This presentation simplifies the various principles specific to sports rehabilitation in an attempt to make them concise and easy to understand.

1. PRINCIPLES OF
REHABILITATION
APOORVA BALODHI
06211202616

2. By definition, rehabilitation is the
‘restoration to a former capacity or
standing, or to rank, rights, and privileges
lost or forfeited’.
It enables a athlete to return to sport with
full function in the shortest time period
possible.

3. WHAT MAKES A REHABILITATION
PROGRAM SUCCESSFUL?
•Explain the program to the patient
•Provide a precise prescription
•Use the facilities available to the utmost
•Begin rehabilitation early

4. COMPONENTS OF A
REHABILITATION PROGRAM
•Muscle conditioning
•Flexibility
•Neuromuscular control
•Functional exercises
•Sport skills
•Correction of abnormal biomechanics
•Maintenance of cardiovascular fitness
•Psychology

5. Return to sport
Still acquisition
Proprioception|Strength|Flexibility
Motor Re-education and Muscle
activation
Progression
of
treatment

6. RESPONSE OF SOFT TISSUE
TO INJURY

7. PARAMETERS FOR PROGRESSION
OF REHABILITATION
•Type of activity
•Duration of activity
•Frequency of activity/Rest
•Intensity of activity
•Complexity of activity

8. STAGES OF REHABILITATION
The rehabilitation process is divided into four stages
each comprising of three subcategories: modalities,
exercises, and cardiorespiratory maintenance.
Progression is made based on the athlete’s level of
function.
The four stages are:
1. Initial Stage
2. Intermediate Stage
3. Advanced Stage
4. Return to Sport

9. STAGE 1: INITIAL STAGE
(poor functional level)
It is marked from the time of injury to the point of
pain-free range of motion. It is also called the
immobilization phase.
This stage corresponds to the acute phase of tissue
healing.

10. GOALS:
•Reduce pain
•Improve soft tissue extensibility
•Improve joint ROM
•Minimize inflammation
•Increase muscle strength
•Maintain cardiorespiratory capacity
•Improve endurance
•Improve stability
•Motor re-education
•Improve proprioception and balance
*The healing of the injured tissue should not be hampered
or symptoms worsened.
Avoid excessive force on the injured area.

11. •Gentle, pain-free ROM (active
and passive) exercises
SHOULDER ACTIVE ROM EXERCISE SHOULDER PASSIVE ROM EXERCISE

12. •Gentle passive mobilization for
pain relief and to improve mobility
SHOULDER MOBILIZATION

13. •Muscle conditioning-initially isolated
movements are performed followed by
more functional movements
Muscle activation
Maximal isometric
exercises
Multiple angle exercises
Short arc exercises *Light weights may be introduced.

14. •Agility type exercises
SIDE STEPPING GRAPEVINE STEPPING

15. •Proprioception and balance
exercises (as tolerated)
SIMPLE STANDING STANDING ON WOBBLE BOARD

16. •Stationary bicycle, upper limb ergometer or
other to maintain cardiorespiratory capacity
STATIONARY BICYCLE UPPER LIMB ERGOMETER

17. •Heat (to relieve muscle tightness),
ice (to reduce pain and swelling)
and other electrotherapeutic
modalities before or after exercise

18. STAGE 2: INTERMEDIATE STAGE
(good functional level)
This stage is entered when the athlete
gains good ROM and reasonable strength.
It corresponds to the repair/proliferation
phase of tissue repair.

19. GOALS:
•Functional rehabilitation
•Improve soft tissue extensibility
•Improve joint ROM
•Increase muscle strength
•Maintain cardiorespiratory capacity
•Improve endurance
•Improve stability
•Improve proprioception and balance
*Progressions to all of the above are introduced.

20. •Flexibility exercises for injured part,
adjacent areas, or any other tight structure
PASSIVE HAMSTRINGS STRETCHING

21. •Joint mobilization exercises for restricted ROM
•Massage therapy
•Electrotherapeutic modalities
•Active (by patient) and passive (by therapist)
ROM exercises

22. *Progressed according to general principle of overload.
Increased resistance and number of repetitions to increase strength and increase in volume
of work to increase endurance.
•Strengthening exercises (isotonic
and isokinetic exercises introduced)
ISOTONIC EXERCISE ISOKINETIC EXERCISE

23. •Closed kinetic chain exercises
SQUAT LEG PRESS STAIR CLIMBING

24. •Functional exercises
(prepare for return to sport)
JOGGING WALKING

25. •Balance and proprioception exercises
SKIPPING HOPPING

26. STAGE 3: ADVANCED STAGE
(good functional level)
The athlete enters this stage when he/she has good
strength and endurance, flexibility, ROM, can tolerate a
reasonable volume of work, and the cardiovascular
fitness is maintained.
The athlete should be able to perform exercises without
adverse effects.
This stage corresponds to the remodelling/maturation
phase of healing.

27. GOALS:
•Increase strength
•Enhance power
•Progressive functional rehabilitation
•Re-learning of correct technique (correction of biomechanics)
•Improve soft tissue extensibility
•Maintain cardiorespiratory capacity
•Improve endurance
•Improve stability
•Improve proprioception and balance
•Restore athlete’s confidence
*Progressions to all of the above are introduced.

28. •Muscle conditioning specific to required
activity (example: CKC exercises for
weight lifters)
Progress strength enhancement with high
load and low repetition, and maintain
endurance with low load, high repetition.
This is decided based on athlete’s sport of
participation.

29. •Enhance power with high speed
isotonic and plyometric exercises
JUMPS DEPTH JUMPS BOUNDING

30. •Functional activities, initially in isolation
and then in a more realistic sports
environment (progress to team drills)

31. •Advanced balance and proprioception
exercises specific to sport

32. STAGE 4: RETURN TO SPORT
(good functional level)
WHEN CAN THE ATHLETE RETURN TO SPORT?
•Tissue healing complete
•Pain-free full ROM
•No swelling
•Adequate strength and endurance
•Good flexibility
•Good balance and proprioception
•Adequate cardiovascular fitness
•Skills regained
•No biomechanical abnormality
•Athlete psychologically ready
•Coach satisfied with training form

33. CONTRAINDICATIONS TO RETURN TO SPORT
•Recurrent swelling
•Joint instability
•Loss of joint ROM
•Lack of full muscle strength
*The rehabilitation does not stop after return to sport.

34. REGULAR ASSESSMENT AND
MONITORING
Monitor
Pain
Tenderness
ROM
Swelling
Heat
Redness
Ability to
perform
exercises

35. REFERENCES
1. Bomgardner Rich. Rehabilitation Phases and Program
Design for the Injured Athlete. Strength and
Conditioning Journal. Vol 23, Number 6, Pages 24-25.
December 2001
2. Brukner and Khan. Clinical Sports Medicine, 3E,
McGraw-Hill Professional. Chapter 12: Principles of
Rehabilitation, Pages 174-196