2233C H A P T E R

Rehabilitation and ReconditioningRehabilitation and Reconditioning

Chapter Outline

Sports medicine team

Rehabilitation and reconditioning strategies

Types of injury

Tissue healing

Principles of Rehabilitation and Reconditioning

Healing tissues must never be overstressed.

Rehabilitation is a team-oriented process.

Athlete must fulfill criteria.

Program must be based on current research.

Program must be adaptable to each individual.

Sports Medicine Team Members

Team physician

Athletic trainer

Physical therapist

Strength and conditioning professional

Exercise physiologist

Nutritionist

Psychologist or psychiatrist

The sports medicine team includes a large

number of professionals working together to

provide an optimal rehabilitation and

reconditioning environment. The relationship

among members requires thoughtful

communication to ensure a safe, harmonious

climate for the injured athlete.

Types of Injury

Macrotrauma: caused by a specific, sudden episode of overload injury to a tissue; results in disrupted tissue integrity

Microtrauma: caused by repeated, abnormal stresses applied to a tissue through continuous training or training with too little recovery time

Tissue Healing: Inflammation Phase

Pain, swelling, and redness

Increased number of inflammatory cells

Decreased collagen synthesis

Tissue Healing: Repair Phase

Collagen fiber production

Decreased number of inflammatory cells

Decreased collagen fiber organization

Tissue Healing: Remodeling Phase

Proper collagen fiber alignment

Increased tissue strength

Rehabilitation and Reconditioning Goals and Strategies: Inflammation

Prevention of new tissue disruption and prolonged inflammation.

No active exercise for injured area.

Function of cardiorespiratory and surrounding neuromusculoskeletal systems must be maintained.

Rehabilitation and Reconditioning Goals and Strategies: Repair

Prevention of excessive muscle atrophy and joint deterioration.

Function of neuromusculoskeletal and cardiorespiratory systems must be maintained.

Possible exercises include

- submaximal isometric, isokinetic and isotonic exercise and

- balance and proprioceptive training activities.

Rehabilitation and Reconditioning Goals and Strategies: Remodeling

Optimization of tissue function

Progressive loading of neuromusculoskeletal and cardiorespiratory systems

Possible exercise options:

- joint-angle specific strengthening

- velocity-specific muscle activity

- closed and open kinetic chain exercises

- proprioceptive training activities

Designing strength and conditioning

programs for injured athletes requires the

strength and conditioning professional to

examine the rehabilitation and reconditioning

goals to determine what type of program allows

the quickest return to competition.

Resistance Training Techniques Used in Rehabilitation

• DeLorme’s method– Based on repetition maximum

of 10– Designed for early rehab– Designed for beginning rehab– Introduced PRE –

“progressive loading”– Builds in warm-up period

• MacQueen’s method– Utilizes varying sets for

beginning/intermediate & advanced

– Set of 10 RM

• Oxford method– Used during early,

intermediate & advanced levels of rehabilitation

– Percentages of 10 RM– Diminishes resistance as

muscle fatigues – “regressive load”

• Sander’s program– Utilized in advanced stages

of rehabilitation– Utilizes percentages of body

weight

• Knight (DAPRE)– Daily Adjustable

Progressive Resistive Exercise

– Adjusted based on individual’s progress

– Based on 6 RM working weight

• Berger– Adjusts within individual’s

limitations– Should allow for 6-8 RM

repetitions on 60-90 seconds– Must be able to achieve 3 sets

of at least 6 RM and no more than 8 RM

– Increases occur in 10% increments

• For rehabilitation– Base program on pain

and healing process– Should be performed

daily early on – Reduce workout to every

other day as progress is made

Isokinetic Exercise• Involves muscle contractions where length change of

muscle is set at a constant velocity

• Maximal resistance throughout the range of motion

• Variety of machines/manufacturers are available

• Can be used with eccentrics & concentric exercise

• Isokinetics as a Conditioning Tool– Maximal effort for maximal strength gains

– Dynamometer will move at a set speed whether maximal or half of maximal effort is put forth

• Athlete can cheat with machine and not put forth the effort

– Not cost effective

• Isokinetics in Rehabilitation– Gained popularity in rehabilitation during the 1980’s

– Provide objective means of athlete/patient evaluation

– Training at fast vs. slow speeds

– Functional speeds

De Lorme Program

• Uses 3 sets of 10 repetitions

• 1st set: 10 reps of 50% of 10RM

• 2nd set: 10 reps of 75% of 10RM

• 3rd set: 10 reps of 100% of 10RM

• The Oxford system is the reverse of De Lorme, it progresses from heavy to light

Daily Adjustable Progressive Resistance Exercise (DAPRE by Ken Knight)

• DAPRE involves four sets with repetitions ranging from 10 to possibly 1 during the final set.

• 1st set: 10 reps of 50% of 1RM• 2nd set: 6 reps of 75% of 1RM• 3rd set: maximum number of reps of 100% of 1RM• The number of repetitions performed in the 3rd set

determines the adjustments to be made in the fourth set. (Table 23.2, p 542).