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Key principles of rehabilitation

Ortho teaching 2015

D Morrissey NIHR/HEE Consultant physiotherapist and Clinical Reader

Sports and Exercise Medicine, QMUL

Learning outcomes

For each participant to have: •  An overview of the rehab process •  A structure for understanding the

rehabilitation process •  Considered the fundamentals of a

rehabilitation process for injured ‘athletes’ •  Why?

– Better understand patient progress – Understand quality care

FIRST - Bubbles

Overview

Workshop

Pain control Training principles

Stages S.A.I.D.

Psychology

Kinetic chain

Motor control

Movement patterns

Estimated reps to failure

Time under tension

Intensity Periodisation

Structure of programme

Modes Machines

Occlusion therapy

Transference

Groups

Protocols

Core stability

H.A.R.M. Inflammation Risks and

complications

Prevention

Rest and recovery

Supplements P.R.I.C.E.R

Functional testing

Return to sport

Diagnosis and grade

Anatomy Co-morbidities

Goal setting Grieving process

Locus of control

Psycho-social factors

Miscellany

Tissue adaptation

Proprioception

ROM

Sports specificity

Special groups

Hydrotherapy Muscle balance Art vs

science

Evidence Muscle stim

MDT Maintain CV

fitness

taping

Manual therapy

Medication

Tickets to treatment

Acupuncture

Injection Electrotherapy

Overview

Workshop

Pain control Training principles

Stages S.A.I.D.

Psychology

Kinetic chain

Motor control

Movement patterns

Estimated reps to failure

Time under tension

Intensity Periodisation

Structure of programme

Modes Machines

Occlusion therapy

Transference

Groups

Protocols

Core stability

H.A.R.M. Inflammation Risks and

complications

Prevention

Rest and recovery

Supplements P.R.I.C.E.R

Functional testing

Return to sport

Diagnosis and grade

Anatomy Co-morbidities

Goal setting Grieving process

Locus of control

Psycho-social factors

Miscellany

Tissue adaptation

Proprioception

ROM

Sports specificity

Special groups

Hydrotherapy Muscle balance Art vs

science

Evidence Muscle stim

MDT Maintain CV

fitness

taping

Manual therapy

Medication

Tickets to treatment

Acupuncture

Injection Electrotherapy

Overview

Pyramid

1.  Return to activity 2.  Tickets to treatment 3.  Motor relearning 4.  Sports-specific

agility drills 5.  Flexibility 6.  Muscle conditioning 7.  Proprioception 8.  PRICER / HARM

Overview

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Aim of rehabilitation

The goal of a rehabilitation programme is to return the person to an optimal activity level

without further injury or restriction of activity

Overview

Rehabilitation structure at BH NHS trust

•  Clear format •  Home exercises

–  Video? –  Paper –  Online resources

•  Gym-based sessions •  Committed to completing the

process

Diagnosis and assessment ò

Manual therapy treatment and home exercise / ergonomics

ò +/- ‘tickets’

ò Rehabilitation

Initial programme teaching Groups with individual programmes

ò Late stage

Return to training Return to sport

Liaison Testing (IKD, sports specific,

functional tests)

Overview

Independence

Phases

•  Early / middle / late – Based on goal attainment

•  Acute / sub-acute / chronic –  Inflammatory / repair / remodelling –  Post –injury model

Overview

Phases: WB proprioception and … Phases: WB proprioception and …

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Phases: WB proprioception and … Phases: WB proprioception and …

Eg Tendinopathy recovery

Time 0 2 4 6 8 10 12 14 16 18 20 22 24 weeks

Hig

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in lo

w fu

nctio

n ……

.…. N

o pa

in, h

igh

func

tion

Plateau or failure to improve

Proprioception challenge

•  Static •  Conscious •  High base of support •  Eyes open •  Abstract

Dynamic Automatic Lower Closed? Functional

SAID

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Sports specificity

•  Transference –  psychology, visualisation, cerebllar connections,

cognitive to automatic –  Eg Gymnast with pars lesion

SAID

Risk phase

SDL 1: Brukner and

Khan: Clinical Sports

Medicine 2: MDT visits

Overview