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FUNCTIONAL REHABILITATION
AND INJURY PREVENTION
Theory Revision

SPORTS REHABILITATION
OLIVIA RATCLIFFE - 1400142

REHABILITATION PROGRAMME
PRINCIPLES
Principles of rehabilitation
...




Timing
...

Individualisation
...





Intensity
...

It is important not to aggravate the injury during the rehab
...
Trainers should aim to rehabilitate the injury in a gradual and progressive manner
...
The sooner rehab starts the sooner
the athlete can return to sport
...
Reintroducing activity is clearly a priority
...

Good communication between the trainer and the injured athletes will ensure that the athlete adheres to the
programme
...

Individualisation
...
The trainer must be aware of
the individual response to each of these factors
...

The order or sequence of rehab exercises must be determined on the basis of the athlete's response to
previous exercises
...
g
...

The balance between exercise intensity and non-aggravation of the injured area is crucial to success and
speedy rehabilitation
...

Rehabilitation must be challenging but safe
...

• ‘the transfer of training effects gained from one discipline to
another’
• ‘the practice of changing ones mode of activity to either
facilitate recovery or lessen the likelihood of injury or
overtraining’
• ‘keeping fit when injured’

CORE AND SPINAL BASICS
Dynamic Global Muscles Stabilisers
 External oblique


Quadratus lumborum



Serratus anterior





Internal oblique



Dynamic Global Muscular Mobilisers
Rectus Abdominus

 Erector Spinae
Indirect

Rhomboids




Rectus Femoris
Hamstrings



Trapezius



Pectoralis Major




Latissimus dorsi
Gluteusmedius/min



Latissimus dorsi



Piriformis



Rotator cuff

LOWER LIMB INJURIES AND EXERCISES
Contractile Injuries – Strain/Tear
 Typically at the muscles
weakest point ◦ Muscle
tendon Junction (1) ◦ Muscle
belly (2)
 During eccentric-concentric
crossover
 Outer range positions
 Fast joint velocities


High Force

Non-Contractile – sprain


Tendons


Tendinopathy ◦ T -O junction,
mid tendon body, location of
stress ◦ Type of tendinopathy?





Typically at Ligament
weak points ◦
Osseous junction ◦
Mid Joint line
High force

Tenosynovitis ◦ Site of
irritation



Impact/landing



Straining of the
ligament until extent
of failure




Bursitis (underlying)
Tendon rupture ◦ Would need
incredible force, where muscle
will usually tear first

Upper Leg Injuries
Common injuries:
Groin strain
ADD long /ADD mag
Inguinal ligament
Non muscular:
Hernia
Osteitis Pubis
Referred joint pain
Hip
Lx
SIJ

Risk Factors:
Eccentric force of adductors to decelerate the abducting leg
Imbalanced ABd/ADd strength ratio
Inability to load transfer from legs and/or torso to the pelvis
Delayed contraction of TrA
Relative muscle length
Further issues:
Lesser blood supply to pubic region
ADD MAGNUS vs SEMI-TENDONOSIS
OSTEITIS PUBIS vs ADDUCTOR TENDONOPOTHY

Anterior & Posterior Thigh
Common Injuries:
Hamstring strain
Quadriceps strain
Risk Factors
 Q/H ratio
 Available ROM for the sport



Control of this ROM
Correct movement patterns




Pelvic control
Hip flexion control




Hip extension control
Eccentric strength (H)

Knee Injuries
Common Injuries:


Intra-articular
- ACL ◦ PCL
- Meniscus
- PLC
- PMC



MCL





LCL
ITBS
Pes Anserine
tendon & bursitis

Risk Factors




Contact, twisting, cutting and
decelerating sports
Knee joint stability ◦ Sensorimotor
control
Muscle strength through the lower
limb chain
Resistive ability of stress



Management of knee joint injuries
 Again we have to look at the
risk factors and mechanism

General balance & co-ordination




Anterior Knee Pain
 Patella tendinopathy
 Patellofemoral joint
Risk Factors
 Time spent weight bearing and loading
consistently in excess of body weight
 Lack of training rest
 Poor techniques – Gait, Movement patterns,
Jumping and landing



Was there initial movement
pattern problems or not?



