KIN 3339 - rehab concepts and special topics in athletic training exam 1 Questions with 100% correct answers + detailed rationales

What are SMART goals?

specific, measurable, attainable (action), realistic, time bound

What is Rehab? What is the goal? What does Rehab entail?

- The process of treatment and education that helps disabled people to attain maximum function, a sense of well-being, and a personally satisfying level of independence.

- WHO Definition: A set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments.

How should we as clinicians act when conducting a rehab? Why?

- Professionalism

- Abiding by ethical standards (e.g. NATA Code of Ethics)

- Abide by legal standards (e.g. state regulations)

- we are expected to be professional. That includes looking like a professional and acting like a professional. Dressing appropriately for the job as well as conducting ourselves in an appropriate manner.

- And being involved in professional organizations is also vital to being a professional. Stay up to date on continuing education and EBPs

what is SOAP Notes?

format used to document an evaluation of a patient

S: subjective data

O : objective data

A : assessment

P : plan of action

Objective Component of the Evaluation

Data from objective:

•Finite measures that are readily reproducible regardless of individual collecting the information

•Provides baseline measures for reevaluations and rehab protocols

Clinical Purpose:

•Determine Diagnosis

•Create Asterisk Signs

⚬Measure patient's condition and progress

Rehabilitative Purpose:

•Identify impairments and functional limitations

Posture abnormalities: the Spine (lumbar, thoracic, cervical)

LUMBAR

Lordosis

•Excessive is >40 degrees

•Anterior Pelvic Tilt

•Overactive hip flexors and low back extensors

•Weak abdominals, glutes, hamstrings

•Increased difficulty in diaphragm inhalation

THORACIC

Flat Back

•Hyperactivity in erector spinae and scapular protractors

•Weakness in scapular retractors and posterior rotator cuff

Kyphosis

•Excessive rounding of thoracic area

•Shortened pectoralis and intercostals

•Lengthened erector spinae, rhomboids, and trapezius

•Protracted scapulas

•Can lead to Thoracic Outlet Syndrome

Scoliosis

•Lateral or Rotational curve of the spine

•Cause muscle fatigue and increased ligament stress and impingement of the nerve roots

•May be corrected

CERVICAL

Forward Head Posture

•Upper Crossed Syndrome

•May increase

⚬Irritation to cervical disk

⚬Nerve root pressure

⚬Risk of impingement

•Can lead to

⚬Dowager’s Hump

⚬Temporomandibular joint disorders

Posture abnormalities: the Hip

Coxa Valga

Higher risk of hip arthritis (170 degrees)

normal position 125 degrees

Coxa Vara

Higher risk for femoral neck fractures (100 degrees)

Abnormal Hip Rotation

Anteversion

Hip IR, decreases joint stability

Retroversion

Hip ER, increases joint stability

Posture abnormalities: the Feet

Tibial Torsion

•Leg looks rotated relative to thigh

•Usually lateral torsion

•Patient is supine with patella facing upwards

•Line bisects the medial and lateral malleoli

•The angle from that line to horizontal line is measured

•Angles greater than 20-25 degrees is positive sign

Abnormal Arch Alignment

Pes Planus (flat foot)

Foot Pronation & Calcaneal Eversion

Associated with genu valgum and Femoral anteversion

Pes planus is usually hypermobile, so we have more excessive rearfoot and forefoot motion during gait. Places excessive stresses on soft-tissue structures during power and agility activities.

