Ephe 344 Injury Management And Rehab

Begins immediately after injury.

Based on short/long term goals.

Control pain and inflammation, prevent secondary complications, support injury.

Maintain/improve ROM

Restore/Increase ROM

Re-establish neuromuscular control

Maintain levels of cv fitness.

Cryotherapy (Ice), thermotherapy (heat), massage.

= general loss of fitness, strength, endurance, coordination.

Must be able to continue full body activity without injury aggravation.

Immobilization will affect everything.

RHR increases half a beat for every day of immobilization.

Depends, on severity and location, but affects rehab.

Manage with RICE, affects strengthening and flexibility exercises. Addressed with modalities.

All injuries are associated with some loss of range

Attributed to contracture of connective tissue or MTU resistance to stretch or both.

Osteokinematics - big things joint should be doing.

Strength essential to restoring pre-injury function.

Must work through full pain free ROM.

Isometrics (Overflow of training), progressive resistance exercise, isokinetics.

Early phase in activity when immobilized.

Used when resistance training through full ROM not possible.

Increase in static strength, decrease in atrophy, increase in muscle pump (improves circulation, moves fluids around)

FW, Machines, tubing.

Concentric, eccentric contractions. Strength deficits in eccentric forces can = injury.

Constant speed accommodating resistance to provide maximal resistance throughout full ROM.

Regain ability to follow oreviously established sensory patterns.

Ability to sense joint in space mediated by mechanoreceptors in joints.

4 key elements: Proprioception, kinesthetic awareness.

Dynamic stability

Preparatory and reactive muscle characteristics

Conscious and unconscious functional and motor patterns

Balance - integration of muscular forces, neuromuscular sensory forces, neuromuscular sensory info, from mechanoreceptors.

Gradual activities, incorporate as early as possible. Progression in speed and skill.

Monitor, if not pain or swelling arise = activity can be advanced to sport specific. Optimal = practice every skill of the sport in progressions.

Do in team practice.

up to 4 days

Primary focus is to control swelling and modulate pain (RICE)

Avoid being overly aggressive during first 48 hrs, may not allow for purpose of inflammation. Rest should be active, avoid aggravating injury but maintain other areas.

By day 3, AROM exercises in pain free ROM.

NSAIDs for swelling & inflammation

Post surgical exercise phase begins 24hrs post op.

Repair underway pain is less.

4- several weeks

Swelling and pain control critical.

Include CV fitness, strength, flexibility and neuromuscular activities gradually.

3months - 2 years

Return to sport

Dynamic functional training, plyometric training.

No longer tender to touch, may be some residual pain with motion.

Thermal modalities and thermal therapy.

Collagen fibers must be realigned according to tensile stresses and strains during sport.

Exercise that is too intense or prolonged can be detrimental

Increase in swelling and pain, decrease or plateau in strength, or plateau in ROM, increase in ligament laxity means too big a load.

Enhancing patient compliance:

1. relationship with patient/therapist attitude

2. clear instructions - verbal and written

3. Encouragement, positive reinforcement.

4. Creativity and variation.

5. Support from coach and peers

6. Fits athletes schedule

7. Pain free

Conduction, conversion, radiation, conversion 2

Heat transferred from a warmer object to a cooler object

Avoid tissue damage temp should not go above 47 degrees, not in contact longer than 30 mins (Moist hot packs, paraffin baths, ice/cold packs

Indirect heating through another medium such as air or fluids

Temp, speed of mvmt, conductivity will impact healing.

Heat is transferred from one object through space to another obect

Eg shortwave diathermy, infared heating, ultraviolet therapy.

Heating through another form of energy

Mechanical energy - eg ultrasound

Electrical current - eg diathermy

Chemical agents ef counter irritation and sensory nerve endings such as voltaren, tiger balm etc.

Use in first aid for trauma to musculoskeletal system.

- wet ice more effective coolant due to energy required to melt ice

Cold penetrates deeper and lasts longer than heat due to fat insulation

Apply with compression and elevation.

RICE employed initially and 2 weeks post.

C: 0-3 mins cold

B/A:2-7 mins burning aching

N: 5-12 numbness

Ice massage - 5-10 min for analgesic effect prior to rehab

Immersion - 10-15 min, reimmerse as pain returns

Ice packs - wet ice is best, 15-20 mins

Chemical packs must be indirect

Vapocoolant sprays.

Physiological effects depend on: TYpe of heat, intensity, duration of application, tissue response.

Desirable therapeutic effects:

Increasing extensibility of collagen tissues

decreasing joint stiffness, reducing pain, relieving muscle spasm, reducing inflammation, edema, exudate in post acute phase, increase blood flow.

Directly increases subcutaneous temp and indirectly spreads to deeper tissues.

Muscle temp increases through a reflexive effect on circulation through conduction

General relaxation and decrease of pain/spasm

Retains constant heat level 20-30 mins.

Imp contraindications:

never apply heat where there is loss of sensation

never apply heat immediately after injury

never apply heat where there is decreased arterial circulation

never apply heat to eyes or genitals

never apply heat to abdomen during pregnancy

never apply heat to a body part that exhibits signs of acute inflammation.

Moist heat causes an indirect increase in deep tissue temp than dry, but dry is better tolerated at high temps.

Indications: Combo of massage and water immersion

Provides conduction and convection

Swelling muscle spasm and pain

Contraindicated for acute injuries due to gravity dependent position.

Systematic manipulation of soft tissue

Mechanical response

Physiological responses

Psychological responses

Mechanical responses: occur as a direct result of pressures and mvmts, envourages venous flow and mild stretching of superficial tissue, positively affect scar tissue.

Increases circulation, aiding in removal of metabolites, overcoming venostasis

Reflec effect

Stimulation

Creates bond of confidence between therapist and athlete

Effleurage - stroking style

Petrissage - kneeding

Tapotement - cupping, hacking, jostling

Friction - horizontal to fiber

Make client comfortable (position, padding, temp, privacy)

Develop confident gentle approach to massage (good body positioning, technique)

Stroke towards heart to enhance lymphatic and venous drainage

Know when to avoid massage- acute conditions, skin conditions, areas where clots can become dislodged.