What else would we have to
rehab?
And what effect will these
have on the ligament?




So, how can we stress or load
ligaments via exercise?

Lower leg, Foot & Ankle
Common Joint & bone injuries


Lateral Ligament



Joint capsule

 Medial ligament
 Tarsal fracture
Risk Factors?
 Common Muscle injuries:


Calf strain achilles tendon sprain

Complexity Continuum
Think in terms of:



Motor Complexity
Applied Loads/Exercise intensity



Frequency of exercise or programme





Repetition of exercises
Within realms of healing stage
Direction of movement



Isolation/integration




Eccentric/concentric/isometric
Stable base needed?

UPPER LIMB INJURIES AND
MANAGEMENT
Common Upper Limb Injuries
Impact
 Dislocation - GH/AC/SC
 Fracture – Clavicle/Acromion/Humerus
 RC tear
 Biceps rupture





SLAP lesion
Bankart
Hill Sachs
Reverse Hill Sachs

Non – Impact
 Subacromial impingement
 Long head of biceps
 RC tear




RC tendinopathy
Adhesive Capsulitis
Elbow tendinopathy

GH-Scapular Risk Factors
• Laxity
• Previous injury
• IR:ER ratio
• Postural position
• Overhead positions
• RC reactivity
• Repetitive patterns/movements
Elbow Injuries
• Biceps rupture
• Medial Epic
...

• GHJ related?
• Rotator Cuff related?
• Trigger pt related?

• Collisions
• Lever arms
• ‘Muscle patterning’
• Winging
• Hitching
• Scap-Humeral rhythm

Elbow & wrist risk factors
• Repetitive actions
• Positional occupations
• Carrying, lifting occupations
• Gripping sports
• Throwing sports

Scapular Taping Intervention
Smith et al
...
(2001) – used McConnell Taping assessing effects on joint repositioning – no statistical effect
found
Hsu et al
...
This influences: Muscle tone, Motor
execution programmes, Reflex joint stabilisation, Cognitive somatic perceptions - Pain, thermoreceptivity,
mechanoreceptivity
FEEDBACK AND FEED-FORWARD
Two motor control mechanisms are involved in interpreting afferent information and coordinating an
efferent response
Feed-forward - Involves planning movements based on sensory information from past experiences
(preparatory muscle activity)
Feedback - Continuously regulates motor control through reflex pathways (reactive muscle activity)

FEED-FORWARD
Prior sensory feedback (experience) concerning the task is used to pre-programme muscle activation
patterns (Pre-activation theory)
...
Does not depend upon reflex pathways and once initiated executes very
quick motor commands
...

Information from joint and muscle receptors are used, reflexively, to coordinate muscle activity towards task
regulate slow movements
...
De-conditioned athletes
may lack sufficient awareness to coordinate muscle activity and dynamic restraint
The speed and complexity of sporting movements requires the rapid integration of sensory information by
feed-forward and feedback NM control systems
...
Any
disruption can be both direct or indirect

Result of ‘De-afferentation’
Mechanical
Instability

Static
Instability

Dynamic
Instability

Functional
Instability

Inc
...

Proprioceptive deficits appear in patients with history of
recurrent ankle sprains
Refshauge et al
...
Kinaesthesia awareness 2
...
Reactive NM control 4
...
KINAESTHETIC AWARENESS
Aim 1 -To restore the neurosensory properties of damaged structures - Early joint repositioning tasks
enhance conscious proprioceptive and kinaesthetic awareness, eventually leading to unconscious
appreciation of joint motion and position
Aim 2 - Restore joint stability during basic activities - Static stabilisation, Closed chain loading, Gentle,
simple perturbation, Weight shifts, Postural holds, ‘Core’ setting
2
...
Therefore spinal reflexes
important to maintain dynamic stability during ‘risky’ manoeuvres
Aim - To encourage preparatory agonist/antagonist cocontraction to balance joint forces and increase joint
congruency, thereby reducing the loads on the static structures
...
Joint
placed in vulnerable conditions whereby dynamic stabilisation is established under controlled conditions
...
REACTIVE NM TRAINING
Designed to restore proprioceptive deficit and reestablish NM control
Aim - Stimulates the reflex pathways from articular and muscular receptors to skeletal muscles to facilitate
reflex muscle activation
...
Unstable platforms and external stimuli
RNT EXERCISES
Used to improve or maintain function
...
Must have a reactionary
foundation
...
Limit auditory and visual cues (input) so
the body ‘relearns’ the movement pattern on a NM level- kinaesthetic input is essential
 Balance, mobility and stability
 Quality NOT quantity
FITTING IT IN TO THE REHAB PROGRAMME
 Progressions
 Slow speeds to fast
 Low force to high



