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SOAP REVIEW (HORSP)
S- subjectiveHistory taking , MOI , Pain etc
O- objectiveObserving , special tests , palpations
A- Assessment Impression as to what is wrong
P-PlanRehabilitation plan
Principles
Design of Rehab plans Assess needsDevelop plan Implement planEvaluate plan
Assess needs
Subjective informationObjective dataList problem areas
Develop plan
Establish goalsSelect techniques based on available
resourcesEstablish how changes will be
documented and monitoredImplement return to plan /activity criteria
Implement Plan
Use procedures and techniques that will fulfill the plan and meet the goals
Incorporate the following into plan Verbal motivation, visualization, imagery
etc
Evaluate Plan
Compare original data with current data at frequent intervals
Modify goals according to changes in patient progress and activity level
Principles
Knowledge of the inflammatory process is crucial in understanding injury rehabilitation
Goals of Rehabilitation will be achieved through the use of therapeutic exercise to develop , improve , restore/maintain Neuromuscular control ROM and flexibility Muscular strength Postural stability and balance Cardiorespiratory fitness
GOAL SETTING: GOALS BASED ON STAGES OF HEALING
Provide correct immediate first aid and management of the injury
↓ swelling, pain, inflammationRe-establish neuromuscular controlRestore ROMRestore and increase muscular strength,
endurance and power Improve postural stability and balanceMaintain (improve) cardio fitnessProtect/prevent further injury
GOAL SETTING: LONG TERM GOALS
Invariably to return the athlete to practice and or competition as quickly and safely as possible
BALANCE BETWEEN HEALING AND RETURN TO PLAY
“Walking a thin line”Walking the tightrope Pushing the envelope
REMAIN SAFE WITHIN CONFINES OF HEALING
PROCESS
Rehab , what we know
RECOLLECT PAST LEARNING:
Physiology and Exercise Physiology Histology Human growth and development Motor Learning Biomechanics and Kinetics Strength and Conditioning Personal Training Sport Psychology
What we will cover
Inflammatory / Healing Process
PHASES OF HEALING:
Inflammatory Phase 2-4 days
Fibroblastic-Repair Phase First few hours post-injury to 4-6 weeks
Maturation-Remodeling 3 weeks to several years
PATHOMECHANICS
Knowledge of NORMAL and ABNORMAL mechanics of biomechanics and functional anatomy is crucial
Once again you need to know anatomy
Kinetic Chain
The therapist must understand the kinetic chain
If a system within kinetic chain is not working efficiently, the other systems are forced to adapt and compensate, this can lead to tissue overload, decreased performance and predictable injury patterns
Psychological Aspects
Individuals deal with injuries differently Injuries and illnesses produce a wide range of
emotions Athletes vary in terms of pain threshold,
cooperation , compliance, competitiveness, denial, depression, anger, fear , guilt and the ability to adjust to the injury
Belief that therapists are 95% psychologist and 5 % clinician
Tools
Electrical modalities, medications, massage, flexibility, strengthening, joint play, proprioception, alternative therapies, plyometrics, cardiovascular conditioning….
PAIN
All injuries will experience some kind of pain
Severity may help to determine extent of pain, however athletes individual pain threshold will determine a major component of the pain.
PAIN IS REAL
PAIN
The therapist should address pain levels at each therapy session, modalities and medicines will be used to help reduce the pain.
Pain levels will dictate the rate of progression, as pain decreases.. Healing will progress.
Re-establish neuromuscular control
Re-establish neuromuscular control is a prime concern
Traditionally, certified athletic therapists have used the terms proprioception, strength, and functional exercise. Neuromuscular control relates to all of these concepts.
Restoring ROM
Loss of movement can be attributed to a number of pathological factors
Resistance of Musculotendinous units to stretch
Contracture of connective tissue Or combination of two Crucial to restore normal ROM , with out it
difficult to achieve many other goals of the rehab program
Restoring ROM
Stretching is utilized to increase flexibility when Musculotendinous units are involved
OR Joint mobilizations are used to increase accessory movement with in a joint
Restoring Muscular strength , Endurance and Power
A major goal in performing strengthening exercises is to work through a full pain free range of Motion
A functional rehab strength program should involve exercises in all three planes of motion, with concentric and eccentric exercise.
Restoring Muscular strength , Endurance and Power
IsometricProgressive resistive exerciseIsokineticPlyometric Core Open and closed??
Maintain (improve) cardio fitness
This stage can be neglected by many Injured athlete miss training time , the
cardio fitness decreases rapidlyActivities must be found to replace this
training time that they miss.. Alternative can be found..what are some of them ??
Criteria for Full Recovery
Physiological healing constraints Pain Status Swelling ROM Strength Neuromuscular control Cardio fitness Sport specific demands Functional testing Prophylactic strapping and or bracing Responsibility of athlete Predisposition to injury Psychological factors Athlete education
FUNCTIONAL TESTS
Valid and reliable Easy to apply, cost efficient, minimal time and space
demands, applicable Unilateral and bilateral function to ensure no
compensation Normative/pre-injury values exceptionally helpful Limb symmetry
Ipsilateral limb/contralateral limb
