Rehabilitation in Sport: Difference between revisions
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== Components == | == Components == | ||
Regardless of the specifics of the injury, however, here are fundamental components that need to be included in all successful rehabilitation programs: | Regardless of the specifics of the injury, however, here are fundamental components that need to be included in all successful rehabilitation programs: | ||
=== Pain Management === | === Pain Management === | ||
=== Flexibility and Joint ROM === | |||
=== Strength and Endurance === | |||
=== Proprioception and Coordination === | |||
=== Proprioception and Coordination === | |||
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" /> | 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" /> | ||
=== Functional Rehabilitation === | === Functional Rehabilitation === | ||
=== The use of Orthotics === | === The use of Orthotics === | ||
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.<ref name="9" /> | 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.<ref name="9" /> | ||
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== Stages == | == Stages == | ||
=== | === 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> 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" /> | 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" /> | ||
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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]
Principles are the foundation upon which rehabilitation is based. Here are seven principles of rehabilitation, which can be remembered by the mnemonic: ATC IS IT.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
A: Avoid aggravation. It is important not to aggravate the injury during the rehabilitation process. Therapeutic exercise, if administered incorrectly or without good judgment, has the potential to exacerbate the injury, that is, make it worse.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
T: Timing. The therapeutic exercise portion of the rehabilitation program should begin as soon as possible—that is, as soon as it can occur without causing aggravation. The sooner patients can begin the exercise portion of the rehabilitation program, the sooner they can return to full activity. Following injury, rest is sometimes necessary, but too much rest can actually be detrimental to recovery.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
C: Compliance. Without a compliant patient, the rehabilitation program will not be successful. To ensure compliance, it is important to inform the patient of the content of the program and the expected course of rehabilitation.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
I: Individualization. Each person responds differently to an injury and to the subsequent rehabilitation program. It is first necessary to recognize that each person is different. Even though an injury may seem the same in type and severity as another, undetectable differences can change an individual’s response to it. Individual physiological and chemical differences profoundly affect a patient’s specific responses to an injury.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
S: Specific sequencing. A therapeutic exercise program should follow a specific sequence of events. This specific sequence is determined by the body’s physiological healing response.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
I: Intensity. The intensity level of the therapeutic exercise program must challenge the patient and the injured area but at the same time must not cause aggravation. Knowing when to increase intensity without overtaxing the injury requires observation of the patient’s response and consideration of the healing process.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
T: Total patient. You must consider the total patient in the rehabilitation process. It is important for the unaffected areas of the body to stay finely tuned. This means keeping the cardiovascular system at a preinjury level and maintaining range of motion, strength, coordination, and muscle endurance of the uninjured limbs and joints. The whole body must be the focus of the rehabilitation program, not just the injured area. Remember that the total patient must be ready for return to normal activity or competition; providing the patient with a program to keep the uninvolved areas in peak condition, rather than just rehabilitating the injured area, will help you better prepare the patient physically and psychologically for when the injured area is completely rehabilitated.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Components[edit | edit source]
Regardless of the specifics of the injury, however, here are fundamental components that need to be included in all successful rehabilitation programs:
Pain Management[edit | edit source]
Flexibility and Joint ROM[edit | edit source]
Strength and Endurance[edit | edit source]
Proprioception and Coordination[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
Functional Rehabilitation[edit | edit source]
The use of Orthotics[edit | edit source]
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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
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. Early protected motion hastens the optimal alignment of collagen fibers and promotes improved tissue mobility. 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. 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
Possible exercise forms during this phase include strengthening of the uninjured extremities and areas proximal and distal to the injury, aerobic and anaerobic exercise, and improving strength and neuromuscular control of the involved areasCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title:
- Isometric exercise may be performed provided that it is pain free and otherwise indicated. Submaximal isometric exercise allows the athlete to maintain neuromuscular function and improve strength with movements performed at an intensity low enough that the newly formed collagen fibers are not disrupted.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Isokinetic exercise can be an important aspect of strengthening following injury. This type of exercise uses equipment that provides resistance to movement at a given speed (e.g., 60°/s or 120°/s).Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Isotonic exercise involves movements with constant external resistance and the amount of force required to move the resistance varies, depending primarily on joint angle and the length of each agonist muscle. Isotonic exercise uses several different forms of resistance, including gravity (i.e., exercises performed without equipment, with gravitational effects as the only source of resistance), dumbbells, barbells, and weight-stack machines. The speed at which the movement occurs is controlled by the athlete; movement speed can be a program design variable, with more acute injuries calling for slower movement and the later phases of healing amenable to faster, more sport-specific movement.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Specific types of exercises exist to improve neuromuscular control following injury and can be manipulated through alterations in surface stability, vision, and speed. Mini-trampolines, balance boards, and stability balls can be used to create unstable surfaces for upper and lower extremity training. Athletes can perform common activities such as squats and push-ups on uneven surfaces to improve neuromuscular control.Cite error: Invalid
<ref>tag; name cannot be a simple integer. Use a descriptive title - Exercises may also be performed with eyes closed, thus removing visual input, to further challenge balance.Cite error: Invalid
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Finally, increasing the speed at which exercises are performed provides additional challenges to the system. Specifically controlling these variables within a controlled environment will allow the athlete to progress to more challenging exercises in the next stage of healing.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Advanced Stage[edit | edit source]
This phase begins at around 21 days and can continue for 6-12 months.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The outcome of the previous phase is the replacement of damaged tissue with collagen fibers. After those fibers are laid down, the body can begin to remodel and strengthen the new tissue, allowing the athlete to gradually return to full activity.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title This 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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Functional Rehabilitation[edit | edit source]
The combination of clinic-based and sport-specific functional techniques will provide an individualized, sport-specific rehabilitation protocol for the athlete.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Rehabilitation and reconditioning exercises must be functional to facilitate a return to competition. Examples of functional training include joint angle-specific strengthening, velocity-specific muscle activity, closed kinetic chain exercises, and exercises designed to further enhance neuromuscular control. Strengthening should transition from general exercises to sport-specific exercises designed to replicate movements common in given sports.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cross-training is encouraged, especially with activities that do not produce any symptoms from the injury.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
It is essential that the rehabilitation and training be sufficiently vigorous to prepare the injured tissue for the demands of the game.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title With each incerase in activity, signs of recurring pain or weakness should trigger a slowdown or a reversal to a tolerable level of activity.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The player will have returned to game during this phase and will have ceased physiotherapy or individual rehabilitation while this process is still continuing.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Unrestricted sports activity is not allowed until all of these steps have been completed and full-effort sports-specific activity is tolerated without symptoms.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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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