Controlled to uncontrolled
Stable to unstable

FUNCTIONAL REHABILITATION
Movements NOT Muscles
 The motor cortex thinks in terms of movements


Training individual muscle isolates and breaks the kinetic chain



Training movements integrates and improves function of the kinetic chain



Working on functional patterns and movements is good motivation for the athlete as they are
closely related to the sport

“Movement is not an isolated event that occurs in one plane of motion
...
”
Vern Gambetta
Recipe for functional success
Co-ordination
Balance
Strength
Speed
Endurance
Co-ordination - A complex, motor ability interrelated with speed, strength, endurance and flexibility
Balance - The ability to reduce force at the right time, plane, direction, in the right activities
Open vs Closed chain?



In function there is no pure open and pure closed chain movements
All movement involves a co-ordinated opening and closing of the chain - The kinetic chain is
characterised by deceleration at one joint and acceleration at the another joint in the chain



Open vs closed is NOT important - Functional vs Non- functional is important

Functional Training force reduction/production
The ability to reduce (absorb) external forces and then produce force in
a co-ordinated and specific manner is key to functional conditioning
Traditional Resistance Training
Piece meal approach
 Isolating specific muscle groups
 Often sitting in non-functional positions
 Controlled range of motion
 Often linear, non-functional movement patterns
Give no protection from injury during simple movements such as:
 Stopping and changing direction
 Running backwards



Recovering from loss of balance
Advantages if used correctly



Greater increases in strength, power and jumping performance

Functional Training some guidelines
 Use bodyweight before adding external resistance



Stress “core” before extremity
Initial load should be eccentric to teach the athlete force reduction before force production



Ability to reduce and absorb external forces is essential to both performance and injury
prevention

Functional Training
Must build from slow to fast:
 Involve as many faster activities as possible
...

Where that activity fits into the big scheme of things Remember! Every activity is a test Every test is
an activity
 Stress correct execution of skills and movement patterns
 Motor learning first
 Movement speed comes later
3 P’s and 3 M’s (Vern Gambetta)
Is it Practical? = Can it be done given the development of the
athlete and the facilities available?
Is it Personal? = Does it meet the needs of the individual
athlete?
Is it Proactive? = Does it anticipate possible roadblock to
progress and provide possible methods to overcome these?

Is it measurable? = See and quantify
the results
Is it manageable? = Accomplished in the
context of the personnel
Is it motivational? = Both parties look
forward to doing

PLYOMETRIC POWER, SPEED AND
AGILITY
Properties of skeletal muscle
Contractile component (CC)
Series elastic component (SEC) Parallel elastic component (PEC)
Contractile Properties (CC) - Contains muscle spindles
Parallel Elastic Components (PEC) - Provides a passive resting tension of the muscle fibres
Series Elastic Components (SEC)
 Tendinous structures, collagen fibres, matrix
 Ability to act viscoelastically
 Contains GTO’s
 Responsible for active stiffness of the MT unit
Viscoelasticity
 Collagen fibres are extensible and elastic
 Extracellular matrix also contains water
 Viscous property - Dampens and absorbs tension and load like fluid in a syringe
 Elastic property - Allows recoil and return
 Together - A responsive, yet adaptive structure to external loads
Stretch shorten cycle

Stored elastic energy - Basically in the form of potential energy in the SEC
...
g
...
Basic training (broad base of pyramid)
2
...
Functional strength and explosive movements against medium
to heavy resistance
4
...
Sport loading
6
...
Overspeed training
Sprint conditioning
• Mechanical specificity hip extension e
...
g
...
g parachute sprints,
weighted vest, harness running
Technique training
 Involves
 Sprint drills (heel flicks, high
knees)
 Frankenstein run (straight leg
run)
 Mini hurdle steps