Pes Cavus (high arch)

Foot Supination

Associated with hammertoes and Femoral retroversion

Pes Cavus produces less mobility of the rearfoot and forefoot. It's ability to absorb stresss is decreased, so the probability for stress fractures is increased

Posture abnormalities: the Knees

Genu Varus (bowleggedness)

Can be related to high arches

Genu Valgus (knock knees)

Can be related to excessive foot pronation

Step Length vs Step Width vs Stride Length

Stride Length

Distance from heel strike of one foot to heel strike of same foot in one cycle

Step Length

Distance from heel strike of one foot to heel strike of the other foot in one cycle

Stride Width

Distance between midline of one foot at midstance and the midline of the other foot at midstance

Purpose of Palpation and Special Test

palpation

•Detect tissue damage

•Identify areas of point tenderness

special tests

Confirm or Rule Out a Suspicion

Specific procedures applied to specific tissues in various ways

Described as Positive (+) or Negative (-)

Ex. O’Brien’s, Lachman’s, Talar Tilt

Active AROM

Active AROM

•Assess first

•Can they move it?

⚬Quantity/Quality

⚬Compensatory patterns?

Should be tested before PROM unless contraindicated

•Patient moves body through ROM

•Bilateral (Uninjured side first)

•Observe for Regional Interdependence

measurements

Subjective: Normal, WNL, or limited compared bilaterally

Objective: Goniometric measurement

What can cause abnormal AROM?

Pain

Muscle weakness

Spasm

Paralysis

Tight / shortened muscles

Joint injury

Limited neuromuscular control

Painful Arc- Represents compression, impingement or abrasion of the underlying tissues

passive PROM

Passive PROM

•Assessed second

•Can I move it?

⚬Quantity?

⚬What provokes pain?

•Clinician moves the patient through ROM

•Assessing the intra-articular barrier

•Only stressing the non-contractile structures since muscles are relaxed

•When the end of the available range is reached, pressure (overpressure) is applied in order to determine the end feel

PROM End Feels (soft, firm, hard)

End Feel: soft; Before complete ROM, feels boggy

structure: Soft Tissue Approximation

EX: Soft Tissue edema, Synovitis

end feel: Firm; Before complete ROM

structure: 1.Muscular Stretch 2.Capsular Stretch 3.Ligamentous Stretch

EX: Hypertone, soft tissue shortening

end feel: Hard; Bony grating/Bony Block

structure: Bone to Bone

EX: Arthritis, loose bodies

Empty: No end feel, pain prevents full ROM

EX: inflammation

Manual Muscle Testing Purpose and Grading

Important to compare bilaterally!

•Is there break away weakness?

•Is there gross weakness?

What is normal for this patient?

•Consider age and ability and contributing pathology

Procedure

•Position against gravity

•Ask PT to perform AROM

•Then position at midrange and hold position

Evidence Based Practice

•Results from the history and functional assessment can reduce the number of tests to be performed

⚬Example: Symptom is gradual onset

￭No need to perform acute fracture special tests

•Crucial to providing optimal care

•Clinician’s skills and experience

•Reliable research investigations

•Patient’s needs, goals, and priorities

•Efficient: Eliminate time wasted performing unnecessary special tests

•Accurate: Eliminate false positives

Phases of Healing

Phases of Healing

Hemostasis Phase:

Begins immediately, Lasts up to 3 days

•Shortest healing phase

•Stops blood flow originating the damaged vessels from flowing into the injury site

•3 steps

⚬Vasospasm

⚬Primary Hemostasis

￭Platelet Plug

⚬Secondary Hemostasis

￭Fibrin Plug

Inflammation:

•Begins once clot is formed

•Lasts 2-10 days

•Necessary “evil” (Needs control)

•Process of Debridement

⚬Chemicals released to:

￭Destroy damaged microorganisms

￭Remove the debris

5 Cardinal/Clinical Signs

Begins immediately, Lasts 2-10 days

Proliferation:

•Duration is 2-4 weeks***

•Overlaps with Inflammation and Remodeling Phase

•Angiogenesis and granulation are formed

•Type III collagen is laid down almost haphazardly

•Increase in fibroblasts; reduced Leukocytes

•Clinical Signs

⚬Redness from increased number of capillaries

⚬Swelling from increased capillaries and water volume

⚬Pain from pressure-sensitive nerve endings

Day 3 - Week 6

Remodeling:

