SPORTS REHABILITATIONmatthew rex acosta madayag, md

physiatrist

SPORTS REHABILITATION

- multi-disciplinary approach to treat injuries

sustained through sports participation so the

athlete can regain normal pain-free mobility

- Primary goal: return to pre-injury activities

• Phase I: Resolving pain and inflammation

• Phase II: Restoring range of motion

• Phase III: Strengthening

• Phase IV: Proprioceptive training

• Phase V: Sports/task specific activities

Phases of Sports Rehabilitation

• Control the inflammatory reaction

1. P – protection

2. R – rest

3. I – ice

4. C – compression

5. E- elevation

Phase I: Resolving pain and

inflammation

• Protection

– Splinting

– Bracing

– Taping/wrapping

• Rest

– Relative rest

• Affected area is rested, the remainder of the body is exercised

Phase I: Resolving pain and

inflammation

• Ice

– Control the initial inflammatory

response

– Facilitates pain control

– 20 minutes 4 to 5 times/day

• Compression

– Limit the edema

– Ice wrapping

– Compressive stockinette

Phase I: Resolving pain and

inflammation

• Elevation

– Control post injury swelling

– Above the level of the heart to optimally assist

with venous and lymphatic drainage

• NSAIDs and TENS can assist with both

inflammation and pain control

Phase I: Resolving pain and

inflammation

• ROM allows for controlled stress which will

stimulate proper collagen deposition.

• Pain free movement of a joint and stretching is

encouraged to prevent contracture.

Phase II: Restoring range of motion

• Early post-injury phase isometric

contractions

– 10 seconds contraction; 10 reps; 10x/day

• ROM recovers isotonic strengthening

• Resistance training

– Against gravity

– Weights

– Resistance tubing

Phase III: Strengthening

• Dynamic motor control

• Simple proprioceptive training

– Seated exercises with wobble board for LE injuries

– Loading exercises of the arm

Phase IV: Proprioceptive training

• Occurs as the athlete successfully meets the

challenges of the previous phases

Phase V: Sports/task specific activities

ACUTE phase: PRICE, TENS, protected ROM, static and closed kinetic chain exercises (isometrics), general conditioning ex, NSAIDs

RECOVERY phase: USD, TENS, HMP, AROM, PNF, dynamic strengthening, sports specific ex

FUNCTIONAL phase: plyometric exercise, flexibility strengthening, power and endurance, sport specific progression ex, return to sports

REHABILITATION OF INJURED ATHLETES:

SPORTS REHABILITATION

Most common sports injuries – SPRAINS and

STRAINS

SPRAIN- injury to the ligaments caused by

overstretching or tearing

STRAIN- injury or tear to the muscle and/or

tendon

Cervical Spine Injuries In Sports

• Results when the accelerating head

& neck strike a stationary object

• Associated with axial loading of

flexed cervical spine

• Burner or ‘stinger’- a transient

neurologic event characterized by

pain and paresthesia in a single upper

limb following a blow to the neck or shoulder

Cervical Spine Injuries In Sports

• May result from strain,

sprain or tetraplegia (SCI)

• Cervical Disc

- Most common: C5-C6

–Acute disc herniation

- Special tests:

Spurlings test : radiculopathy

Shoulder abduction test: relief

Cervical Spine Injuries In Sports

Treatment:

in acute injuries- immobilization (protection)

in severe cases: X-ray cervical spine

in recovery phase: modalities

stretching

Calliet neck ex

Cervical Spine Injuries In Sports

Rotator Cuff Injury= overuse syndrome

- baseball, tennis, swimming, etc...

- LOM, ms weakness, pain,

clicking sound

- if with tears,supraspinatus ms

- morphology of acromion in

relation to rotator cuff tear

- type 1= flat

- type 2= curved

- type 3= hooked

Shoulder

• Shoulder Impingement syndrome:

- most common cause of shoulder pain

- subacromial space narrowing causing

compression and inflammation on subacromial

bursa, biceps tendon and SITS ms

Shoulder

• Special tests for impingement syndrome

- Neer’s impingement sign- passively flex the

arm > 90 degrees, if with pain, supraspinatus

tendon is compressed between acromion and

greater tuberosity

- Hawkin’s sign- same as above but with IR of

shoulder. Supraspinatus tendon is compressed

against the coracoacromial jt

- painful arc syndrome- arm pain in abduction

60-120 degrees

Shoulder

• Special tests for rotator cuff tears

Drop arm test- passively abduct shoulder with

IR. Pt unable to maintain abduction due to

complete tear of rotator cuff. (deltoids will

initially hold abduction but fails eventually)

Shoulder

Shoulder Dislocation

Anterior dislocation:

excessive ER and

abduction

Posterior dislocation:

fall on the forward

flexed and adducted

arm

Shoulder

• Rehabilitation

– Pain control and inflammation reduction

– Restoration of motion: but limit movements that

would increase the chances of dislocation

– Strengthening

– Proprioceptive training

– Return to task

– in case of recurrent shoulder dislocation: refer to

orthopedic surgeon for closed reduction or

possible surgery

Shoulder

• Tendinitis

– Lateral epicondylitis: tennis elbow

• Extensor carpi radialis brevis and Extensor

digitorum communis

• Pain is 1-2 cm distal to the lateral epicondyle

• Pain with resisted extension (Cozen’s test)

