chapter

22Rehabilitationand Reconditioning

Chapter Objectives

• Identify members of the sports medicine team and their responsibilities during injury rehabilitation and reconditioning.

• Recognize types of injuries athletes sustain. • Comprehend timing and events of tissue healing.• Understand goals of each tissue healing phase.• Describe the strength and conditioning profes-

sional’s role during injury rehabilitation and reconditioning.

Rehabilitation and Reconditioning

• Principles of Rehabilitation and Reconditioning– Healing tissues must not be overstressed.– The athlete must fulfill specific criteria to progress from

one phase to another during the rehabilitative process.– The rehabilitation program must be based on current

clinical and scientific research.– The program must be adaptable to each individual and his

or her specific requirements and goals. – Rehabilitation is a team-oriented process requiring all the

members of the sports medicine team to work together.

Sports Medicine Team

• Sports Medicine Team Members – All members of the sports medicine team are

responsible for educating coaches and athletes regarding injury risks, precautions, and treatments.

– The sports medicine team also works to prevent injuries and rehabilitate injured athletes.

– Several different professionals play important roles in assisting an injured athlete’s return, so effective communication is necessary.

Key Terms

• team physician: A person that provides med-ical care to an organization, school, or team.

• athletic trainer: A person typically responsible for the day-to-day physical health of the athlete; certified by the National Athletic Trainers’ Association Board of Certification as a Certified Athletic Trainer (ATC).

Key Terms

• physical therapist: A person with a back-ground in orthopedics or sports medicine that can play a valuable role in reducing pain and restoring function to the injured athlete.

Key Terms

• strength and conditioning professional:A person who plays a valuable role within the sports medicine team and is an integral part of the rehabilitation and reconditioning process. Ideally, this person should be certified by the National Strength and Conditioning Association (NSCA) Certification Commission as a Certified Strength and Conditioning Specialist (CSCS) to ensure that he or she has the knowledge and background to contribute to the rehabilitation process.

Key Terms

• exercise physiologist: A person who has a formal background in the study of the exercise sciences and uses his or her expertise to assist with the design of a conditioning program that carefully considers the body’s metabolic response to exercise and the ways in which that reaction aids the healing process.

Key Terms

• nutritionist: A person who has a background in sport nutrition may provide guidelines regard-ing proper food choices to optimize tissue recovery. Ideally, the nutritionist has been formally trained in food and nutrition sciences and is a Registered Dietitian (RD) recognized by the American Dietetic Association.

Key Terms

• psychologist or psychiatrist: A licensed professional with a background in sport may provide strategies that help the injured athlete better cope with the mental stress accom-panying an injury.

Sports Medicine Team

• Communication– Strength and conditioning professionals must

understand the following:• The diagnosis of the injury• Indications—forms of treatment required• Contraindications—activity or practice prohibited

due to the injury– They must also inform the rest of the sports

medicine team about the exercises performed by the athlete and the athlete’s response to the exercise.

Key Point

• The sports medicine team includes a large number of professionals working together to provide an optimal rehabilitation and reconditioning environment. The relation-ship among members requires thoughtful communication to ensure a safe, harmoni-ous climate for the injured athlete.

Types of Injury

• Macrotrauma: A specific, sudden episode of overload injury to a given tissue

• Dislocation: A complete displacement of the joint surfaces

• Subluxation: A partial displacement of the joint surfaces

• Sprain: Trauma to a ligament, classified as 1st, 2nd, or 3rd degree depending on severity

(continued)

Types of Injury (continued)

• 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

• Microtrauma: An overuse injury caused by repeated, abnormal stress applied to a tissue by continuous training or training with too little recovery time

(continued)

Types of Injury (continued)

• Stress fracture: The most common type of overuse injury that occurs in bones

• Tendinitis: An overuse injury that results in inflammation of a tendon

Tissue Healing

• All tissues follow the same basic pattern of healing:– Inflammation– Repair– Remodeling

(continued)

Tissue Healing (continued)

• The timing of events within each phase of tissue healing differs for each tissue type and is affected by a variety of factors:– Age– Lifestyle– Degree of injury– The structure that has been damaged

Key Point

• The process of returning to competition following injury involves – Healing of the injured tissues– Preparation of these tissues for the return to function– Use of proper techniques to maximize rehabilitation

and reconditioning

Table 20.1

Tissue Healing

• Inflammatory response phase– Inflammation is the body’s initial reaction to injury

and is necessary for normal healing to occur.– The injured area will become red and swollen.

• Fibroblastic repair phase– Once the inflammatory phase has ended, tissue

repair begins; this phase allows the replacement of tissues that are no longer viable following injury.