•Can last 6-18 months

•Wound matures and converts to scar tissue

•Type 1 Fibers replace Type III Fibers

•Reduction in fibroblasts, macrophages, and capillaries

•Scar tissue gains tensile strength through completion of healing process

•Clinical signs

⚬Reduced redness

⚬Reduced edema

Reduced pain

Day 7 - over a year

Cardinal Signs of Inflammation

Heat, redness/discoloration, swelling, pain, and loss of function

Tensile Strength

•Original stress that tissue could withstand decreases up to 50% during inflammation phase

•During the first 5 days, the strength of the injured site is weak, because it's given from the injured area

•At day 5, tensile strength increases and continues to increases as collagen arrives and properly aligns

•Tensile strength may take up to a year to attempt to reach maximum, but will still remain below pre-injury strengths

Factors impacting healing

oxygen:

Increased need for oxygen

Poor vascular status may develop into chronic or unhealed

Surgical Repair Techniques

Injured Size

Infection

Nutrition

Muscle Spasm

drugs:

Beneficial or harmful

Absorption and Interactions

NSAIDS

•Detrimental for fractures and chronic inflammation

•Inhibits prostaglandin production, which then reduces local nociceptors and vascular permeability

•Can cause GI issues

age

swelling

3 R's of Rehab

Relieve Symptoms

- Initial efforts aimed towards relieving the signs and symptoms that occur

- Modalities & Therapeutic Exercise

Restore Deficiencies

- Begins once injury advances from inflammation stage to proliferation stage

- Modalities & Therapeutic Exercise

Return to Function

- Occurs in later proliferation and re-modeling phase to regain pre-injury function

- Therapeutic Exercise

what does ATC IS IT stand for? NEED TO KNOW

Avoid Aggravation: Do no harm using knowledge of phase of healing

Timing: phase of healing

Compliance: Empower the patient, so they buy into the program

Individualization: Physiological, biochemical,

biomechanical, non-physical

Specific Sequence: Refer to the Rehab Pyramid

Intensity: Progress from: easy to hard, closed to open chain,

low to high impact

Total Patient: Cardiovascular & un-injured pair considerations

Phases of Rehab

Inactive phase (inflammation phase)

Clinician Goals/Aim:

Relieve Pain, Edema, Muscle Spasm

Protect injured tissue

Prevent deconditioning

Therapeutic Actions

Refrain from exercise

Use of modalities

Manual Therapy

Assist with controlling the Inflammation

active phase (proliferation phase)

Clinician Goals/Aim:

Restore Range of Motion and Mobility

Therapeutic Actions

Modalities as needed

Stretches

Manual Therapy

Advance from PROM -> AROM

Initiate Balance and Coordination

Eventually add resisted exercises

resistive phase (Proliferation and Remodeling

Phases)

Clinician Goals/Aim:

Restore muscle strength and endurance, proprioception, and agility

Therapeutic Actions

Strength exercises

(Progress from straight plane to diagonal plane)

Continue flexibility routine

Proprioception and agility

advanced phase (Remodeling Phase)

Clinician Goals/Aim:

Restore to optimal performance

Resume all pre-injury participation

Maintain flexibility and strength

Therapeutic Actions

Plymometrics

Functional Exercise Progression to Performance Exercises

Immobilization

- There are soft tissue changes. It can cause the Type I Collagen Fibers to produce a dense meshwork, which limits tissue mobility

Pros

•Decrease pain

•Stabilize joint

Cons

•Decrease in activity can cause loss of:

⚬Muscular Strength and Endurance

⚬Oxygen capacity and decreased blood flow

⚬Coordination

•Decrease in Range of Motion and Mobility

⚬Leads to increase of collagen binds and scar tissue

⚬Increased risk of atrophy

Fat infiltrates the muscle

Components of Rehab

Progress from one step to the next throughout the rehab

Remember to evaluate at each step to adapt the rehab program to determine patient's goals and outcomes

Therapeutic Goals of Phases of Rehab and Healing

Therapeutic Modalities:

•Tools used in conjunction with rehabilitation

•Assists in reaching particular goal

•Considerations of Modalities

⚬What’s the treatment site? How will modality affect the tissue and/or structure?

