Rehabilitative Process

Neuromuscular control

Neuromuscular control

-Utilization of mechanoreceptors Repetition to understand specific motor patterns or movements -More complex or functional the movement pattern is the more beneficial to the athletes return is known as-

A kinetic chain is a linked system of-

-Rigid bodies -Human body

AAROM

active assisted range of motion

Abdominal muscles-

-rectus abdominis -external oblique -internal oblique, transversus abdominis

Accessory motion refers to the-

manner in which one articulation surface moves relative to another -Must be normal to allow for full range of physiological motion -If restricted normal physiological movement will be restricted

AROM

active range of motion

As we do isotonic actions, what's more important?

-Eccentric action is important and found to be better in early healing process -Enhance the eccentric action

Balance-

Ability to maintain equilibrium by controlling COM within the base of support

Body's stabilization system had the function to optimally to-

effectively utilize the strength of prime movers

Both accessory and physiological occur-

simultaneously and ultimately work together to optimize joint ROM

Center of mass

-Base of support dependent on how feet are planted on the ground

CKC later as strength develops in the injured area-

-Typically higher overall forces on the system and requires proper coordination level (neural, muscular, and segmental coordination) -Higher compressive forces, typically lower shear forces

Closed Kinetic Chain-

-Terminal segment is fixed -During landing the foot that lands on the ground is fixed to the ground -Push up

Contract-Relax

-Passively moved until resistance is felt

• Patient contracts isometrically against resistance for 10 seconds or until fatigue

• Patient relaxes for 10 seconds and then limb is pushed to a new stretch

Contracture of connective tissue or resistance to stretch of musculotendinous unit =

decreased ROM

Contracture or fibrosis can cause issue where ?

within both physiological or accessory motion

Controlling pain

-Some degree of pain will experienced -Pain will be dependent on the severity of the injury athletes response, percentage of pain -Pain can interfere with rehab and must be addressed throughout the rehab -Pain spasm pain cycle

Coordination relies on-

feedback and feed forward

Coordination-

Smooth pattern of movement is produced through recruitment of muscles acting together with appropriate timing and intensity

Core is defined as?

the lumbo-pelvic complex area where the center of gravity is located

does full function always return after an injury?

not always

Dynamic stability-

-Postural sway maintains static balance

• Dynamic rehab process create more dynamic stability to control the relative mass position to the base of support -Preparatory and reactive muscle characteristics -Conscious and unconscious functional and mother patterns

dynamic stretching is controlled by-

Rhythmic motion that brings a joint through a ROM

• have heavy involvement in strength and proprioceptive capabilities of muscle and joints -multiple short bouts of dynamic motion with increase ROM or movement achievement

Equilibrium-

state in which all competing influences are balanced

Establish how much active ROM an athlete has by-

-Utilizing PROM to move through as much pain free ROM -Stretching

Establishing or Enhancing Core Stability is a-

important component of all strengthening and comprehensive injury prevention program

Feedback

movement takes place and then sensory, visual, and auditory information interprets the results and then helps to make adjustments to correct the movement

Feedforward

Action produce is based on pervious knowledge and activity that provide that body with information that allows for accuracy and percision of movement

• helps body anticipate actions -Pre-activation

Flexibility

Ability of musculotendinous unit to elongate from a force causing a stretch

Following injury the body has lost the capability on-

how to integrate information coming into form multiple biological sources

Functional or Sport specific exercises-

Utilization of higher dynamic and higher force/output exercises based on sport

Great example is plyometrics-

-Utilizes the stretch shortening cycle to help enhance muscular capabilities ---Force and power output -Must have muscular capabilities to handle loads experienced during plyometrics activities -Highly dynamic and forceful activities place parge loads on tendon and joints

Hip muscles-

-Gluteus maximum -Medius( helps control the trunk and frontal plane on one leg balance, weak will create abduction of the stance leg) -Psoas

Hold-relax

• Patient moves until resistance is felt -Patient contracts isometrically against resistance for 10 seconds -Patient relaxes for 10 seconds and then limb is pushed to a new stretch

how are joints effected by immobilization?

• loss of normal compress leads to less lubrication causing generation

• cartilage deprived of normal nutrition leading to loss of articular cartilage

how are therapeutic exercises used to restore function in the body's natural healing process?

