Principles of Rehab

• Inflammatory Phase Deficits

  • Pain
  • Swelling
  • ↓ ROM
  • ↓ strength
  • ↓ function (WB, walking, using upper ext ADLs, sport)
  • Compensations
  • Lig = ↓ stability
  • ↓ proprioception
  • ↓ mental state (anxiety, depression, frustration, fear)
• Inflammatory phase goals

  • ↓ Pain
  • ↓ Inflammation
  • = ROM
  • = strength
  • = function
  • Protect the injury (technical aid, brace, etc)
  • Limit the compensations
  • = proprioception
  • Improve mental state
  • Education (about the injury, about the rehab, things to avoid, things to do)
  • Prevent deconditioning
  • Prevent muscle atrophy (maintain general strength)
  • Maintain general flexibility
  • Maintain CV
• Rest

  1. Crutches? Sling?

  2. Active rest

  3. Until swelling disappears and progress safely according to the healing process
• Ice application

  1. Extremities such as ankle and hands (ice bucket, 10 min)

  2. Other areas (ice bags, 10-20 min)

  3. Recommended to ice every 1.5-2 hour at the beginning inflammatory period
• Compression

  1. Compression wrap (The wrap should be on at all time except during sleep and ice application)

  2. Show the athlete how to self-apply
• Elevation


  As much as possible (At night: pillow under the mattress)
• Heat

  1. When to apply: Once the swelling has resolved, when you want to gain ROM, to increase muscle flexibility, for stiff neck/back muscles

  2. How long: Magic bag (until it cools down), Moisturize heat pack from hydrocollator (max 10-15) or increase the number of towels between skin and heat pack
• Contrast baths

  1. 2 buckets: 1 with ice-cold water, 1 with lukewarm water. 30 sec in each starting and finishing in cold water (7 min and half)

  2. To get rid of stubborn swelling (6-7 days)
• ROM exercises

  1. Active, passive or self-assisted

  2. Alphabet

  3. Pure ROM ex's: Active or Passive with no pain

  4. Focus on normal biomechanics (gait)

  5. Weight vs non-weight bearing
• Repair phase

  • Deficits
  • Goals
  • Residual Pain
  • Residual swelling
  • ↓ ROM
  • ↓ strength
  • ↓ function
  • Compensations
  • Lig = ↓ stability
  • ↓ proprioception
  • ↓ neuromuscular control
  • ↓ flexibility (localized)
  • ↓ mental state (anxiety, depression, frustration, fear)
  • ↓ CV fitness
  • ↓ flexibility (general)
  • ↓ general strength
• Repair phase goals

  • Eliminate pain
  • Eliminate swelling
  • ↑ ROM (Re-establish Normal)
  • ↑ strength (normal – symmetrical)
  • ↑ function
  • Eliminate compensations
  • Promote dynamic stability
  • ↑ proprioception
  • ↑ neuromuscular control
  • ↑ flexibility (localized)
  • Improve mental state
  • Education: balance between progression and protection
  • Prevent deconditioning (or improve)
  • Prevent muscle atrophy (maintain general strength)
  • Maintain general flexibility
  • Maintain CV
• Strengthening exercises

  1. Elastic bands, Free weights, Body weight, Machines

  2. Open-chain vs Closed-chain

  3. Type of contraction (isometric, concentric eccentric, isokinetic)

  4. # of reps and sets

  5. Isolated muscle vs major chain

  6. Focus on proper technique (less weight, better quality reps)
• Isometric contraction

  Without change in muscle length
• Concentric contraction

  Shortening of muscle length
• Eccentric contraction


  Lengthening of muscle length
• Isokinetic

  Constant contraction velocity
• Load and number of reps

  1. Refer to 1RM calculation to determine the load

  2. Shotput, high jump (moderate with low to moderate load, adjust to preserve technique)

  3. Volleyball, basketball (moderate with low to moderate load, adjust to preserve technique)
• Flexibility

  1. Static stretches

  2. Dynamic stretches

  3. PNF techniques

  4. Sets and reps??

  5. Which is most useful?

  6. Are all techniques equivalent? Appropriate for all situations?

  7. Yoga
• Sport-specific rehab

  • Specialty of athletic therapists
  • Design exercises that will stress the injured body parts like they would be in a game or practice situation
  • Start with taping then progress without taping
  • Ex: one-legged balance, passing the ball (soccer player)
  • Agility drills with agility ladder
  • Speed of execution is indicative of recovery
• Remodelling phase

  • Deficits
  • Goals
  • ↓ strength
  • Possible residual ↓ ROM
  • ↓ function
  • Compensations (techniques, or sport-specific movement)
  • ↓ flexibility (localized)
  • Residual loss of tissue strength
  • ↓ proprioception
  • ↓ neuromuscular control
  • ↓ reaction time
  • ↓ CV fitness
  • ↓ flexibility (general)
  • ↓ general strength
  • Psychological (impatience and fear of injury)
• Remodelling phase goals

  • Normalize strength (if weakness > 100%)
  • Eliminate compensation (optimize movements)
  • ↑ proprioception
  • ↑ neuromuscular control
  • ↑ flexibility (localized)
  • Improve mental state (reduce fear of re-injury)
  • Conditioning > 100%
  • Education (prevention, body mechanics, lifestyle habits)
• Power

  1. Jumping

  2. Stable vs unstable surface

  3. Upper body??
• Proprioception


  • The body's ability to know how it is positioned in space
  • The body's ability to correct itself before injurious position
  • Balance exercises (Stable surface vs Unstable surface, Double leg stance vs single, Upper extremity?)
• Neuromuscular control

  • How the CNS and the MSK systems work together to optimize movement
  • Injury Prevention: Optimization of contractions and co-contractions to prevent dangerous position (risk of injury) at the joints
  • Includes local action (each joint) and controlling the center of mass over the base of support (core)
  • Has to become an automatic process
  • Progression: Simple task in safe ROM with full attention, Increasing task complexity, Increasing task complexity cognitively, Adding a dual-task
• Sequence, core, coordination, endurance

  1. Movement combination involving the entire body

  2. Capoeira sequence – Body combat 84 – Credit Les Mills 2021
• Difference between good clinicians and GREAT clinicians

  • Think outside the box
  • Challenge the athlete
  • Be confident but no BS
  • Be knowledgeable
  • Personality (smile, listen, be patient)
  • Learn to know your athletes, coaches, etc
• Squats

  1. 3X10, 70%1RM, tempo 2:2, 2-3x/week

  2. Upright trunk, maintain lordosis, knees align with 2-3 metatarsals not going over toes, push with heels

  3. Hypertrophy, strength, and endurance of gluteus max, quadriceps, core stability

  4. Functional ex's in preparation for sport-specific activities; also area of weakness mentioned by patient
• Walk in the pool

  1. 10-15 min 3-4x/week

  2. Focus on proper gait, no external rotation, full ROM of the knee, symmetrical WB

  3. Decreased swelling, improve gait and function, maintain general ROM and strength of LE

  4. Walking in the water allows for proper gait technique with a decrease in WB