Sports Lec

8/14/2019 Sports Lec

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Review

/Acute Stage Inflammatory Stage

/Subacute Stage Repair

/Chronic stage Remodelling

STAGES of

INFLAMMATION and REPAIR



REHABILITATION of

SOFT TISSUEand

SPORTS INJURIES

. ,ICHAEL D MAGPANTAYPTRPP h y s i o t h e r a p i s t

– .,o r o Sp l as h F o u nd a ti on In c

p o rt s C li n icmoro

:TP T 1 3 0 Me di c al R eh ab i li t at io n L ec tu r es 2

,ni ve r s ity of t h e P h il i pp i ne s M an i l a C o ll eg e o f ll ie d Med i ca l P r of e ss i on s



SPORTS MEDICINE TEAM

Family physicianPhysiotherapistSports physicianMassage therapistOrthopedic surgeon

RadiologistPodiatristDietician / NutritionistPsychologistSports Trainer / Athletic Trainer

Other professionals such asOccupational Therapist, orthotistand nurses

Coach



SPORTS MEDICINE TEAM

There may be aconsiderable amountof overlap between thedifferent practitioner

“Multiskilling” isparticularly important if the practitioner is

geographically isolatedor is travelling withsports team



SPORTS MEDICINE MODEL

Athlete - Coach

Physician

Psychologist Podiatrist

Physiotherapist / OT

Others

Massage TherapistDietician

Trainer



SPORTS MEDICINE

The secret of successis to take a broad viewof the patient and his or

her problem

Ask “Why has thisinjury / illness occurred

Diagnosis andtreatment



SPORTS MEDICINE

Diagnosis

Precise anatomical andpathological cause of thepresenting problem

Presenting problem andcause of the problem

History, physicalexamination andinvestigation



Treatment

Treatment of presentinginjury and treatment to

correct the cause

Combination of differentforms of treatment will

usually give the best result

Evaluate effectiveness of treatment constantly

SPORTS MEDICINE



SPORTS MEDICINE

Meeting Individual Needs

Every patient is a uniqueindividual with specific

needs

Treatment depends on the

patient’s situation, notpurely on the diagnosis



SPORTS MEDICINE

“Love Thy Sport”

It is essential to knowand love the sport

It is essential to be onsite



SPORTS INJURY REHABILITATION

Primary goal is to enable theathlete to return to sports withfull function in the shortestpossible time

Inadequate rehabilitationProne to reinjury of theaffected areaIncapable of performing at

pre-injury standardPredisposed to injuring other part of the body




Keys to a successful rehabilitation

Explanation

Provide precise prescriptionMake the most of the availablefacilities

Begin as soon as possible




Components of Rehabilitation

Muscle conditioningFlexibility

Neuromuscular control,balance and propriceptionFunctional exercisesSports skills

Correction of abnormalbiomechanicsMaintence of CV fitnessPsychology



Return toSport

Skill Aquisition

Proprio-ception

Strength Flexibility

Motor Re-educationand

Muscle Activation



SOFT TISSUES LESIONS(Mechanism of Injury or Onset of Symptoms)