⚬What are the indications/contraindications?

￭Is it appropriate? Will it do harm?

⚬What is the protocol to administer treatment?

Therapeutic Interventions to Improve Flexibility & ROM:

Manual Therapy: Alter connective tissue to improve ROM, reduce spasm and pain, increase blood flow

Stretching: Increase flexibility through various techniques to promote increased stretch tolerance

Facial Mobilizations:

Manipulation of mature collagen fibers to stretch and lengthen the fascia

Sports Psych Techniques

•Arousal Regulation

•Goal Setting

•Imagery

•Pre-Performance Routines

•Self-Talk

Barriers to Recovery

fear of re-injury, low self-efficacy, negative self-talk, lack of social support, poor coping mechanisms, anxiety about returning to play, depression, denial of injury severity, perfectionism, and negative expectations about recovery

Kubler Ross cycle AKA Grief Cycle

denial > anger > bargaining > depression > acceptance

Psychology Coping Skills

Distraction:

Pros:

•Gives your heart & mind a break

•Great for short term relief

Cons:

•Can’t do it for very long or in every situation

•Doesn’t resolve the issue

EX: Talk to friend, read, puzzle, doom scroll, watch tv, play a game, clean, learn something new, arts & crafts

Grounding:

Pros:

•Helps slow/stop numb feeling

•Reduces physical anxiety

•Increases relaxation

Cons:

•Sometimes brain needs to stay busy or distracted

EX: Use the 5 senses.

Take a breath, smell the air, feel the ground, what sensations are you experiencing?

Emotional Release:

Pros:

•Great for anger & fear

•Releases the pressure of overwhelming emotions

Cons:

•Can’t always do depending on where you are or who you’re with

EX: Scream into pillow, cold shower, punch a pillow, throw a ball around

Psychology Coping Skills pt.2

Self-Care:

Pros:

•Great for feelings of guilt or shame

•Recharges batteries

•Much deserved

Cons:

•Sometimes can feel hard to do or feels superficial

EX: Do something you enjoy, make your favorite meal, massage, clean space, write in journal, take a nap

Golden Rule:

Pros:

•Reminds us everyone has value & purpose can be found in everyday things

Cons:

•Don’t get stuck trying to save everyone and forget about yourself or have kindness used against you.

EX: Help someone else, smile, pray or meditate, volunteer, random acts of kindness, play with your pet, join a club

Thought Challenge:

Pros:

•Can help shift thinking to positive habits

•Focusing on logic can help reduce extreme emotions

Cons:

•May be more difficult if more emotional- may need another strategy first

EX: Write negative thoughts and list reasons why they may not be true. If a friend had this though, what would you tell them? For every negative, write two positives

Mindfulness Acceptance Commitment Theory (KNOW THE 6 CORE PRINCIPLES!)

Accept what is out of your control and commit to an action which improves and enriches your life

Teaches skills to effectively deal with painful thoughts and feelings to lessen the impact and influence over you

Clarifies your values and priorities, and uses that knowledge to guide, inspire, and motivate you

6 core principles:

Cognitive Diffusion, Acceptance, Contact with Present Moment, Observing Self, Values, Committed Action

Motivation intrinsic vs. extrinsic

Intrinsic:

Self-esteem and self-confidence

I want to play/I love the game

Who am I if I don’t?

Extrinsic:

Playing for your parents not yourself

Coaches/media/fame

Scholarships/NIL/$$$

Maslow's Hierarchy of Needs

psychological needs (food, water, warmth, rest)

safety needs (security, safety)

belongingness and love needs (intimate relationships, friends) esteem needs (prestige and feeling accomplishment)

self actualization needs (achieving ones full potential, including creative activities)