Rehabilitation and Treatments

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Mark Harmsworth
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 Principles of Rehabilitation
z Prevention is better than z Effective planning
cure z Commences immediately
z Needs a whole body following injury and post
approach and is aimed return to activity
towards the individual z Must integrate a range of
z Aim is to return to sport therapeutic activities
with full function. There z Stages – initial,
is constant pressure to intermediate, advanced
facilitate the safe return and return to sport
to competition / activity z Look for and correct any
in the shortest time found biomechanical
possible
abnormalities
 Principles of Rehabilitation / Treatments
z Musculoskeletal injuries can z Psychology target
have immediate and z Return to sport skills
significant detrimental z Maintenance is often
effects on function required to prevent
z Must integrate a range of reoccurrence
therapeutic activities
z Soft tissue response,
muscle conditioning,
flexibility, neuromuscular
control and functional
exercises
 Proprioception
z Sensorimotor controls all z When proprioception
activities and enables an is poor, so will be
individual to maintain a biomechanical control
position (neuromuscular) z There is a real need
z Is a sensory feedback to restore early
proprioceptive input to
mechanism for balance the injured area
and control z Is not stressful to
z Body reacts to incoming healing tissue
information and the z Exercises varies to
feedback mechanism achieve aims
adjusts balance and
movement control
 Rehabilitation
z Motor control stability z Strength training – in
training, addresses relation to functional
altered patterns of muscle performance
recruitment and seeks to z ROM enhancement -
improve fine tune muscle small limitations can
coordination and improve have a profound
the efficiency of effect – best use
movement static stretching
exercises
z Example – trained using
z Fitness / endurance
slow sustained
contractions at low loads
 Treatments
z Clients should benefit z Immobilization first
from the appropriate and early mobilization
element of the available z Protected mobilization
treatments z Continuous passive
z The most important motion mobilization
time of acute STI is the and exercise therapy
first 24 – 48 hours z Heat used on longer
z RICE term injuries can be
z PRICE helpful in selected
z MICE conditions, but NOT on
new injuries
 Soft Tissue Massage / Therapy
z Sports massage therapy z Very underestimated
involves manipulation to the general sports
of soft tissue person
z Designed to assist in z Aims to enhance
correcting problems performance, aid
and imbalances in soft recovery and prevent
tissue, that are caused
from repetitive and injury
strenuous physical z Sports massage
activity / trauma practitioners need
qualification
z Can self massage
 Soft Tissue Techniques
z Neuromuscular
z Palpation technique (NMT)
z Stroking (effleurage) z Muscle energy
z Kneading (petrissage) technique (MET)
z Squeezing z Soft tissue release
z Friction (STR) – trigger points
z Rocking and shaking z Connective tissue
z Percussion manipulation (CTM) –
(tapotement) myofacial techniques
 Effects of Sports Massage Techniques
z Stretches soft tissue z Increases general / micro
z Relieves muscle tension blood circulation and
lymph flow
z Improves flexibility
z Increases oxygen and
z Reduces muscle spasm nutrients to soft tissue
z Improves formation of z Helps tissue flexibility and
scar tissue, adhesions
and fibrous tissue, interstitial permeability
created by scar tissue z Removes waste products
z Reduces swelling z Stimulates the nervous
z Relieves pain system
z Relieves tension / anxiety
 Soft Tissue Therapy Contraindications
z Acute soft tissue z Skin, tumours and other
inflammation (within cancers
48 hours) z Bleeding disorders
z Wounds / recent z Myositis ossificans
surgery z Caution in diabetics
z # / dislocations and z Caution in pregnant
joint injuries women
z DVT / Varicose veins z Cardiovascular type
z Infectious skin conditions
conditions
Diagnostic Musculoskeletal Ultrasound Scan
z Imaging tendons, z Real and short time,
ligaments, muscles and biofeedback advantage
other soft tissue e.g. z Has less graphic
achilles, patella, rotator images than other
cuff tendons, muscles methods though
thigh / calf, hamatoma z Larger structures good
formation, calcification, but not deep tissues
localizing foreign bodies
z MRI scan alternative
Ultrasound Therapy / Electro Muscle Stimulation
z Can help to speed up Therapeutic uses :-
the repair process of
soft tissue z Helps absorption of
z Therapeutic U/S of intercellular tissue fluid
1MHz = 1 million cycles z Increased blood supply
per second
z Analgesia effects
z Power in Watts
z Softens fibrous tissue
z Continuous (chronic) or
