General Principles of Exercise Rehabilitation
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Top Contributors - Wanda van Niekerk, Kim Jackson and Jess Bell
Introduction[edit | edit source]
In order for clinicians to design an effective rehabilitation programme, they need to understand what the specific performance needs of the athlete or individual are. What are the athlete's goals, but also what is their current status? Identifying an athlete's current status will also identify the athlete's current constraints, and most often these constraints are around tissue injury.
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Performance Backward Thinking
Performance Needs Analysis
What is the performance goal or end goal?
What is required to reach this goal?
What physical qualities underpin these?
What are the current capabilities?
What are the barriers and facilitators?
Consider: Sport, role, position
What is the athlete’s role within the activity or sport
Performance duration
Total duration of the athlete’s whole performance
What is the duration and frequency of training sessions?
Activity duration
Continuous activity or does it require bursts of varying intensity and duration
Activities
What is involved? Jumping, landing, sprinting, change of direction, kicking, throwing, lifting, carrying?
Impact sport/Collision sport/Contact sport
Distances covered and directions moved in
Endurance and capacity-based requirements
Strength requirements
Predominant muscle groups
Predominant muscle actions
Flexibility and range of movement demands
Motor skill requirements
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Performance Needs Analysis Comparison between 100m sprinter and general person walking to the shops in table form
Olympic Sprinter
Ability to run 100 m under 10 seconds
Consistently perform at a high level over a few days during competition
Needs endurance and resilience – system and tissue level
Physical attributes necessary
Rapid force generation across key muscles
Isometric force generation
Endurance and speed – system and tissue level
Dissociation of movement and well-coordinated movement – Movement skills
Person walking to the shop
Ability to walk a set distance while carrying an unevenly distributed load
Up and downhill walking or on uneven surfaces
Appropriate force and force generation in ankle and calf muscles for walking
Load accept through hip and knee – stepping up and down curbs
Balance
Upper body strength
Even for seeming simple tasks, there are numerous requirements necessary to perform a task.
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Performance requirements can include level of strength, level of mobility, level of endurance, coordination tasks
With an injury, the current status of the injured tissue as well as the athlete’s holistic status needs to be assessed. Reliable and sensitive assessments are necessary to assess the current tissue status.
What can the injured tissue tolerate at this moment in time?
What can the individual do in relation to the injured tissue at this current time with injury?
Consider dichotomised versus graded assessment approaches
Dichotomised assessment:
Specific structure is painful, therefor it is injured
Simple test with a yes or no answer or yes the structure is injured or no, the structure is not injured.
Graded assessment
Graded exposure of the tissue to load to see how much load the injured tissue can tolerate.
The assumption is often that an acute muscle/ligament/tendon injury will have zero load tolerance when the structure is injured, but often these injured structures can still tolerate a level of load even if it is very little.
The level of load an injured tissue can tolerate needs to be clearly identified.
For example:
If an injured tendon can only tolerate low repetitions of body weight load, then activities such as walking can be restricted, or the relative load reduced by utilising walking aids. However, if the tendon only becomes painful or irritated after running for 10 km, it would be unsuitable to restrict the athlete from running altogether as this will most likely lead to tissue atrophy.
If an athlete can lift a 5 kg weight without pain or symptoms, then this would be the starting loading point.
Testing examples:
Muscle or tendon: test for the ability to tolerate load with an isometric make-test in mid-range. If the athlete passes the test, then a break-test can be performed where the tissue is eccentrically loaded. Following that, the muscle can be tested in outer range or elongated position, and so forth. In this manner, the tissue load is determined through a graded assessment and a clearer understanding is achieved of the current status of the injured tissue.
Note that significant muscle atrophy can occur within 5 -14 days of inactivity (Wall et al 2013). It is, therefore, crucial to determine the minimum activity an injured athlete can perform to reduce the occurrence of atrophy due to underactivity.
Once the gaps have been identified and a starting point for loading has been identified, that can be seen as the establishment of a stable baseline.
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A certain amount of micro failure is allowed when loading the tissue as this brings on physiological changes, which leads to tissue adaptation, and this strengthens the tissue. If we consider the load-deformation curve and sub-optimally load tissue (loading in the left-hand side of the micro failure, this will lead to tissue atrophy and the tissue will weaken to the level of the loads applied. Similarly, if the tissue is overloaded (loading to the right-hand side of the micro failure zone, this can lead to irreparable damage).
Therefore, it is imperative to apply the maximum load the specific tissue can tolerate.
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