rehab exam 1
rehabilitation philosophy
assist the natural process of the body while doing no harm primary goals: positive influence on INF and repair process, expedite recovery of function, prevent reinjury
psychosocial responses to injuries
at the core of the biopsychosocial models: cycle typically starts before injury and goes beyond return to play, we are influenced by the physical characteristics of the injury itself identifying and assessing psychosocial responses to injury becomes an important part to AT's work
common responses to Musc-skel injury
attributions related to the cause of injury perceptions of the injury occurrence flashbacks related to the injury occurrence perceived benefits of injury, self-identity, self-confidence, self-efficacy related thoughts
rehabilitation adherence measure for athletic training
contains 16 items across 3 subscales: attendance/participation communication attitude/effort
PNF techniques
contract-relax hold relax slow reversal hold relax
plyometrics should not be
exclusive
biopsychosocial model of sport injury rehabilitation fails to?
explain the cyclical interaction between thoughts, emotions, and behaviors
what should be central in determining assessment needs?
injured athletic patient's overall health and well-being
PNF
proprioceptive neuromuscular facilitation
factors that determine levels of strength, endurance, and power
size of muscle number of muscle fibers neuromuscular efficiency age (peaks at 20-25) biomechanical considerations overtraining (imbalance between exercise and recovery)
resistance training differences between males and females
the approach does not differ between males and females females tend not to develop significant muscle bulk, less testosterone; muscle tone will increase
slow twitch fibers
type 1 or slow oxidative resistant to fatigue time required to generate force is greater in slow twitch primarily associated with long duration, aerobic type activities
types of collagen
type I: skin, fascia, tendon, bone, ligament cartilage, interstitial tissue type II: hyaline cartilage, vertebral disks type III: skin, smooth muscle, nerves, blood vessels
purpose of graston
used to relieve discomfort and restore normal function
rehabilitation over-adherence questionnaire
useful tool when patients who are not complying with their rehabilitation contains 10 items across 2 subscales-> ignore practitioner recommendations and attempt an expedited rehabilitation
integrated model of psychological response to sport concussion injury and rehabilitation
uses the integrated model as a foundation incorporates range of neurobiological, psychogenic, and pathophysiological causes/responses
Delorme's method
Based on repetition maximum of 10
contract relax
move body passively into agonist pattern patient contracts isotonically against resistance patient then relaxes and AT passively pushes body further into agonist pattern
importance of collagen
structural protein forms strong, flexible, inelastic structures holding connective tissue together 16 types (types 1-3 make up 80% to 90% in body) able to resist tensile stress, not shear or compressive loads mechanical: elasticity, viscoelasticity, plasticity physical: force relaxation, creep response, hysteresis
self-determination theory
theory of human motivation and personality proposes that 3 innate psychological needs (sense of autonomy, sense of competence, and sense of relatedness) serve as the foundation
stretch reflex
muscle is placed on stretch muscle spindles and GTO respond immediately muscle spindles fire relaying info to spinal cord spinal cord relays message to muscle to increase tension resisting stretch GTO also signal the spinal cord after 6 secs, GTO relays signal for muscle tension to decrease-> cause reflex relaxation prevents injury- protective mechanism
chronic inflammation
occurs when acute inflammation DOES NOT eliminate injuring agents and restore tissue to normal physiological state specific mechanism is unknown neutrophils are replaced with macrophages, lymphocytes, and plasma cells
4 steps of goal setting
1) assess and identify patient's personal and physical needs that are pertinent for successful rehab and recovery 2) identify and set appropriate physical, psychological, performance, and lifestyle goals 3) consider factors that may influence the goal setting effectiveness 4) follow a step-by-step program to integrate goal setting into rehab
psychological biophysical models
1)model of stress and athletic injury 2)integrated model of psychological response to sport injury and rehabilitation 3)biopsychosocial model of sport injury rehabilitation 4)integrated model of psychological response to sport concussion injury and rehabilitation
Sport Injury Rehabilitation Adherence Scale (SIRAS)
AT rates injured athlete's behaviors in relation to-> intensity of rehabilitation completion frequency of following rehab instructions and advice receptivity to changes w/in the program
psychosocial responses to concussion injury
often include content that appears to downplay the injury severity many athletes choose not to report their symptoms
what is critical in injury prevention?