pulsed (acute or close z Other types – Tens,
to bone) as it reduces interferential stimulation,
heat and low level laser
z Effects – heat and
oscillation of particles
 Corticosteroids Injection Therapy
z Treatment of some z Kenalog / adcortyl
musculoskeletal disorders, corticosteroid are
usually given with a local normally used
anaesthetic z Lidocaine local
z Suppresses inflammation anaesthetic
z Breaks up inflammation normally used
damage – repair – damage z Most feared
cycle (bridge) complication is
joint sepsis
 Taping / Strapping
z Used for prevention, z Tape should reinforce
treatment, rehab and the normal supportive
proprioception structures in their
z The application of relaxed position
tape to injured soft z Should protect the
tissue / joints injured tissues from
provides support and further damage
protection z Functional fascial
z Minimizes pain and taping
swelling in the acute z Only has limited use
stage during active sport, as
it loses support quickly
 Other Treatments
z Glucosamine (500 mg +) z A combination of both
z Used in the body to form will help restore
new connective molecules synovial fluid and all
(help repair) the other effects
z It stimulates growth of z May take 2 months for
cartilage and hydrates benefits to be felt
tendons and ligaments z May reduce muscle
(protection) soreness
z Chondroitin (300 mg +) z Topical analgesics
z Keeps cartilage filled with usually acts as a skin
fluid, nourishing and counter-irritant
hydrating it z Topical anti -
inflammatory agents
 Develop Active Lumbar Stability
z 3 overlapping stages z Phase 2 (building core
z Phase 1 (muscle re- stability control)
education) z Heelside (hollowing),
z Voluntary control over plank (bridge) - lateral
stabilizing muscle (deep and prone
abdominals, gluteals, z Phase 3 (reduced
intersegmental muscle attention) impose spine
spine and multifidus alignment and muscle
z kneeling (four point) / stabilise to realign
prone lying abdo z Resistance training in
hollowing exercise gym, balance board and
swiss gym ball
 Types of Muscle Contraction
z Isometric – muscle works z Eccentric - muscle is
without movement happening stretched as it tries
i.e. muscle does not change to resist a force
length (stretching exercises) pulling the bones of
attachment away
z Isotonic – muscle force is from each other.
constant but muscle length Lengthening while
changes. Commonly used by contracting
strength exercises (WT z Concentric - muscle
shortens to move the
machine / free weights) attachments closer
z Isokinetic muscle contraction (contracts to move a
at a constant speed over the weight)
full ROM (special machines)
 Stretching
z Tight muscles can cause z Static stretching - hold
problems, while poor a position, that is the
flexibility is associated with farthest point and hold.
increased injury risk Using prior to running
z Muscles work in pairs, so it type exercise, is now
effects more than 1 muscle questioned, if it
increases injury risk.
z Logical to increase and
maintain flexibility z Dynamic stretch,
simulates the muscles
z Frequent daily stretches will
for the activity you are
help lengthen muscles
warming up for
z Held for 15 – 30 seconds &
z Stretching post exercise
repeated 3 – 5 times
is very important
 References
z Alter, M., 1998. Sports Stretch. 2nd ed. USA : Human Kinetics.
z Anderson, M, Parr, G, Hall, S., 2008. Foundation of athletics
training. USA : Lippincotte, Williams and Wilkins.
z Beil, Andrew., 2005. Trail Guide to the body. 3rd ed. USA :
Books of Discovery.
z Brukner, P and Kham, K., 2007. Clinical sports medicine. 3rd
ed. London : McGraw-Hill.
z Cash, M., 1996. Sports & Remedial massage therapy. London
: Ebury Press.
z Field, D and Hutchinson, J., 2006. Anatomy palpation and
surface marking. 4th ed. London : Elsevier.
z Fox, S and Pritchard, D., 2003. Anatomy, physiology and
pathology for the massage therapist. 2 ed. Gloucestershire :
Corpus.
z Kendall, F, McCreary, E, Provance, P., 2005. Muscle testing
and function with posture and pain. USA : Lippincotte,
Williams and Wilkins.
 References
z Macdonald, R., 2004. Taping Techniques. 2nd ed. London :
Butterworth – Heinemann.
z Moore, K and Dalley, A., 2006. Clinical oriented anatomy. 5th
ed. London : Lippincotte, Williams and Wilkins.
z Norris, C., 2004. Sports Injuries. 3rd ed. London :
Butterworth - Heinemann.
z Paine, T., 2007. Sports Massage. 2nd ed. London : A&C Black
publishers.
z Palmer, L and Epler, M., 1998. Musculoskeletal Assessment
techniques. USA : Lippincotte, Williams and Wilkins.
z Peterson, L and Renstrom, P., 2005. Sports injuries. 3rd ed.
London : Taylor & Francis.
z Sanderson , M., 2002. Soft tissue release. Gloucestershire :
Corpus publishing.
z Saunders, S and Longworth, S., 2006. Injection techniques in
ortho’s and sports medicine. 3rd ed. London : Elsevier.

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