• each phase of healing has specific mechanisms

• important to understand which exercises to use during each phase

How do agonist and antagonist muscles impede joint of motion?

If agonist and antagonist are nit moving efficient it'll limit the active movement of its full range of motion

how do functional progressions improve the overall rehab process?

restore the normal function of tissue through ways the appropriately advance the athletes return to sport without hindering

how does holding muscle tension in a static position help reduce the effects of muscle immobilzation?

helps reduce the amount of atrophy and muscle fiber type conversion

how has prehab aided in post surgery outcomes?

• increased pre and post operative neural control or proprioceptive capabilities

• improved state of muscle strength and joint ROM

how is conditioning used to prevent injury?

improves performance of strength, power, and endurance for on field aspects while preventing injury

how is muscle effected by immobilization?

• loss of muscle mass due to atrophy especially in type 1 fibers

• decreased neuromuscular efficiency

• muscles develop less tension

how is the cardiorespiratory system affected by immobilization?

• resting HR increased about 1/2 beats per minute each day

• decrease in stroke volume, max oxygen uptake, and vital capacity due to increased HR

how long after physical inactivity or immobilization does an athlete out of sport see decreases in sport variables?

depends on the reduction of PA but physical fitness and strength decrease fast

how long can it take a ligament to fully remodel after immobilization?

12 months or more

how long does it take for aerobic and anaerobic capacities to decrease from inactivity?

about 2 weeks

How long does static stretching results last?

-Research shows that total flexibility reduced within 5-30 mins after stretching -Total ROM achieved is still greater than before capabilities

• Long term stretching can improve stretch/ROM

If muscle and tendon are impacting physiological movements then stretching may be employed to fix ROM issue in-

Flex/Extension Abduction/ Adduction Internal/ External Rotation

If the joint capsule or ligament issue/healing are limiting accessory motion what should be utilized?

Mobilization techniques to address capsular and ligamentous dysfunction

Individual and health care professional both move the joint through a range of motion when the individual doesn't have the active capabilities to produce the entire range of motion is known as-

AAROM

Individual relaxed extremity and allow for external force or person to move extremity through ROM ( used initially after injury depending on severity ) is known as-

PROM

Injury to a joint will always be associated with-

some loss of function

Isokinetic

-Movement of joint through fixed speeds -Incorporated in later stage of rehabilitative process before more dynamic closed kinetic chain exercises -Uses fixed speeds with accommodating resistance to improve maximal resistance throughout ROM -Isokinetic unit allow for calculation of torque, average power, and work

isometric

-No joint change in position -Maintain muscle length while tension is developed -Manual muscle tests of grades 1-2 -Start with desired positions that target weak muscles Performed in early part of rehab following period of immobilization -Used when resistance through full range or motion could make injury worse -Increase static strength work to decrease or limit atrophy create a muscle pump to decrease swelling

Isotonic

-Normal joint motion -Concentric and eccentric actions conducted in the movement -Utilizes muscle contractions to generate force while muscle changes length -Start with uniplanar motion and progress to multiplanar movements -Concentric and eccentric muscle contractions

Joint mobilization and traction

used to improve joint mobility or decrease pain by restoring accessory motion allowing for non restricted pain free ROM

Kinetic chain-

-Offers biomechanically efficient position for the entire kinetic chain

• A weak core is a fundamental problem of inefficient movements which leads to injury

Lumbar spine muscles-

-Transverspinalis -Erector spine -QL( connects ribs to pelvis) -Latissimus Dorsi

Manual Muscle Testing numerical/Point scales

5 Normal 4 Good 3 Fair 2 Poor 1 Trace 0 Zero

Manual Muscle Testing-

Test to determine the foundation of strength capabilities of person before addressing the programs of a patient

Mobility

ability of bony structures like joints to move through a ROM

Mobilization may be used to-

• Reduce pain -Decrease muscle guarding -Stretch or lengthen tissues surrounding a joint

• Produce reflexogenic effects that don't inhibit or facilitate muscle tone or stretch reflex

• All of this is neural system response

• can also be used in conjunction with traction

Neuromuscular control relies on-

the CNS to integrate all areas produce coordinated movement

OKC earlier-

-Can focus on singular joints or muscles to target -Reduced compressive forces but increased shear forces -Increased shear forces shouldnt be an issue unless doing high velocity movements, the higher the velocity the more shear stress placed on the system

Once extensive or chronic inflammation takes place what can occur ?

