Rehabilitation in Sport: Difference between revisions
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== Principles == | == Principles == | ||
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.<ref name="7">Buschbacher R, Prahlow N, Dave SJ. Sports and Medicine Rehabilitation - A Sport-Specific Approach. 2nd ed. Philadelphia: Lippincott Williams and Wilkins. 2009</ref> | |||
== Components == | == Components == | ||
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.<ref name="7" /> | |||
== Stages == | == Stages == | ||
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=== Initial Stage === | === Initial Stage === | ||
This phase lasts approximately 4-6 days.<ref name="8">Gray J. Phases of Rehabilitation after Injury: An Evidence-Based Literature Review. Bok Smart. 2009</ref> The body's first response to an injury is inflammation.<ref name="2">Human Kinetics. Excerpt: Understand rehabilitation to facilitate a return to competition. http://www.humankinetics.com/excerpts/excerpts/understand-rehabilitation-to-facilitate-a-return-to-competition (accessed 20 May 2016).</ref> 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.<ref name="3">Sports Injury Clinic. General Injuries and Conditions. Inflammation. http://www.sportsinjuryclinic.net/sport-injuries/general/inflammation (accessed 25 May 2016).</ref> | This phase lasts approximately 4-6 days.<ref name="8">Gray J. Phases of Rehabilitation after Injury: An Evidence-Based Literature Review. Bok Smart. 2009</ref> The body's first response to an injury is inflammation.<ref name="2">Human Kinetics. Excerpt: Understand rehabilitation to facilitate a return to competition. http://www.humankinetics.com/excerpts/excerpts/understand-rehabilitation-to-facilitate-a-return-to-competition (accessed 20 May 2016).</ref> 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.<ref name="3">Sports Injury Clinic. General Injuries and Conditions. Inflammation. http://www.sportsinjuryclinic.net/sport-injuries/general/inflammation (accessed 25 May 2016).</ref> 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.<ref name="9" /> | ||
The physiotherapist is usually the professional in charge of this phase although the process may be started by a medical doctor.<ref name="8" /> | |||
==== Control pain and swelling<ref name="1">Chiro-medical Group. Physical Therapy. Phases of rehab. http://www.chiromedicalgroup.com/phases-rehab (accessed 20 May 2016).</ref> <br> ==== | ==== Control pain and swelling<ref name="1">Chiro-medical Group. Physical Therapy. Phases of rehab. http://www.chiromedicalgroup.com/phases-rehab (accessed 20 May 2016).</ref> <br> ==== | ||
Primary treatment in initial phase of rehabilitation is [[RICE Therapy|RICE]].<ref name="2" /> 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.<ref name="4">University Health Services. RICE: Rest, Ice, Compression and Elevation for Injuries. http://www.uhs.wisc.edu/health-topics/muscles-and-bone/rice.shtml (accessed 25 May 2016) | Primary treatment in initial phase of rehabilitation is [[RICE Therapy|RICE]].<ref name="2" /> 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.<ref name="4">University Health Services. RICE: Rest, Ice, Compression and Elevation for Injuries. http://www.uhs.wisc.edu/health-topics/muscles-and-bone/rice.shtml (accessed 25 May 2016)</ref> | ||
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.<ref name="3">Anderson MK, Foundations of Athletic Training: Prevention, Assessment, and Management. 4th ed. In: Therapeutic Modalities. Lippincott Williams and Wilkins. 2008</ref> | |||
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.<ref name="2" /><ref name="6" /> 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.<ref name="2" /> Athlete needs to understands the reasons for following a particular treatment regime or exercise program, as well medical professional’s advice should be sought before embarking on any regime as more harm can be done than good if carried out incorrectly.<ref name="6">Sports Injury Clinic. Rehabilitation and Exercises. http://www.sportsinjuryclinic.net/rehabilitation-exercises (accessed 26 May 2016)</ref> | 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.<ref name="2" /><ref name="6" /> 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.<ref name="2" /> Athlete needs to understands the reasons for following a particular treatment regime or exercise program, as well medical professional’s advice should be sought before embarking on any regime as more harm can be done than good if carried out incorrectly.<ref name="6">Sports Injury Clinic. Rehabilitation and Exercises. http://www.sportsinjuryclinic.net/rehabilitation-exercises (accessed 26 May 2016)</ref> | ||
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.<ref name="7" /> If movement of the injured limb is not contraindicated, isolated exercises that target areas proximal and distal to the injured area may 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.<ref name="2" /> 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.<ref name="7" /> <br> | |||
=== Intermediate Stage === | === Intermediate Stage === | ||
| Line 48: | Line 50: | ||
This phase lasts from day 5 to 8-10 weeks.<ref name="8" /> 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.<ref name="2" /> | This phase lasts from day 5 to 8-10 weeks.<ref name="8" /> 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.<ref name="2" /> | ||
==== | ==== Begin with ROM and resume cardiovascular training<ref name="1" /> ==== | ||
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. 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.<ref name="2" /><br> | |||
<br> | <br> | ||
| Line 58: | Line 60: | ||
Restore ROM, improve strength and endurance, proprioception, continue cardiovascular training<ref name="1" /> | Restore ROM, improve strength and endurance, proprioception, continue cardiovascular training<ref name="1" /> | ||
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. | |||
=== Return to Sport === | === Return to Sport === | ||
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Introduction[edit | edit source]
Rehabilitation is the restoration of optimal form (anatomy) and function (physiology).Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Rehabilitation Plan[edit | edit source]
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The ultimate goal of the rehabilitation process is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate altogether the disability.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Multidisciplinary Approach[edit | edit source]
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Principles[edit | edit source]
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Components[edit | edit source]
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Stages[edit | edit source]
Initial Stage [edit | edit source]
This phase lasts approximately 4-6 days.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The body's first response to an injury is inflammation.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The physiotherapist is usually the professional in charge of this phase although the process may be started by a medical doctor.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Control pain and swellingCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
[edit | edit source]
Primary treatment in initial phase of rehabilitation is RICE.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Athlete needs to understands the reasons for following a particular treatment regime or exercise program, as well medical professional’s advice should be sought before embarking on any regime as more harm can be done than good if carried out incorrectly.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title If movement of the injured limb is not contraindicated, isolated exercises that target areas proximal and distal to the injured area may 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Intermediate Stage[edit | edit source]
This phase lasts from day 5 to 8-10 weeks.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Begin with ROM and resume cardiovascular trainingCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]
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. 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Advanced Stage[edit | edit source]
Restore ROM, improve strength and endurance, proprioception, continue cardiovascular trainingCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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.
Return to Sport[edit | edit source]
Restore strength, add sport specific movements with progression of velocity of these movement patterns to game speedCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Monitoring[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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