Rehabilitation in Sport

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Elvira Muhic, Kim Jackson, Philans Cosmos Ankrah, Evan Thomas, Naomi O'Reilly, Wanda van Niekerk, Claire Knott, WikiSysop, 127.0.0.1, Michelle Lee, Amrita Patro, Jess Bell and Rishika Babburu  

Introduction

Rehabilitation is the restoration of optimal form (anatomy) and function (physiology). The noun rehabilitation comes from the Latin prefix re-, meaning “again” and habitare, meaning “make fit.” It is a process designed to minimize the loss associated with acute injury or chronic disease, to promote recovery, and to maximize functional capacity, fitness and performance.

The process of rehabilitation should start as early as possible after an injury and form a continuum with other therapeutic interventions. It can also start before or immediately after surgery when an injury requires a surgical intervention.

Rehabilitation Plan

Injuries during sports competitions may result from high forces during actions or movements inherent to the sport. The rehabilitation plan must take into account the fact that the objective of the patient (the athlete) is to return to the same activity and environment in which the injury occurred. Functional capacity after rehabilitation should be the same, if not better, than before injury.

Multidisciplinary Approach

The rehabilitation of the injured athlete is managed by a multidisciplinary team with a physician functioning as the leader and coordinator of care. The team includes, but is not limited to, athletic trainers, physiotherapists, psychologists, and nutritionists. The rehabilitation team works closely with the athlete and the coach to establish the rehabilitation goals, to discuss the progress resulting from the various interventions, and to establish the time frame for the return of the athletes to training and competition.

Stages

Initial Stage 

Control pain and swelling

This phase lasts approximately 4-6 days. The body's first response to an injury is inflammation. It's main function is to defend the body against harmful substances, dispose of dead or dying tissue and to promote the renewal of normal tissue. The goal for treatment during this phase is to provide a healty environment for new tissue regeneration and formation, and to prevent prolonged inflammation and disruption of new blood vessel and collagen production. These cells increase in number with movement and decreases with immobilisation. Clinically the role </span>of medical professionals during this phase would be to strike a balance between too little inflammation and too much inflammation. The physiotherapist is usually the professional in charge of this phase although the process may be started by a medical doctor.

The most immediate emotional response at the point of injury is shock. It's degree may range from minor to significant, depending upon the severity of the injury. It is important to note that denial itself is an adaptive response that allows an individual to manage extreme emotional responses to situational stress.

The goals during the initial phase of the rehabilitation process include limitation of tissue damage, pain relief, control of the inflammatory response to injury, and protection of the affected anatomical area. The pathological events that  take place immediately after the injury could lead to impairments such as muscle atrophy and weakness and limitation in the joint range of motion. These impairments result in functional losses, for example, inability to jump or lift an object. The extent of the functional loss may be influenced by the nature and timing of the therapeutic and rehabilitative intervention during the initial phase of the injury. If functional losses are severe or become permanent, the athlete now with a disability may be unable to participate in his/her sport. The goals during the second phase of rehabilitation

include the limitation of the impairment and the recovery from the functional losses. A number of physical modalities are used to enhance
tissue healing. Exercise to regain flexibility, strength, endurance, balance, and coordination become the central component of the intervention. To the extent that these impairments and functional losses were minimized by early intervention, progress in this phase can be accelerated. The final phase of rehabilitation represents the start of the conditioning process needed to return to sports training and competition. Understanding the demands of the particular sport becomes essential as well as communication with the
coach. This phase also represents an opportunity to identify and correct risk factors, thus reducing the possibility of re-injury. The use of orthotic devices to support musculoskeletal function and the correction of muscle imbalances and inflexibility in uninjured areas should receive the attention of the rehabilitation team.

RICE: Rest, Ice, Compression, Elevation

Primary treatment in initial phase of rehabilitation is RICE. It is the term that stands for Rest, Ice, Compression and Elevation. RICE can be used immediately and 24 to 48 hours after many muscle strains, ligament sprains, or other bruises and injuries.