– This phase of tissue healing begins as early as 2 days after injury and may last up to 2 months.

(continued)

Tissue Healing (continued)

• Maturation–remodeling phase– The weakened tissue produced during the repair

phase is strengthened during the remodeling phase of healing.

– Tissue remodeling can last up to 2 to 4 months after injury.

Key Point

• Healing tissue must not be overstressed, but controlled therapeutic stress is necessary to optimize collagen matrix formation. The athlete must meet specific objectives to progress from one phase of healing to the next.

Rehabilitation and Reconditioning Strategies

• Goals of Rehabilitation and Reconditioning– Choose a level of loading that neither overloads

nor underloads healing tissue.• Healing tissue must never be overstressed.• But, controlled therapeutic stress is needed to

optimize collagen matrix formation.– The athlete must meet specific objectives

(established by the physician, athletic trainer, physical therapist, or a combination of these) to progress from one phase of healing to the next.

Goals of Rehabilitation and Reconditioning

• Inflammatory response phase– Treatment goal

• Preventing disruption of new tissue– Exercise strategies

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

(continued)

Goals of Rehabilitation and Reconditioning (continued)

• Fibroblastic repair phase– Treatment goal

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

– Exercise strategies (after consultation with team physician, athletic trainer, or physical therapist)

• Submaximal isometric exercise• Isokinetic exercise• Specific exercises to improve neuromuscular control

Goals of Rehabilitation and Reconditioning (continued)

• Maturation–remodeling phase– Treatment goal

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

– Exercise strategies• Transition from general exercises to sport-specific

exercises• Specificity of movement speed an important variable• Velocity-specific strengthening exercises (velocities

must progress to those used in the athlete’s sport)

Figure 20.3Loading During Rehabilitation

Figure 20.4Soft Tissue Injury Response

• Pain is often used as a guide for tissue health.• Pain levels often decrease well before tissue healing is

complete, which may lead athletes to believe they can return to competition before the body is actually ready.

Figure 20.5a and bRotator Cuff Rehabilitation

• Exercises generally transition from– (a, b) isolation exercises to (c, d) multijoint, sport-specific exercises.

Key Term

• closed kinetic chain: An exercise in whichthe terminal joint meets with considerable resistance that prohibits or restrains its free motion; that is, the distal joint segment is stationary. Typically a weight bearing exercise.

Figure 20.6Closed Kinetic Chain ExercisesSquat (a) and Push-up (b)

Key Term

• open kinetic chain: An exercise that uses a combination of successively arranged joints in which the terminal joint is free to move; open kinetic chain exercises allow for greater concentration on an isolated joint or muscle.

Figure 20.7Open Kinetic Chain Exercise

(Seated Knee Extension)

Figure 20.8Kinetic Chain: Sprinting

• Sprinting offers an example of open and closed kinetic chain movements occurring together.

Rehabilitation and Reconditioning Strategies

• Program Design – Resistance Training

• Several programs have been developed to assist with the design of resistance training programs for injured athletes, including the De Lorme and Oxford programs and Knight’s DAPRE (Daily adjustable progressive resistive exercise) program.

• DAPRE allows more manipulation of intensity & volume.• The demands of the athlete’s sport determine the

training goal, which should dictate the design of the resistance training program during the remodeling phase.

Rehabilitation andReconditioning Strategies

• Program Design – Resistance Training

• (DAPRE) system– First set requires 10 repetitions of 50% of the estimated

1RM.– Second set requires six repetitions of 75% of the

estimated 1RM.– Third set requires the maximum number of repetitions

of 100% of the estimated 1RM.– The number of repetitions performed during the 3rd set

determines the adjustment to be made in resistance for the 4th set.

Table 20.2

Rehabilitation andReconditioning Strategies

• Program Design– Aerobic and Anaerobic Training

• Although research has yet to determine an optimal aerobic training program for use in the rehabilitation setting, the program should mimic specific sport and metabolic demands.

Key Point

• Designing strength and conditioning programs for injured athletes requires the strength and conditioning professional to examine the rehabilitation and recondi-tioning goals to determine what type of program will allow the quickest return to competition.

Reducing Risk of Injury and Reinjury

• Previous injury is the most substantial risk factor for future injury in active individuals.

• Risk factors for upper extremity injury – Decreased glenohumeral ROM– Scapular dyskinesis– Decreased shoulder strength

(continued)

Reducing Risk of Injury and Reinjury (continued)

• Risk factors for lower extremity injury – Decreased balance– Decreased neuromuscular control during jump

landing– Decreased lower extremity muscle strength

• Structured programs should be specific to sport demands.