Excessive tissue damage

Open Kinetic Chain-

-Terminal segment of the chain is freely movable --Kicking a soccer ball --Dumbbell curl

People who feel better about how they move have-

less caution in highly dynamic motions

Physiological movement results from-

active voluntary muscle contraction -Moving an extremity through a ROM -Must go through more specific therapeutic exercise to extend or strengthen the muscles to go through a ROM

POLICE

protection optimal loading ice compression elevation

PRICE

protection rest ice compression elevation

PROM

passive range of motion

Propriception

• Mechanoreceptive or sensory information -Kinesthetic awareness of segmental/whole body motion and position -Increase body's awareness in space

Propriceptive neuromuscular facilitation-

Helps in promoting increase in flexibility, strength, and coordination

Regaining Balance-

-Involves complex integration of muscular forces, neurological sensory information from mechanoreceptors and biomechanical information -Entails positioning CoG within the base of support -If CoG extends beyond this base the limits of stability have been exceeded and a corrective step or stumble necessary to prevents -Even when motionless body is constantly undergoing constant postural sway

Restoring Function Through Therapeutic Exercises and Body's healing process-

Re-establishing neuromuscular control balance, and postural control

slow reversal hold relax

-Patient moves until resistance is felt -Patient contracts isometrically against resistance for 10 seconds -Patient relaxes for 10 seconds, relaxing the antagonist while the agonist is contracted moving the limb to a new limit

Stability-

the capacity of an object to return to equilibrium or to its original position after it has been displaced

The better a base of support the better-

The neuromuscular connection and control of balance and postural control there is

Traction

-pull articulating segments apart (joint separation )

• Occurs in perpendicular treatment plane

• Used to treat pain or joint hyphmobility

what are general effects of inactivity?

rapid loss of fitness for highly conditioned athlete appears more dramatic than normal population

what are the 8 phases of treatment?

• mobility

• flexibility

• proprioception

• muscular strength

• muscular endurance

• muscular power

• cardiorespiratory endurance

• sport specific function

what are the basic principles of strength that apply to rehab

• individuality

• overload

• specificity

• reversibility

• periodization

what are the effects on an athlete of reduced PA and increased immobilzation?

• reduced neuromuscular function

• reduced function of the damaged joint, ligament, or tendon

what are the major components of a rehab program?

• minimize swelling

• control pain

• re-establish neuromuscular control

• core stability

• range of motion

• muscular strength, power, endurance

• cardio respiratory endurance

• incorporating functional progressions

what are the nine components of swelling?

• minimize swelling

• control pain

• re-establish neuromuscular control

• core stability

• range of motion

• muscular strength, power, and endurance

• balance and postural control

• cardiorespiratory endurance

• funcional progressions

what can health care professionals do to help reduce the rate of detraining?

prehab and rehab

What does stretching do?

-Reduce stiffness -Reduce tonic reflex

• Increase tolerance to stretch -potential nervous system/pain response

• Nerve glides

What happens the more COM moves outside the base of support?

increase in injury

what happens to physical activity during the initial healing process?

reduction in PA for possible days to weeks to months or injury and immobilized based on severity

what happens when an injury occurs?

general loss of physical fitness and injured part from immobilization due to inactivity

What happens with the inability to control swelling?

the healing process will be prolong and increase/cause pain sensation

what is prehab?

use of therapeutic exercises or reconditioning aspects in exercise programs before onset of surgical intervention

what is the effect of short term immobilization?

shown to help the healing process during initial injury

what is the preoperative exercise phases?

• applies to those needing surgery

• exercise is used as a means to improve outcome post surgery

• minimizes or enhances components of the rehab program

what is the purpose of long term goals in rehab?

• return to work

• return to full competition

what is the purpose of prehab?

• reduce likelihood of sustaining an athletic injury

• mitigates loss of function post surgery

What is used to increase accessory ROM?

Joint mobilization and traction

what occurs during stage 1 of the exercise repair phase?

• acute inflammatory response

• low intensity exercises

• less dynamic exercises

• isometric actions

what occurs during stage 2 of the exercise repair phase?

• enhanced repair phase

• introduction of more dynamic exercises

what occurs during stage 3 of the exercise repair phase?

• maturation and remodeling phase

• highly dynamic exercises

• sports specific demands

• testing of strength, power, and more