of the why, when and how factors of their rehab. programRelationship takes time to developMust build trust and rapport with athletesMust involve coach in discussions of athletes progression and athletes return to activityCan help determine what and athlete can and cant do during practice.Failure to communicate may cause misunderstanding between those involved and possibly exacerbating the athletes injury or symptomsPhilosophy of Sports Medicine RehabilitationApproach in athletic setting is considerably different than in most other rehab. settingsCompetitive nature of athletics necessitates an aggressive approach to rehabilitationCompetitive season is relatively short and athlete does not have the luxury of timeGoal is to return the athlete to activity as soon and as safely as possibleA.T. tends to play games with healing process and return athletes before complete healing has occurredBalancing act between not pushing athlete enough and being too aggressiveMistake in judgment may hinder the athletes return to activityUnderstanding healing processProgression of rehab program must be based on the process of injury/tissue healing

A.T. Must have a sound understanding of the different phases of tissue healing and apply appropriate treatment/rehab

Failure to do so may interfere with tissue healing and increase the length of time required for rehabilitation, thus slowing the athletes return to activity

Little can be done to speed the healing process physiologically, but many things can be done to impede healingUnderstanding healing processExercise intensitySAID Principle: Specific Adaptations to Imposed DemandsWhen an injured structure is subjected to stresses and overloads of varying intensities, it will gradually adapt over time to whatever demands are placed on it

Exercises must not be too great that they will exacerbate the injury before it has had time to adapt

Exercise that is too intense can be detrimental to the rehab programIndications include an increase in swelling, pain, loss or plateau in strength and range of motion.Understanding healing processExercise intensity must be commensurate with tissue healing

Submaximal exercise in short bouts initially, several times a dayAs recovery increases, the intensity of exercise increasesUnderstanding Psychological Aspects of RehabilitationPsychological aspects of how athlete deals with injury are critical and often neglected factor

Wide range of emotional reactions

A.T. needs to develop an understanding of the psyche of each individual and adjust rehab accordinglyPain threshold, cooperation and compliance, competitiveness, denial, intrinsic and extrinsic motivation, anger, fear, guilt and ability to adjust to injury are all factors

Sports psychology can also be used to improve total athletic performanceUnderstanding the Pathomechanics of InjuryWhen joint or anatomical structures are injured, normal biomechanical function is compromised

A.T. must have solid foundation in biomechanics and human anatomy to design effective rehab program

Must be able to identify and correct postural and biomechanical dysfunctions in order to appropriately design rehab planUnderstanding the Concept of the Kinetic ChainEntire body is a kinetic chain that operates as an integrated functional unitComposed of muscular systems (muscles, tendons, fascia), articular systems and neural systemsAll systems function simultaneously with the others for structural and functional efficiencyCNS sorts info. from these systems for neuromuscular control.If any system in kinetic chain is not working effectively, other systems are forced to adapt and compensateCan lead to tissue overload, decreased performance, and predictable patterns of injuryUnderstanding the Concept of the Kinetic ChainMovements in everyday activity require dynamic and postural control through multiple planes of motion and different speeds of motionRehabilitation should focus on functional movements that integrate all components necessary to achieve optimal movement performanceConcepts of muscle imbalances, myofascial adhesions, altered arthrokinematics, and abnormal neuromuscular control need to be addressedUnderstanding the Concept of Integrated Functional MovementFunction: Integrated, multiplanar movement that requires acceleration, deceleration and stabilizationRehab. must address all links of the kinetic chain to develop functional strength and neuromuscular efficiencyFunctional Strength: ability of neuromuscular system to reduce force, produce force, and dynamically stabilize the kinetic chain during functional movement in a smooth coordinated fashionUnderstanding the Concept of Integrated Functional MovementNeuromuscular Efficiency: ability of CNS to allow agonist, antagonist, synergist, stabilizers and neutralizers to work efficiently and interdependently during dynamic kinetic chain movementsRehab may begin with isolated strengthening in single planes of motion, but progress to multi-plane functional movement that mimic sport activityUsing Tools of RehabilitationTool BeltA.T. have many tools in their tool beltManual therapy techniquesTherapeutic modalitiesAquatic TherapyPhysician prescribed medicationsTherapeutic ExerciseHow A.T. utilizes tools is often a matter of individual preference and experiencePatients differ in their responses to various treatment techniquesA.T. should avoid cookbook" rehabilitation protocolsA.T. should develop broad theoretical knowledge from which specific techniques can be selected and practically applied to each individual caseUsing Tools of RehabilitationTherapeutic Modalities

Useful tools in injury rehabilitationWhen used appropriately can greatly enhance the patients chance for safe and rapid return to full activityA.T. should have knowledge of scientific basis of various modalities and their physiological effects.Therapeutic Exercise however, is more critical than the use of modalities

Using Tools of RehabilitationTherapeutic Exercise:

Exercises that force the injured anatomical structure to perform its normal functionKey to successful rehabilitationAROM, PROM, RROM and functional exercisesUsing Tools of RehabilitationMedications to facilitate Healing

Prescription and over the counter (OTC) medications can effectively aid the healing process during rehabilitation

A.T. must have some knowledge of the effects of medications and make decisions on appropriate use with guidance from team physicianEstablishing Short and Long Term GoalsShort Term GoalsProvide correct immediate care and management following injury to limit or control swellingReduce or minimize painEstablishing core stabilityRe-establishing neuromuscular controlImproving postural stability and balanceRestoring full range of motionRestoring or increasing muscular strength, endurance and powerMaintaining cardiorespiratory fitnessIncorporating functional progressions

Establishing Short and Long Term GoalsLong Term GoalsTo return to athlete to practice or competition as quickly and as safely as possible

Establishing reasonable and attainable goals and integrating specific exercises or activities to address these goals is critical to rehab. plan.

Can be difficult knowing when and how to progress, change, or alter rehab program to most effectively accomplish short and long term goalEstablishing Short and Long Term GoalsImportant not to give exact time frame or date

May discourage athlete if time frame not met

Set series of progressions or successes to keep athlete motivated

Keep athlete involved in goal setting and planning the processes of their rehab plan.Importance of Controlling SwellingInitial first aid and management techniques may be the most critical part of any rehab programHas significant impact on the course of the rehabilitation processOne major factor is the presence of swellingSwelling caused by bleeding, production of synovial fluid, accumulation of inflammatory by-products, edema or combination of these factorsProduces increased pressure that causes increased painCan also cause neuromuscular inhibition, thus weak muscular contractionsUsually occurs in first 72 hours after injuryImportance of Controlling SwellingIf swelling can be controlled initially in acute stage of injury, the time required for rehab is likely to be significantl

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