Injury rehabilitation

• rehabilitation - the process of restoring full physical function after an injury has occured
• stages of rehabilitation:

  early stage - gentle exercise encouraging damaged tissue to heal

  mid stage - progressive loading of connective tissue and bones to develop strength

  late stage - functional exercises and drills ro ensure the body is ready to return to training
• treatment methods

  • stretching
  • massage
  • cold, heat and contrast therapies
  • anti-inflammatory drugs
  • physiotherapy
  • surgery
• stretching

  • acute phase (3 days)-no stretching. PRICE
  • mid phase (3-14 days)-inflammation, bleeding & swelling should have subsided & gentle rehabilitation can start. heat therapy, & gentle static & passive stretching exercises to increase tension & allows tissues to lengthen.
  • later phase (14-28 days)-range of motion, strength & coordination are focused on. PNF stretches are added to the continued static & passive stretching. Desensitise stretch reflex & increase range of motion, & strengthen connective tissues
  • long term-active & dynamic stretching used regularly
• Massage therapy - a physical therapy used for injury prevention and soft tissue injury treatment
• massage

  • deep muscle therapy, realigning connective tissue fibres and flushing toxins from a damaged area
  • popular treatment for soft tissue injuries as well as injury prevention by increasing joint mobility and flexibility
• massage

  • moves fluid and nutrients through damaged tissue to encourage healing and accelerate the removal of waste products
  • stretch tissues, releasing tension and pressure and improving elasticity
  • break down scar tissue from previous injuries that can lead to inflexible, injury and pain
  • reduce pain and generate heat, circulation and relaxation
• massage cannot be used on certain soft tissue injuries such as ligament or tendon ruptures, contusion or open wounds as bleeding will be increased and injury may be complicated
• cold therapy/cryotherapy - applying ice or cold to an injury or after exercise for a therapeutic effect, such as reduced swelling.
• cold therapy

  • reduce tissue temperature, metabolic rate and speed of nerve impulses
  • vasoconstrict vessels, decreasing blood flow, inflammation, swelling and pain associated with injury
  • used after acute injuries for periods up to 20 mins and reapplied every 1-3 hours
• cold therapy types:

  • PRICE - applied as early as possible and continued for 24-48 hours
  • Cold water immersion (ice bath) - for 10 minutes at around 10 degrees has been shown to reduce the pain
  • cryokinetics - involve ice application followed by rehabilitation exercises
  • cryostretching - combined cold application and stretching to reduce muscle tension and increase flexibility, useful to decrease the pain associated with exercise induced muscle damage
• cold therapy - acute injuries and after exercise to relieve symptoms of exercise induced muscle damage

  advantages:

  • vasoconstriction of blood vessels decreasing blood flow, swelling and pain
  • reduce sensitivity of muscles to reduce pain

  disadvantages:

  • tissue and nerve damage if in contact for too long
  • skin abrasion if in direct contact
• heat therapy - applying heat to an area before training for a therapeutic effect, such as increased blood flow.
• heat therapy

  • use of heat to reduce muscle tension, stiffness and pain
  • vasodilates blood vessels, increasing blood flow and healing response to damaged area
  • used on chronic injuries and late stages acute injuries around 48 hours post injury and during rehabilitation
  • can be used before exercise to raise temperature of superficial muscles
• heat therapy

  • localised applied heat - heat patch, hot towels and heat rubs
  • systematic heat - hot tubs or sauna
  • up to 20 minutes at a time
  • may be combined with stretching to increase connective tissue elasticity during rehabilitation and before exercise
  • should not be used during acute phase of injury as greater blood flow will increase swelling
• heat therapy - chronic injuries and late stage acute injuries before exercise

  advantages:

  • vasodilation of blood vessels increasing blood flow, decreasing muscle tension, stiffness and pain

  disadvantages:

  • increased swelling and pain after acute injury
• contrast therapy - the use of alternative cold and heat for a therapeutic effect, such as increased blood flow
• contrast therapy

  • use of alternative cold and heat therapy to increase blood flow and decrease swelling and pain after exercise or in the late stage of an injury
  • once bleeding has stopped and inflammation has disappeared after the acute phase of an injury, contrast therapy can be used
• contrast therapy

  • to immerse the body ip to shoulder level post exercise
  • to use cold water followed immediately by warm water
  • to have a cold:warm ration of 1:3 or 1:4 minutes
  • to have accumulating 6-10 mins in the cold water
• contrast therapy

  • applying cold vascoconstricts blood vessels and when followed immediately by heat, blood vessels vasodilate, causing a pumping action with large increases in blood flow and nutrients delivery for the damaged tissues
• contrast therapy - acute injuries after bleeding and inflammation have stopped and to relieve symptoms of exercise induced muscle damaged

  advantages:

  • large increases in blood flow and nutrients delivery to damaged tissue
  • decreased swelling and pain

  disadvantages

  • limited benefit over cold therapy
• non steroid anti-inflammatory drugs (NSAID's) - medication taken to reduce inflammation and pain following injury
• Non-steroid anti-inflammatory drugs

  • ibuprofen and aspirin
  • treatment of acute sports injuries
  • chemicals released by damaged cells cause vasodilation of blood vessels and an increase in blood and cellular fluid which causes swelling and redness and activates pain receptors.
  • NSAID reduce this inflammatory response by inhibiting the chemical release
  • symptoms: heartburn, nausea, headaches and diarrhoea
  • long term use can lead to intestinal, bleeding, shock, amnesia, stroke and heart attack
• physiotherapy - physical treatment of injuries and disease using methods such as mobilisation, massage, exercise therapy and postural therapy
• physiotherapy

  • mobilisation and manipulation of joints and tissues
  • electrotherapy to repair and stimulate tissues
  • exercise therapy to strengthen muscles
  • massage to stretch and relax tissues, relieve pain and increase circulation
  • sport specific rehabilitation programme design and advice
  • posture and alignment training to release tension, minimise injury and maximise power output
• surgery

  • following a serious injury were other treatments have failed to prevent
  • includes repair of damaged soft tissue, realignment of bones and repositioning of joints
• types of surgery:

  • knee ligament surgery - ACL reconstruction in which, following rupture, a tissue graft is used to replace the ACL and restore full function
  • shoulder stabilisation surgery - following repeated shoulder dislocations surgery can be used to stabilise the joint by anchoring the humerus into the scapular and repairing the joint capsule known as the Bankart repair.
  • meniscal tear surgery - following cartilage tear in the knee surgical techniques aim to repair the damaged cartilage. Meniscus can be resurfaced to remove rough projections and in extreme cases a cartilage implant.
• types of surgery

  arthroscopy (keyhole surgery) - under general or local anaesthetic a small incision is made and a tiny camera is used to guide the repair. The damage to the surrounding tissues is minimised, therefore will suffer less pain and risk of infection. Used to repair cartilage and soft tissue damage.

  open surgery - under general or local anaesthetic an incision is made to open the joint to repair or reconstruct damaged structures. Although this can create a stronger repair, the risk of infection is high and scarring is significant. Typically used to repair fractures.