Strength and Conditioning - Chapter 22 & 14: Rehabilitation and Reconditioning

The 5 principles of Rehabiliation

1. Healing tissues must not be overstressed

2. Athlete has specific criteria before proceeding to next phase

3. Program must be based on current research

4. Program must be adaptable

5. Rehab is a team-oriented process

Macrotrauma

a specific, sudden episode of overload injury to a given tissue

What are the aspects of Macrotrauma?

dislocation, subluxation, sprain, contusion, and strain

Dislocation

A complete displacement of the joint surfaces

Subluxation

A partial displacement of the joint surface

Sprain

A trauma (stretch or tear) of a ligament caused by a twisting motion or excessive force and classified as 1st, 2nd, or 3rd degree depending on severity

Contusion

A musculotendinous injury caused by direct trauma

Strain

Tears in the muscle fibers caused by indirect trauma that are classified into 1st, 2nd, or 3rd degree based on severity.

What are the 3 forms of Macrotrauma?

Ligamentous Sprain, Musculotendinous Contusion, and Musculotendinous Strain

Ligamentous Sprain

A stretching or tearing of a ligament, often resulting from sudden movements or impacts that exceed the ligament's range of motion.

What are the three degrees of Ligamentous Sprain?

Partial/stable, partial/minor instability, and complete, unstable

Musculotendinous Contusion

Area of excess blood/fluid accumulation surrounding injured muscle due to direct trauma

Musculotendinous Strain

Muscle fiber tears due to indirect trauma

What are the 3 degrees of Musculotendinous Strain?

strong/painful, weak/painful, and weak/painless

Microtrauma

An overuse injury caused by repeated, abnormal stress applied to a tissue by continuous training or training with too little recovery time. Including stress fracture and tendinitis

Stress Fracture

The most common type of overuse injury that occurs in bones often from rapid increase in training volume or training on hard surfaces

Tendinitis

An overuse injury that results in inflammation of a tendon which can become tendinopathy if untreated

How does microtrauma occur?

Training errors, suboptimal training environment (surfaces), faulty biomechanics, insufficient motor control, and decreased tissue extensibility.

What are th 3 phases of tissue healing?

Inflammation response , Fibroblastic Repair, and Maturation-Remodeling

Inflammatory Response Phase

• Pain swelling and redness

• Decreased collagen synthesis

• Increased number of inflammatory cells

  • Day 1-5

• Release of histamine and bradykinin increases blood flow and capillary permeability (edema)

• Phagocytosis: allows macrophage release and debris removal

Fibroblastic Repair Phase

• Collagen fiber production

• decreased collagen fiber organization (Type III collagen) - weaker

• Decreased number of inflammatory cells

  • Begins as early as 2 days after injury and lasts up to 2 months

Maturation-remodeling Phase

• Proper collagen fiber alignment longitudinally (Type I Collagen) - stronger

• Increased tissue strength (weakened tissue produced during repair is strengthened during remodeling phase)

  • lasts up to 2-4 months (or years) after injury

Which of the following factors affects healing of the tissues?

Age, lifestyle, degree of injury, and the structure that has been damaged

Treatment Goal of the Inflammatory Response Phase

Preventing disruption of new tissue

Treatment Goal of the Fibroblastic Repair Phase

Preventing excessive muscle atrophy and joint deterioration in the injured area; maintaining muscular and cardiovascular function in uninjured areas 

Treatment Goal of the Maturation Remodeling Phase

Optimizing tissue function by continuing and progressing the activities performed during the repair phase and adding more advanced, sport-specific exercises 

Exercise Strategies of Inflammatory Response Phase

General aerobic and anaerobic training and resistance training of uninjured extremities, with priority given to maximal protection of the injured area

Exercise Strategies of Fibroblastic Repair Phase

Placed after consultation with a professionals (PT, Physician, and trainer), exercises include submaximal isometric exercise, isokinetic exercise, and specific exercises to improve neuromuscular control

Exercise Strategies of Maturation Remodeling Phase

There is a transition from general exercises to sport-specific exercises, specificity of movement speed and important variable, and velocity-specific strengthening exercises (velocities must progress to those used in athelet’s sport)

What are some risk factors for upper extremity injury?

Decreased glenuhumeral ROM and shoulder strength and scapular dyskinesis

What are some risk factors for lower extremity injury?

Decreased balance, neuromuscular control during jump landing, and lower extremity muscle strength

POSITIVE EFFECTS ON PERFORMANCE SLIDE (13)

Components of Warm-ups

typically 5-10 minutes of slow activity (ex. jogging or skipping) which then incorporates movements similar to those of the athletes sport taking a total of 10-20 minutes.

RAMP Protocol

Raise, Activate and Mobilize, and Potentiate

Raise

Elevate body temperature, heart rate, respiration rate, blood flow, and joint fluid viscosity via low-intensity activities that simulate the movement patterns of the upcoming activity.

