principles of rehabilitation

1. Principles of
Rehabilitation
BY:
HALLA TAJ ELSIR
orthopedic Physiotherapist

2. •Rehabilitation is the
restoration to a former
capacity; so it is required
to return the athlete to the
previous level of function.
•If rehabilitation is
inadequate the athlete is:
1. prone to re-injury of
the affected area.
2. incapable of
performing at pre-injury
standard.
3. predisposed to injuring
another part of the body.

3. The rehabilitation program:
• Every athlete is an individual:
An appropriate, individualized rehabilitation plan
according to the diagnosis & assessment.
• Keys to a successful rehabilitation program:
1. Explanation:
(time frame, goals, rationale behind the program).
2. Provide precise prescription:
(exercise technique, progression, limitation and
modification of ex’s).

4. 3. Make the most of the available
facilities.
4. Begin as soon as possible:
• The important components of
rehabilitation are:
1. muscle conditioning
2. flexibility
3. neuromuscular control (balance,
proprioception)
4. functional exercises
5. sport skills
6. correction of abnormal biomechanics
7. maintenance of cardiovascular fitness
8. psychology.

5. Soft tissue response to injury:
1. Acute inflammatory phase (0–72 hours).
2. Proliferation/repair phase (2 days – 6 weeks).
3. Remodeling/maturation phase (4 weeks – 12 months).

6. Muscle conditioning:
•The effect of injury upon
muscle:
• After injury, there is rapid muscle atrophy due to
a cellular response to pain, inflammation and
immobility. Muscle strength decreases, increased
fatigability and less endurance after
immobilization.
• Persistent pain alone will cause muscle weakness
due to decreased neural input; A joint effusion
may also lead to reflex inhibition of surrounding
muscles.
• Muscle atrophy patterns depend on length of the
immobilized muscle.

7. •several methods of assessing deficits in muscle
strength such as MMT & isokinetic machine.
•It is important for the clinician to recognize the
common patterns of weakness either in
association with, or as a possible predisposing
factor to, injury.

8. Principles of muscle conditioning:
1. Specific adaptation
to imposed demand
(SAID).
• The strengthening
program should be
injury specific and
sport-specific (speed,
intensity, type of fiber
stimulated).

9. 2. Overload.
A muscle must be overloaded in order
to increase it’s performance by
one of the following methods:
1. Increasing the speed, resistance,
number of repetitions &
frequency or duration.
2. Decreasing the recovery time
between work-outs
3. Altering the form of exercise/
range through which a muscle is
being worked.

11. Components of muscle conditioning:
1. Muscle activation and motor re-education
2. Muscle strength
3. Muscle power
4. Muscle endurance.

12. Muscle activation and motor re-
education:
• pain and swelling, have an inhibitory effect on muscle’s ability to
contract, certain injuries are often associated with abnormal motor
patterns in groups of muscles, so stability is important as strength
(difference between local and global muscles). And the patient must
learn a new movement pattern.
• Lack of flexibility can cause abnormal pattern… stretching.
• If there is weak muscle; start localized strengthening program first
then gradual loading added with new pattern.

13. Muscle strength training:
• It depend on 5 biochemical and physiological
factors that are all stimulated by conditioning:
1. increased glycogen and protein storage in
muscle
2. increased vascularization
3. biochemical changes affecting the enzymes of
energy metabolism
4. increased number of myofibrils
5. recruitment of neighboring motor units.
• Strength improvement is related to increased
neuromuscular facilitation.

14. Factors maximize strength:
1. Adequate warm-up to increase body temperature and metabolic
efficiency
2. Good quality, controlled performance of the exercise
3. Pain-free performance of exercise
4. Use of a slow, pain-free pattern initially with little or no resistance
to develop a good base for neural patterning to occur
5. Comprehensive stretching program to restore/ maintain full range
of motion
6. Muscle strengthening throughout the entire range of motion
available.

15. Types of exercise:
1. Isometric
2. Isotonic (concentric/
eccentric)
3. Isokinetic
•Exercises can also be open
chain or closed chain.

17. Muscle power training:
• Power training include:
• Fast speed isotonic or isokinetic
exercises
• Increased speed of functional
exercises plyometric activities.

18. Muscle endurance training:
Flexibility: (mobilization & stretching).

19. Joint range of motion:
• CPM.
• P,A,AA ROM.
• Passive mobilization.

20. Recommendations for effective stretching:
• preceded by an adequate
warm-up.
• Preceded by heat
/cryotherapy application.
• Correct position (relaxed),
holding time?.
• Overloading (gradually).
• Stretching should always be
pain-free.

21. •ballistic stretching may be helpful in activity
incorporate fast stretching, but it result in soreness
or injury which prevented by:
1. Warmed up
2. Preceded by slow static stretching
3. Introduced in the advanced stages of a
stretching program
4. Taught carefully and performed with accuracy
and care.
5. It is performed slowly and in a controlled
manner, gradually increasing speed.

22. Neuromuscular control
(proprioception and balance):

23. •Functional exercises:
•Sport skills:
•Correction of
biomechanical
abnormalities
•Cardiovascular fitness
(NWB;Deep-waterrunning).
•Hydrotherapy

24. Progression of Rehabilitation:`
• different parameters that the therapist may manipulate to progress the
athlete’s program to a level at which return to sport is possible which
are:
1. Type of activity
2. Duration of activity
3. Frequency of activity/rest
4. Intensity of activity
5. Complexity of activity.

25. Stages of rehabilitation:
• There are 4 stages according to the athlete’s level of function:
1. The initial stage:
is considered to be from the time of the injury to the point of almost
full, pain-free range of motion.
2. intermediate or pre-participation stage:
Corresponds with resumption of normal activities of daily living and
commencement of some sporting activity. This activity is primarily
skill-related. Fitness maintenance is also included, taking care to
avoid stressing the injured area.
3. Advanced stage :
Corresponds to the commencement of functional activities related to
the sport.
4. Return to sport:
involves full participation in training and competition.

27. Monitoring the rehabilitation program:
• both subjectively and
objectively,
• parameters should be
monitored:
1. Pain
2. Tenderness
3. Range of motion
4. Swelling
5. Heat
6. Redness
7. Ability to perform
exercises and
functional activities.

28. Psychology and rehabilitation of injury:
• Fear of injury and the possibility of
recurrence!!
• The factors that affect rehabilitation
include:
1. Type/ circumstances of injury
2. External pressure (e.g. Fear of
losing position on the team)
3. Pain tolerance
4. Psychological attributes of the
player
5. Player–player and coach–player
support system.

29. •Rehabilitation of the injured athlete
requires careful assessment and
subsequent correction of the athlete’s
deficit. The rehabilitation program
should be individualized for the
athlete’s need. Functional and sport-
sport-specific activities should form a
major part of the program. The injured
injured athlete should be able to return
return to sport without functional

30. Thanks..