Physical Therapy 

Therapeutic modalities and medications are used to create an optimal environment for injury repair by limiting the inflammatory process and breaking the pain-spasm cycle. Use of any modality depends on the supervising physician's exercise prescription, as well as the injury site, and type and severity of injury. In some cases, a modality may be indicated and contraindicated for the same condition. For example, thermotherapy (heat therapy) may be contraindicated for tendinitis during the initial phase of the exercise program. However, once acute inflammation is controlled, heat therapy may be indicated. Frequent evaluation of the individual’s progress is necessary to ensure that the appropriate modality is being used.

Despite the fact that rapid return to competition is crucial, rest is necessary to protect the damaged tissue from additional injury. Therefore, exercise involving the injured area is not recomended during this phase, although there are a few exceptions such as the tendinopathy protocols used to rehabilitate Achilles and patella tendon injuries. However, it is important to realize that a quick return to function relies on the health of other body tissues. The power, strength, and endurance of the musculoskeletal tissues and the function of the cardiorespiratory system must be maintained. Athlete needs to understands the reasons for following a particular treatment regime or exercise program and medical professional’s advice should be sought before embarking on any regime as more harm can be done than good if carried out incorrectly. Assuming that this requirement is fulfilled, exercises may include general aerobic and anaerobic training and resistance training of the uninjured extremities. If movement of the injured limb is not contraindicated, isolated exercises that target areas proximal and distal to the injured area may also be permissible provided that they do not stress the injured area. Examples include hip abduction and rotation exercises following knee injury or scapula stabilizing exercises following glenohumeral joint injury. Active range of motion is performed under one's own control, while passive range of motion occurs when another person or device produces the movement. Isometric exercises are used for strengthening when range of motion is restricted or needs to be avoided due to the fracture or acute inflammation of a joint. Otherwise, isotonic strengthening can begin within the painless arc of joint motion. 

Loss of proprioception occurs with injury to ligaments, tendons, or joints, and also with immobilization. Restoration of proprioception is an important part of rehabilitation in order to prevent further injuries.

Intermediate Stage

Begin with ROM and resume cardiovascular training

This phase lasts from day 5 to 8-10 weeks. After the inflammatory phase, the body begins to repair the damaged tissue with similar tissue, but the resiliency of the new tissue is low. Repair of the weakened injury site can take up to eight weeks if the proper amount of restorative stress is applied, or longer if too much or too little stress is applied.

Focus of the treatment during this phase is to prevent excessive atrophy and joint deterioration of the injured area. Rehabilitation in the form of exercise therapy must be initiated during this phase to increase the strength of the muscle tissue adjacent to the scar and to facilitate a healthy, functional scar being laid down. In addition, a precarious balance must be maintained in which disruption of the newly formed collagen fibers is avoided but low-load stresses are gradually introduced to allow increased collagen synthesis and prevent loss of joint motion. To protect the new, relatively weak collagen fibers, the athlete should avoid active resistive exercise involving the damaged tissue. Too little activity, though, can also have a deleterious effect, as newly formed fibers will not optimally align and may form adhesions, thereby preventing full motion. Early protected motion hastens the optimal alignment of collagen fibers and promotes improved tissue mobility. As in the inflammatory phase, therapeutic modalities are permissible, but their goal during the second rehabilitation phase is to promote collagen synthesis. Again, the maintenance of muscular and cardiorespiratory function remains essential for the uninjured areas of the body. The strength and conditioning professional has considerable expertise to offer the other members of the sports medicine team regarding selection of the appropriate activities.

Advanced Stage

Restore ROM, improve strength and endurance, proprioception, continue cardiovascular training

Return to Sport

Restore strength, add sport specific movements with progression of velocity of these movement patterns to game speed

References

References will automatically be added here, see adding references tutorial.