OVERUSE INJURIEACUTE INJURIES



OFT TISSUES LESION( )Site

BONE

LIGAMENT

ARTICULAR CARTILAGE

JOINT

MUSCLE

TENDON

BURSA



BONE Acute Injuries Overuse Injuries

Fracture Stress Fracture

‘ ’,Bone Strain

‘ ’Stress Reaction

PerisostealContusion

,OstitisPeriostitis

Apophysitis



ARTICULAR CARTILAGE Acute Injuries Overuse Injuries

/Osteochondral Chondral

Fractures

ChondropathySofteningFibrilationFissuringChondromalacia

Minor Osteochondral

Injury



JOINT Acute Injuries Overuse Injuries

Dislocation Synovitis

Sublaxation Osteoarthritis



LIGAMENT Acute Injuries Overuse Injuries

/Sprain Tear Inflammation



MUSCLE Acute Injuries Overuse Injuries

/Strain Tear Chronic CompartmentSyndrome

Contusion Delayed Onset

Muscle Syndrome

Cramp Focal Tissue/Thickening

Fibrosis Acute CompartmentSyndrome



TENDON Acute Injuries Overuse Injuries

Tear Tendinopathy



BURSA Acute Injuries Overuse Injuries

TraumaticBursitis

Bursitis



JOINT/Dislocation Sublaxation

Dislocation occurs when traumaproduces complete dissociation of

articulating surfaces




Shoulder (Glenohumeral Joint) Dislocation- anterior dislocation results from the

arm being force into excessive abductionand Supraspinatus

- immobilized with elbow extended andshoulder external rotation




Management:Protection Phase

Protect healing tissueActivity restrictionAvoidance of

Abduction withexternal rotators




Management:Controlled Phase.Provide ProtectionIncreased Shoulder

Mobility

Increase Stabilityand Strength of Rotator Cuff andScapulars




Management: Returnto Function Phase.

Restore FunctionalControlReturn to maximum

function



LIGAMENTSprain

Ankle – Anterior Talo Fibular

Ligament

Inversion



LIGAMENTSprain

Ottawa Ankle Rules



LIGAMENT Ankle Sprain

Management:

Protection Phase

Educate the PatientDecrease InflammationUse Gentle Joint Mob to maintain jointintegrity




Management:

Controlled Motion Phase

Attain Full range of motionStart StrengtheningBalance and Propriception




Management:


Progress strength trainingProgress Balance and propriception

exercisesSports movement and skills



Anterior cruciate ligament (ACL)injuries occur from both contactand noncontact mechanisms.

blow to the lateral side of theknee resulting in a valgus forceto the knee.

rotational mechanism in whichthe tibia is externally rotated onthe planted foot

LIGAMENT Anterior Cruciate Ligament





LIGAMENT Medial Collateral Ligament

Result of valusstress on a semiflexed knee





Meniscectomy

A symptomatic (pain and locking),displaced tear of themeniscus sustained by an older,inactive individual associated

with pain and locking of the kneeA tear extending into the central, lessvascular thirdof the meniscus if not determinedrepairable when

arthroscopically visualized and probedA tear localized to the inner, avascular third of the meniscus

Indication for Surgery



Meniscectomy

Management:

Protection Phase

Educate the PatientDecrease Inflammation

M i t



Management:


Attain Full range of motionStart StrengtheningBalance and Propriception

Meniscectomy

M i t



Management:


Progress strength trainingProgress Balance and

propriception exercisesSports movement and skills

Meniscectomy



Tendinopathy

• Rotator cuff tendinopathy

• Supraspinatus tendinitis

• Bicipital tendinitis

• Cumulative trauma disorder • ITB tendinitis

• Patellar tendinitis

• Tibialis posterior tendinitis

• Plantar fasciitis•



Tendinopathy


• Primary• Due to anatomic abnormalities

• Osteophytes

• Type III Acromion process

• Secondary• Excessive load on the shoulder due

to

• impaired scapulohumeral

rhythm• Joint instability

• Muscle imbalance



Tendinopathy


• Clinical features

• Pain with overhead activity or movement

• Painful arc 60-120 degrees of abd.• Abduction less than 90 degrees are

usually pain free

• Pain and tenderness in thesupraspinatus muscle particularly

at the insertion• Pain with excessive shoulder flexion



Tendinopathy

Bicipital Tendinitis

• Long head of thebicepssusceptible tooveruse injury

• Occurs withindividualsperforming highvolume of weight training

• Referred pain androtator cuff tendinopathycan producepain in thebiceps

• Symptoms

• Localtenderness of the

bicepstendon

• Muscletightness

• Chronicintermuscular andfascialthickening

• Pain on



Tendinopathy

Acute• PRICEMEM

• PT: Taping

• Physical agents

•

•

•

Subacute

•

•

•

Mobility/Strength

Low level functional

activities

Chronic

•Power •ADL in the pain free

range



Tendinopathy

Cumulative Trauma Disorders

• Chronic Inflammation• repetitious movements over a prolonged period of

time originating from the body part results in micro-

trauma of the area

•

•

Pain is the primaryManifestation •Characterized by increasedcollagen production andresorption of mature collagen•Efforts to stretch the inflamedtissue perpetuate the irritation