Lateral speed
 Essential for
 Changing direction
 Side stepping
 E
...
g
...
Rate of prestretch is far more important than
magnitude of the stretch
- Adequate rest - Essential for intensity and
quality
...
e
...
They also fatigue quickly – lessened neural motor input to muscle
...
/antag
...
g
...
Med, soleus) show greatest selective atrophy of type 1 fibres
...
QL
LBP =TFL – GM – ipsilat
...
Upper
Traps – ipsilat UT – lower scap muscles
Pain =Ipsilat
...
UT –
lower scap Ms
=Ipsilat
...
UT

Prehabilitation
 Co-ordination




Movement stability and control
Proprioception, Dynamic
Stability, RNT
Strength




Endurance
Education



Cognitive facilitation

FATIGUE AND OVERTRAINING
Fatigue v Weakness
• Fatigue-Failure to maintain the required or expected
output
...
e
...

Practicalities: Trainability Tips
 Qualities that cannot be improved in a state of fatigue:


Pure speed





Acquisition/technique (refinement of new motor skills)
Speed-strength
Max
...
g
...
g
...
For 2 reasons: (i) The contact time with your
patient is vastly reduced (once every 2 weeks) (ii) The end goals/criteria for return to “fitness” are
much lower



Exercises are still functional



Still require increase in strength, mobility and function



Early rehabilitation is key!



This may actually make up the entire rehabilitation process



May not require components such as:
- Plyometrics
- Advanced neuromuscular control
- Sprint, SAQ, Foot quickness training

Goal setting
 The end/outcome goals will be totally different to professional athletes
 Much more varied so have to be adaptable
 Consequently your “end stage” rehabilitation principles will change



Consider the patient’s goals
E
...
for an office worker is the ability to perform a single leg drop and depth jump essential to
their outcome?

Stretching and their effects
Stretching
 Essential component in a comprehensive rehabilitation programme
 Should always look to increase mobility prior to working on strength aspects
 Useful to incorporate into all aspects of rehabilitation depending upon the aim of the exercises
Therapeutic stretching
Typically, four types of stretching are used:
Static
Dynamic
Ballistic
Proprioceptive Neuromuscular Facilitation

PERIODISATION
Planning and periodization - The structured, sequential development of athletic skill or physiologic capacity,
brought about by organising training regimes into blocks of time
...
g
...
g
...
g
...
g
...
Closely linked with resistance
programme

General Preparatory Period
 Aims – to develop a broad fitness base
involving: Strength, power, local muscle
endurance development
 Endurance work of low- medium intensity
Skill
 Sport specific drills
 ‘Keeping your eye in’
Flexibility work to maintain or enhance ROM in
specific joints
Proprioception
Competitive Period
Time- Varies!
Aims –


Maintenance of fitness and skill level



Injury prevention (how do we best ensure
this?)



Peaking & tapering

Evalution and Feedback
training
performance

planning
evalution

Planning training Programmes
3 Questions need to be asked


Where are you now?



Where do you want to be?



How do you get there?

Where do you want to be?
Sport?
SMART Goals
(specific, measurable, agreed, realistic,
time constraint)

Where are you now?
Fitness profile
Training age
Experience

Out of pattern activities
DOMS
CNS fatigue

How do you get there?
Analyse demands of the sport
– muscle groups
- energy systems
- competition structure
what training?
- Specificity
- Intensity
- Frequency
- Duration
- Rest
Plan
- The training year
- Periodisation
- Milestone
Feedback
- Continued testing –
evaluate effectiveness of
programme

Metabolic Fatigue

Injuries

Immuno supression

Definitions
 Volume - QUANTITATIVE component of training – duration, length or extent of exercise
 Intensity - QUALITATIVE component
 Frequency - Number of training sessions within a given time frame
 Specificity - Refers to the content or direction of training

Peaking and Tapering



Peaking for a competition requires that every area of fitness is fully recovered
...
g

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