Notes on Principles and Phases of Rehabilitation

Avoid aggravation: Do no further harm to the injury.
Timing: Starts as soon as safely possible.
Compliance: Explain to the patient the rehab process and expected outcomes.
Individualization: Adapt programs to account for individual differences in responses.
Specific sequencing: Follow the body’s physiological healing response for rehab progression.
Intensity: Challenge the patient without aggravating the injury—requires knowledge of tissue healing stages.
Total patient approach: Address all areas of fitness, not just the injured site (e.g., cardiovascular, joint ROM, strength).

Evaluated based on pain reported and extent of physical damage.
Higher severity means more cautious exercise choices are necessary, with slower progression.

Refers to how easily symptoms are aggravated by activity.
High irritability: Mild activity reproduces significant symptoms that last long.
Low irritability: Symptoms only emerge with more intense activity, subsiding quickly.

Relates to the medical diagnosis and history—important for understanding the trauma type (e.g., repetitive strain vs. major injury).

Relates to phases of inflammation, tissue repair, and recovery.
Exercise management varies with these stages and can be initiated at any time depending on clinical judgment.

Goals:
- Protect the healing site and restore pain-free range of motion (ROM).
- Enhance comfort by decreasing pain and inflammation.
- Minimize detriment from immobilization.
- Encourage independence with home exercise programs.

Increase tissue load tolerance, address biomechanics, and maintain general condition.
Incorporate mechanotherapy and unload injured tissues.

Emphasis on ingraining new movement patterns, maintenance, and recovery strategies.

Role of range of movement rehabilitation is significant in amplifying recovery.
Four key parameters impacted by injury: Force, Range/Length, Velocity, and Endurance.

Osteoporosis results in faster breakdown of old bone than formation of new bone, increasing fracture risk.

Conducted through DXA scans focused on hip and spine, with assessment using T-scores.

Exercise stimulates bone resorption, formation, and other adaptations to improve bone density and structure.
Key loading characteristics:
1. Dynamic loading over static loading (cyclic rather than continuous).
2. High bone strains to induce adaptive responses.
3. Rapid application of load.

For healthy individuals: High-intensity (80-85% 1RM) exercises including running, jumping, and weight training (4x per week, 30 mins).
For frail individuals: Lower-intensity balance and weight-bearing exercises (2x per week, 30 mins).

Low-risk: Normal bone mass, no risk factors.
Moderate-risk: Low bone mass with some risk factors.
High-risk: Osteoporotic patients with previous fractures and multiple risk factors.

Implement balance training pre-aerobic exercises if gait is impaired.
Prescribe resistance training to combat muscle weakness.
Adapt activities to avoid high-risk movements, ensuring safety measures are in place to prevent falls.
Focus on strong sitting/standing posture and avoid spinal flexion or twisting movements during exercise.

Groups to develop rehabilitation programs for two patients, considering specific needs, intensity, and type of activity.

Understanding the principles, phases, and management strategies can optimize rehabilitation outcomes for patients with acute injuries and conditions like osteoporosis. Special attention should be given to individual differences and the psychological aspects of recovery.

Beck, B., et al. (2017). Exercise and Sports Science Australia position statement on exercise prescription for osteoporosis management.
Blaise Dubois, and Jean-Francois Esculier. Soft-tissue injuries management. Br J Sports Med 2020; 54:72-73.