Tendinopathy

Typical Movements Typical Job Activities

flexion and extensionof the elbow

small parts assemblyhammeringmeat cuttingplaying tennisbowling

Tennis elbow

Golfers Elbow•Rare•



Tendinopathy

Tennis Elbow

• Pain at the siteradiating tothe lateral

epicondyle• ECRB +

Supinator

• ROM Complete

• Weak grasp

•

Golfers Elbow• Pain at site

reproduced byresisted wrist

flexion,pronation,grasping



Tendinopathy

• Tennis and Golfers Elbow

• Treatment is consistent with stages

• Ergonomic modifications



Tendinopathy

De Quervains Disease

• Stenosing tenosynovitis

• APL and EPB tendon

•

•



Tendinopathy

Typical Movements Typical Job Activities

combined forceful gripping andhand twisting

sawinguse of pliers“turning" control such as ona motorcycleinserting screws in holes

forceful hand wringing

De Quervain’s

Primary Treatment: Ergonomics and Joint protection



Tendinopathy

Management GuidelinesAcute

• Control of inflammation

• Focus on non-stressful activities /non-stressful intensitiesSubacute and Chronic

• Exercise programs with controlled

stress(until CT can withstand thestress)

• Identify the cause of faulty muscleand joint mechanics



Tendinopathy

OT

• Pallative treatment





Tendinopathy

ITB tendinitis

• ITB Friction syndrome

• Pain at insertion (GerdysTubercle)

• Treatment consistent with stages



Tendinopathy

Patellar Tendinitis

• “Jumpers knee”

• Inferior pole of the patella

Sinding Larsen Johansson• Osteochondritis of proximalattachment

Osteochondritis Dissecans

• Partial to complete avulsion of TT

•



Tendinopathy

Tib Post

• Pain in the navicular bone

• Resisted ankle inversion

Achilles tendinitis• Pain in calcaneus

• PlantarflexionPlantar fasciitis

• Pain in plantar aspect• Rule out heel spurs



Tendinopathy

Treatment

Tib Post

AchillesTendinitis

Plantar Fasciitis

Acute Chronic



Bursitis

Subacromial /Subdeltoid bursae

OlecranonBursitis“Miners Elbow”

Ischiogluteal bursitis“Weavers bottom”

Prepatellar bursitis“Housemaids knee”

Superficial infrapatellar bursitis“Nun’s Knee”

Pes anserine bursitis



Bursitis

• Clinical Feature

• Pain present in all motions

• Leads to secondary complications(wekaness, LOM)

• Continued use willl lead to erosion,rupture, adhesive pericapsulitis



ACHILLES TENDON REPAIR




Rehabilitation Guidelines: Maximum Protection Phase

Protect the woundPrevention of early re-ruptureMaintain strength of non immobilized joints

Prevent reflex inhibition of immobilized muscle groupsSpecially Tibialis Posterior Prevent joint stiffness on operated ankle and footRe-train proprioceptionControl swelling

Maintain scar integrityImprove Gait pattern





Rehabilitation Guidelines: Moderate ProtectionPhase

Increase strength of hip and knee of operatedextremityImprove proprioception and balanceAttain Full Range of Motion on the operatedankle towards dorsiflexionIncrease Strength of operated ankle and footMaintain scar integrityNo swellingImprove Cardiovascular Endurance




Rehabilitation Guidelines: ModerateProtection Phase

Progress strengthening on operated ankle

Progress strengthening of hip and knee of operated extremityMaintain scar integrityProgress proprioception and balance

Attain Full Range of Motion on the operatedankle towards plantarflexionImprove Cardiovascular EndurancePrepare for jogging






Rehabilitation Guidelines: Minimun ProtectionPhase

Progress strengthening of hip and knee of

operated extremityProgress proprioception and balanceImprove Cardiovascular EnduranceImprove coordination

Prepare for SprintsImprove agilityIncrease Power





Rehabilitation Guidelines: Return to FunctionPhase

Progress strengthening on operated ankle

Progress strengthening of hip and knee of operated extremityProgress proprioception and balanceImprove Cardiovascular Endurance

Improve Power Return to Sport

MUSCLE STRAINS



MUSCLE STRAINSMaximum Protection Phase-

No stretching-No strengthening-Protect healing muscle-Mobilize unimmobilized areas-

Moderate Protection Phase-Strengthening

-Isometrics as tolerated isotonic-Core-Start stretching, massage-

Minimum Protection PhaseStrengthening

isotonic eccentrics

Stretching calf, hamstrings and quads





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Sports Lec