KNPE 443 Tissue Healing and Program Design

For exam 2

Frontal (coronal)

Front to back

Sagittal

Left and right

Transverse

Top and bottom

Anterior

Front

Posterior

Back

Superior

Above

Inferior

Below

Medial

Towards the mid-line of the body

Lateral

Away from the mid-line of the body

Flexion

Decreasing the angle of a joint

Extension

Returning towards zero degrees

Abduction

Moving away from the mid-line of the body

Adduction

Moving towards the mid-line of the body

Internal rotation

Rotation to the center of the body

External rotation

Rotation away from the center of the body

Proximal

Closer to the point of origin

Distal

Farther away from the point of origin

Guiding principles of rehabilitation

Avoid aggravation

Timing

Compliance

Individualization

Specific sequencing

Intensity

Total patient

Evidence-based practice

Application of current quality research combined with clinician skills and experience

Outcomes based practice

Assessing outcomes in your patients, evaluation is key

Guiding principles of rehabilitation: Assesment

History, observation, palpation, special tests

When should assessment happen

Prior to/after each treatment session

Tools of therapeutic interventions

Therapeutic modalities, medications, therapeutic exercise, conditioning exercise

Basic components of therapeutic interventions program

(Bottom) Correct deviations and decrease pain

Flexibility and range of motion

Strength and endurance

Balance, coordination, and agility

Function

(Top) Performance

Phase 1 of Therapeutic interventions program

Range of motion, flexibility

Phase 2 of Therapeutic interventions program

Muscle endurance, strength

Phase 3 of Therapeutic interventions program

Agility, coordination, proprioception

Total body

Do not forget cardiovalcular fitness

Priority for beginning stages of healing

Allow inflammation to occur but minimize debilitating damage

Phase 1 - inactive phase

Goals: relieve pain, edema, and muscular spasm

How to accomplish: rest, immobilization, modalities, medication

Avoid aggravating the injury

Potential ROM exercises

Proliferation phase

Day 3 of inflammation

Scar tissue begins to form in late inflammatory phase

“The clean up”/repair

Goals of proliferation

Promote optimized tissue formation, minimize stiffness, minimize atrophy, manage lingering discomfort, manage lingering swelling

Phase 2 - active phase

Goals: increase ROM and flexibility

Aggressive ROM and mobilization exercises

early strengthening/proprioception exercises (balance)

Avoid: reverting back to pain and edema stage, rely on day to day evaluation and easy strengthening exercises

Pain and edema have been controlled

Remodeling regeneration

“Rebuilding after the storm”

Rehab goals for remodeling

Promote optimized strength

Restore muscle strength, endurance, and power

Return to ADL’s

Return to physical activity

What to avoid during remodeling

Avoid quick changes in mechanical load

Phase 3 - resistive phase

Goals: using resistance exercises to restore any deficiencies in strength, agility, and endurance, increase balance exercises

Muscle healing

Careful balance between allowing scar tissue and preventing atrophy

First 10 days weak site that could easily be re-injured

Let pain be the guide

Phase 4 - aggressive phase

Goals: Functional and performance. Getting back to goals of what the patient wants to be able to do.

Strength has been restored to a point where power, strength, and coordination can be progressed. Flexibility, strength, and endurance have been achieved. Easily overlooked in lot of programs

Questions to ask before returning

Have goals been achieved?

Has physician cleared?

Is it safe to return?

Exercise progression 1: Planar movements

Unloaded → gravity neutral → loaded

Exercise progression 2: locomotion

Walk → lunge → sidestep→ jog/run → skip/gallop → slide

Exercise progression 3

Hopping - jumping

Exercise progression 4

Specific skills/ performance specific