• Mgt= ice, rest, PT, counterforce brace

Elbow

– Medial epicondylitis: golfer’s elbow/ little

leaguer’s elbow in children

• Inflammation of the common flexor tendon’s origin

Elbow

• Wrist fractures

– Scaphoid-Most commonly fractured carpal bones

– Lunate- most commonly dislocated carpal bone

– Distal radius fracture

Wrist and Hand

• Ligamentous Injuries of the thumb

– Gamekeeper’s thumb

• Ulnar collateral ligament of CMC jt

• Grade

– I – pain and no increased motion

– II – increased opening with pain on stressing

– III – no pain from the absence of an intact ligament and

continued motion while stressing

Wrist and Hand

• De Quervain’s Stenosing Tenosynovitis

- Inflammation of the 1st dorsal compartment (APL

EPB tendons)

- Overuse gripped and wrist ulnar deviated

- Radial wrist pain is noted with resisted

thumb extension

- Finkelstein’s test

Wrist and Hand

• Injuries to the digits

- Mallet finger –rupture of extensor tendon

- Jersey finger- rupture of flexor tendon at its

insertion

Wrist and Hand

Hip Pointer

- Direct blow to the pelvic brim

or hip region which results in a

contusion to the soft tissues and

underlying bone ( bleeding in

hip abductors)

- Contact sports such as football

and hockey

- lasts for 1-6 wks depending on

the severity

- Tx: icing, active ROM, rest

Hip

• Patellofemoral Pain Syndrome (PFPS)

- biker’s or runner’s knee

- Most common anterior knee pain syndrome

- Overuse injury by repeated microtrauma

- due to vastus lateralis tightness

and medial weakness

Knee

• Patellofemoral pain Syndrome

– Vastus Medialis Obliquos ( VMO) Insufficiency

• Help maintain proper patella tracking during extension

of the knee

• Dynamic medial stabilizer

– ITB tightness

• Abnormal patellar tracking

– Hamstring tightness

• Increase patellofemoral joint reaction force in stance

Knee

• Patellofemoral pain Syndrome

– Treatment:

• Ice, NSAIDs

• Avoid kneeling, excessive stair climbing and prolonged

sitting

• Proper stretching (vastus lateralis, ITB and hamstrings)

• VMO strenghtening

• Patellar mobilization technique

Knee

• Anterior Cruciate Ligament Injury

- most common ligament injured in athletics

- MOI: knee hyperextension injury or deceleration

injury

- most commonly in landing flat on their heels

– Unhappy triad: ACL, MCL, medial meniscus

– Common with rotatory activity

– PE: anterior drawer test or

Lachmann test

Knee

Anterior Cruciate Ligament Injury

- women> men : due to general muscular strength, reaction time of muscle contraction and coordination, and training techniques

- Dx: MRI

- Sx: sudden popping sound, swelling, and instability of the knee

- conservative mgt: strengthening of hamstrings and knee braces

- surgery: ACL reconstruction

Knee

ACL - post operative rehabilitation phases

Phase 1: reduce pain and swelling while gaining ROM

Phase 2: 3-4 wks, mini wall sits and stationary bike, ROM upto 100 degrees flexion

Phase 3: 4-6 wks, controlled ambulation phase, flexion to 130 degrees, aim is to improve balance

Phase 4: 6-8 wks, moderate protection phase, full ROM with resistance training regimen

Phase 5: 8-10 wks, light activity phase, strengthening with balance and mobility

Phase 6: 10 wks ---, return to activity phase, jogging to return to sports

Knee

• Posterior Cruciate Ligament

- direct impact to the front of the tibia itself, usually

when the knee is bent

- (+) posterior drawer sign – most sensitive test for

PCL

- (+) posterior sag test

- Surgical

- Strengthening of quads

Knee

• Meniscal tear

- Direct blow to the knee/twisting type of knee

- Swelling, tightness

- Symptoms increase with

knee flexion & localized

to the joint line

- McMurray test

- Appley compression test

Knee

Meniscal tear

- Conservative mgt: RICE, NSAIDS, electrotherapy,

quadriceps strengthening, glucosamine sulfate

- Surgery: arthroscopic surgery

preserve as much of the meniscus cartilage as

possible

Knee

Medial and lateral Collateral ligament injuries:

- Medial > lateral

- (+) varus / valgus stress test

- (+) appley distraction test

Knee

• Achilles Tendinitis

– Inflammatory reaction

– Running is the most commonly associated activity

– Overuse – most common cause

– Treatment:

• Decrease inflammation

• Stretching of the gastrocnemius/soleus complex

• Eccentric strengthening

Ankle

Inversion ankle sprain

- Most common traumatic injuries

- Lateral ligament

- Grade:

• I – mild sprain of the anterior talofibular ; (-) anterior

drawer and talar tilt test

• II – disruption of the anterior talofibular with sprain of

the calcaneofibular, (+) ant drawer test , (-) talar tilt

• III – disruption of the lateral ligament complex with (+)

ankle drawer and talar tilt test

Ankle

• Deltoid Ligament Injuries

– Eversion injury

– Occur concomitantly with

inversion injury

• Treatment

– Ice, NSAIDs, relative rest, early mobilization

– Strengthening, proprioceptive exercises

Ankle

• Plantar Fasciitis

- Sudden loading of the feet

– Occur in both a pes planus foot and pes cavus foot

– Focal tenderness at the origin of plantar fascia

– Pain elicited by hyperdorsiflexion of the great toe

– Tightness of gastrocnemius comples

– Treatment

• Aggressive stretching

• Strengthening exercises

Foot

Thank you