Activate and Mobilize

Actively move through a range of motion.

Potentiate

Perform sport-specific activities that progress in intensity until the athlete is performing at the intensity required for the subsequent competition or training session.

Temperature related effects to Warm Ups

Increased muscle and core temp, enhanced neural function, and disrupt transient connective tissue bonds

Nontemperature related effects to Warm Ups

Increased blood flow to muscle, elevated baseline oxygen consumption, and post-actvation potentiation

T/F: Warm ups should end no more than 15 minutes before the start of activity

True

Felxibility

A measure of range of motion (ROM); has static and dynamic components.

Static Felxbility

the range of possible movement about a joint and its surrounding muscles during a passive movement.

Dynamic Felxibility

the available ROM during active movements; it requires voluntary muscular actions.

Factors affecting flexibility

1. Joint structure

2. Age and sex

3. Muscle and connective tissue

4. Strength tolerance

5. Neural control

6. Resistance Training

7. Muscle bulk

8. Activity level

Factors affecting flexibility: Joint Structure

Structure determines the joint’s range of motion.

Factors affecting flexibility: Age and Sex

Older people tend to be less flexible than younger people; females tend to be more flexible than males.

Factors affecting flexibility: Muscle and Connective Tissue

Elasticity and plasticity of connective tissues affect ROM.

Factors affecting flexibility: Stretch tolerance

The ability of an athlete to tolerate the discomfort of stretching.

Factors affecting flexibility: Neural Control

Range of motion is controlled by the central and peripheral nervous system, including both afferent and efferent mechanisms.

Factors affecting flexibility: Resistance training

Exercise through a full ROM and develop both agonist and antagonist muscles to prevent loss of ROM.

Factors affecting flexibility: Muscle bulk

Large muscles may impede joint movement.

Factors affecting flexibility: Activity level

An active person tends to be more flexible than an inactive one, but activity alone will not improve flexibility.

Flexibility Improvements

1. Acute effects of stretching on ROM are transient

2. For longer-lasting effects, a stretching program is required.

3. 2 sessions per week for 5 weeks minimum; Poses held at mild discomfort for 15-30 seconds

When should you stretch following practice and competition?

stretching should be performed within 5-10 minutes after practice. post-practice stretching may also decrease muscle soreness (although evidence is ambiguous)

When should you stretch as a separate session?

Stretching should be preceded by thorough warm-up to allow for increase in muscle temp (necessary for stretching) and can be useful as a recovery session day after a competition

Flexibility: Proprioceptors - Stretch Reflex

Occurs when muscle spindles are stimulated during a rapid stretching movement and can limit motion so should be avoided.

Flexibility: Proprioceptors - Autogenic inhibition

Accomplished via active contraction before a passive stretch of the same muscle, result from stimulation of Golgi Tendon Organ which causes reflexive muscle relaxation

Flexibility: Proprioceptors - Reciprocal Inhibition

accomplished by contracting the muscle opposing the muscle that is being passively stretched, result from stimulation of Golgi Tendon Organ which causes reflexive muscle relaxation

Static Stretching

This method moves to the point in t he ROM where you experience a sensation of mild discomfort where movements are slow and constant with the end position help for 15-30 seconds.

Ballistic Stretching

This method typically involves active muscular effort and uses a bouncing-type movement in which the en d position is not held. It can increase injury risk and is best avoided even with effective increase of ROM.

Dynamic Stretching

This method is functionally based exercise that uses sport-specific movements to prepare the body for activity, carried out in 5-10 reps per movement with an increase in ROM each rep. Speed of motion is increased on subsequent sets when appropriate and active control of muscular actions as you move through the ROM.

Dynamic Stretching

Proprioceptive neuromuscular facilitation (PNF) Stretching

Hold Relax, Contract Relax, and Hold-relax with agonist contraction are all techniques used in this advanced stretching method to enhance flexibility by alternating between contracting and relaxing muscles.

Hold Relax

Type of PNF stretching that involves a hold followed by a relaxation phase to improve flexibility.

• Passive prestretch (10 sec)

• Isometric hold (6 sec)

• Passive stretch (30 sec)

Contract Relax

Type of PNF stretching to facilitate muscle relaxation and increase flexibility by engaging the muscle being stretched.

• Passive prestretch (10 seconds)

• Concentric muscle action through full ROM

• Passive stretch (30 seconds)

Hold-relax with agonist contraction

Best form of PNF stretching that combines hold-relax techniques with contraction of the opposite muscle.

• Passive prestretch (10 seconds)

• Isometric hold (6 seconds)

• concentric action (30 seconds)

The hold-relax with agonist contraction is most effective PNF stretching because…

It facilitates both reciprocal and autogenic inhibition