Functional Progressions and Functional Testing in

Rehabilitation

Rehabilitation Techniques for Sports Medicine and Athletic Training

William E. Prentice

IntroductionTo reduce lasting effects of injury, athletic trainer

should direct rehabilitation toward improving neuromuscular coordination and agility as well as strength and enduranceReturn athlete to pre-injury activity levels

Function refers to patterns of motion that use multiple joints acting with various axes and multiple planes

Focus on functional rehabilitation will ready patient for activity and competition

Role of Functional Progressions in Rehabilitation

A.T. must adapt rehabilitation to the sports specific demands of each individual sport and position

Functional ProgressionSuccession of activities that simulate actual motor

and sport skillsEnable patient to acquire or reacquire skills needed

to perform athletic endeavors safely and effectivelyPlaces stresses and forces on each body system in a

well-planned positive and progression fashionImproves patients overall ability to meet the demands

of daily activities as well as sport competition

Role of Functional Role of Functional Progressions in Rehabilitation

A.T. breaks down activities involved in a given sport into individual componentsPatient concentrates on components in a

controlled environment before combining them together in an uncontrolled environment

Essential in the rehabilitation processTissues not placed under performance level

stresses do not adapt to the sudden return of such stresses when full activity is resumed

Benefits of using Functional Progressions

Assist patient and A.T. in reaching the goals of the entire programRestoration of joint ROMStrengthProprioceptionAgilityConfidence

Allow patient to reach desired level of activity safely and effectively

Physical Benefits Improving functional stability

Maintained by neuromuscular control mechanisms involved in proprioception and kinesthesia

Performance during functional task can be evaluated and corrected Functional testing can be used to provide objective measure of ability

Muscle strength Muscles involved will be strengthened dynamically under stresses

similar to those encountered in competition Using SAID and Overload Principles

Endurance Muscular and cardiorespirtaory endurance can be enhanced with

functional progressions Through repetition of of individual activities and their combination into

one general activity

Physical Benefits Flexibility

Injured area stressed within a controlled range during functional progression

Improved mobility and flexibility crucial to patient return to activity

Strength and endurance do not mean much if injured area cannot move through normal ROM

Muscle relaxation Functional progression can teach an individual to

recognize muscle tension and eventually control or remove it by relaxing muscles after exerciseRelieve muscle guarding that may inhibit normal ROM

Physical Benefits

Motor SkillsCoordination, agility and motor skills are complex

aspects of normal functionNeeded to transform strength, flexibility and

endurance into full-speed performanceRepetition and practice are are important to

learning motor skillsRehabilitation exercises must stress

neuromuscular coordination and agility to increase performance and decrease chance of reinjuryDevelop automatic reactions needed during activity

Psychological BenefitsFunctional progression can help reduce common

emotions found after injuryAnxiety

Athlete gradually placed into more demanding situations.Experience success and not be as concerned with failure

DeprivationAthlete can engage in activity during practice to remain close

in proximity and socially feel little loss in team cohesionApprehension

Enable patient to adapt to imposed demands of their sport in a controlled environment

Restore confidence

Components of a functional progression

Four principles Individuality of the patient, sport and the injuryActivities should be positive not negative; no

increase in signs or symptomsOrderly progressive programProgram should be varied to avoid monotony

Vary exercise techniquesAlter the program at regular intervalsMaintain fitness baseSet achievable goals , reevaluate, and modify regularlyUse clinical, home and on field programs

Use sport specific activities to enhance patients return to activity

Designing a Functional Progression

No cookbook, be creative and specific to athletes goals and injury status

Progressions should start early in rehabStart with low impact and progress to high impact

Assess athlete periodically to determine ability to progress to next exercise

Achieving a certain skill level occurs when a the skill can be completed at functional speed with high repetition without increase in pain, swelling or a decrease in ROM

Functional TestingPatient performs certain tasks appropriate to their

stage in rehab Isolate specific deficits

A.T. able to determine current functional level and set functional goals

Indirect measure of muscular strength and power

Uses maximal performance of an activity

Provide A.T. with objective data

Functional TestingThree purposes

Determine risk of injury due to limb asymmetry

Provide objective measure of progress during rehab plan

Measure the ability of the individual to tolerate forces

Functional TestingA.T. must evaluate what test will be used

Validity : test should measure what it intends to measure

Reliability: Test should consistently provide similar results regardless of evaluator

Observe unilateral and bilateral function to determine compensation patterns

A.T. should also consider stage of healing, strength, patients ability and physician approval

Functional TestingPreseason baseline measurements are preferred

so A.T. has data to compare post injury activity levels

Not always obtained by A.T., however individual sports may do baseline testing

With or without baseline measurements a score of 85% or better compared to noninjured side is recognized as standard for limb symmetry scores

Functional TestingUses functional progression drills for the purpose of

assessing the athlete’s ability to perform a specific activity

Entails a single maximal effort to gauge how close the athlete is to full return

Pre-season baseline testing for comparison post injuryVariety of tests

Shuttle runs -Vertical jumpsAgility runs -BalanceFigure 8’s -Hopping for distanceCarioca tests -Co-contraction test

Lower Extremity Functional Progression

Walking: Normal Gait

Walking: Heels walks

Walking: Toe walks

Side step/Shuffle

Lunge 90° to Lunge 180°

Step ups forward to lateral step ups Increase speeds

JoggingBegin straight ahead, gradually increase intensity 50%-

100% Introduce curves: Oval,“S” course, figure “8” course, “Z”

course

SprintStraight ahead varying intensitiesAdd acceleration/deceleration drills

Box Runs

Carioca

Hopping:Double Leg to Single Leg to Alternate

Jumping:Plyometrics

Progress intensitiesSport specific

Speed and Agility drills:Sport specificLadder drillsCutting, jumping on command

Position specific activities

Upper Extremity Functional Progression

Assisted PNF techniques

T-band exercises simulating specific sport/position motionsStrength and endurance

Closed chain exercises: Push up progression

Upper Body Plyometrics

Interval throwing programFocus on mechanics and biomechanical dysfunctionsBegin with general warm upStep 1: 45 ft. phase

Warm up throwing25 throwsRest 10 minutesWarm up throwing25 throws

Step 2: 45 ft. phaseWarm up throwing’25 throws15 minute restWarm up throwing25 throwsRest 10 minutesWarm up throwing25 throws

Repeat steps 1 & 2 for 60, 90, 120, 150, 180 ft.Only progress if pain free and no signs or symptoms

developWhen program completed move to position specific

throwingFor example: pitcher throw off mound

Designing a Functional Progression

Full Return to PlayPhysicians releasePain freeNo SwellingNormal ROMNormal strength (in reference to contralateral

limb)Appropriate functional testing completed with no

adverse reactions