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32 Cards in this Set
- Front
- Back
Intro to 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. |
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Therapeutic modalities include |
Cryotherapy (Ice), thermotherapy (heat), massage. |
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Sudden innactivity and immobilization |
= 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. |
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Manage pain and swelling |
Depends, on severity and location, but affects rehab. Manage with RICE, affects strengthening and flexibility exercises. Addressed with modalities. |
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Ranges of motion |
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. |
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Muscular strength , endurance and power |
Strength essential to restoring pre-injury function. Must work through full pain free ROM. Isometrics (Overflow of training), progressive resistance exercise, isokinetics. |
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Isometrics |
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) |
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Equipment variety in rehab |
FW, Machines, tubing. Concentric, eccentric contractions. Strength deficits in eccentric forces can = injury. |
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Isokinetics |
Constant speed accommodating resistance to provide maximal resistance throughout full ROM. |
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Neuromuscular control and balance |
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. |
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Functional progressions |
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. |
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Rehab plan phase 1 - acute inflammatory stage |
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. |
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Rehab plan phase 2 - fibroblastic repair stage |
Repair underway pain is less. 4- several weeks Swelling and pain control critical. Include CV fitness, strength, flexibility and neuromuscular activities gradually. |
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Rehab stage 3 - Maturation and remodelling |
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. |
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Adherence to rehab |
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 |
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Modalities - thermal |
Conduction, conversion, radiation, conversion 2 |
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Conduction |
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 |
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Conversion |
Indirect heating through another medium such as air or fluids Temp, speed of mvmt, conductivity will impact healing. |
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RRadiation |
Heat is transferred from one object through space to another obect Eg shortwave diathermy, infared heating, ultraviolet therapy. |
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Conversion 2 |
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. |
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Thermal modalities - cryotherapy |
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 |
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Types of cryotherapy |
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. |
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Thernal modalities - thermotherapy |
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. |
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Thermotherapy - superficial heat |
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. |
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Special considerations with superficial heat |
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. |
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Thermotherapy - moist heat |
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. |
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Massage |
Systematic manipulation of soft tissue Mechanical response Physiological responses Psychological responses |
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Mechanical response to massage |
Mechanical responses: occur as a direct result of pressures and mvmts, envourages venous flow and mild stretching of superficial tissue, positively affect scar tissue. |
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Physiological response to massage |
Increases circulation, aiding in removal of metabolites, overcoming venostasis Reflec effect Stimulation |
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Psychological response to massage |
Creates bond of confidence between therapist and athlete |
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Massage strokes |
Effleurage - stroking style Petrissage - kneeding Tapotement - cupping, hacking, jostling Friction - horizontal to fiber |
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Massage special considerations |
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. |