passive ROM
according to MSAI, what variables can influence the stress response?
personality, history of stressors (old or new), and coping resources, cognitive-behaviors interventions
biomechanical considerations
position of the tendon attachment length-tension relationship: determined by overlap/interaction of actin-myosin filaments
increasing muscle temp prior to stretching
positive effect on ability of collagen and elastin to deform optimal temp: 39 C or 103 F low intensity, warm-up type exercise or modalities
fast twitch fibers
produce quick, forceful contractions with tendency to fatigue more quickly useful in short-term, high intensity activities type IIa (fast oxidative glycolytic): moderately resistant to fatigue type IIb (fast glycolytic): true fast twitch fibers type IIx: fatigue resistance with force generating capacity less than type IIa, but greater than type IIb
Functional Strength Training
provides a unique approach to strength training MUST understand the concept of the kinetic chain and must realize that the entire kinetic chain is an integrated functional unit combination of concentric, eccentric, and isometric contractions functional movements occur in 3 planes
goal setting
provides patients a direction and plan of action most common strategy found to have a direct influence when used as a motivational strategy
____ loading= ____ firing frequency= _____ reflexive contraction
rapid; greater; greater
the strength of the muscle spindle response is determined by the ____
rate of stretch
plyometrics training relies more on _____ than ____
rate of stretch; length of stretch
3 phases of rehabilitation
reaction to injury reaction to rehabilitation reaction to return to sport/participation patient will make cognitive appraisals of the demands, available resources, and consequences related to the situation and will experience recovery-facilitating or recovery-debilitating
factors that impede healing
Extent of injury edema hemorrhage poor vascular supply muscle spasm atrophy corticosteroids keloids and hypertrophic scars infection humidity, climate and oxygen tensions health, age, and nutrition
strength training must focus on ______
FUNCTIONing of muscle
nerve healing
regeneration is slow, occurs at a rate of 3-4 mm per day
Autogenic inhibition
relaxation of antagonist result of GTO activating serves as a protective mechanism-> muscle is able to stretch through relaxation w/o exceeding extensibility limits
social support
rely heavily on family, friends, teammates, ATs, coaches, and physician involvement SHOULD be something that is on-going even before injuries
PRE techniques
repetitions rep max (RM) set intensity recovery period frequency
key points for effective goal setting
should be specific ad measurable positive talk challenging but realistic have a timetable short-, medium-, long-term link outcome goals to process goals link sports goals to life goals patient education two-way communication written material
recommended techniques of resistance training
single set tri-sets multiple sets superset
with any injury, there will be generally
some degree of lost range of motion
Program Development
specificity is KEY complex movements -> broken down into basic movements patterns should start basic and work up plyometrics-> prepare body to accept increasingly larger loads, fine tune NM system
neuromuscular coordination
speed of contraction may be limited training with explosive pre-stretch results in improved neuromuscular performance(system becomes more automatic) emphasis placed on reducing amortization phase
referrals can also be
spontaneous
Neuromuscular efficiency
strength is directly related to efficiency of the neuromuscular system enhanced strength in 3 ways: increase motor unit recruitment, increase in firing rate, enhance synchronization of motor unit firing
size of muscle
strength is proportional to cross-sectional diameter of muscle fibers increased cross-sectional area= increased strength and force production
physiological adaptations to resistance exercise
strength of non-contractile structures improved oxygen intake increased metabolic enzymes(enhances metabolism)
Muscular Strength vs endurance
strength: ability to generate force against some resistance endurance: ability to perform repetitive muscular contractions against some resistance
_____ and ____ have the strongest associations with injury incidences
stress-response and history of stressors
Conversion of elastic energy to force output
stretch is applied-> potential energy is stored and released when returned to original length
Flexibility
ability of neuromuscular system to allow for efficient movement of a joint or series of joint through a full, non-restricted pain free ROM
ratio of concentric component to eccentric component should be
about 1 to 2
Fibroblastic Repair Phase
active scar formation may last 4-6 weeks inflammation S&S will subside endothelial capillary buds provide more blood flow granulation tissue develops with breakdown of fibrin clot collagen is deposited randomly at day 6 or 7 (results in increased scar tensile strength)
berger method
adjusts w/in athlete's limitations should allow for 6-8 RM reps on 60-90s must be able to achieve 3 sets of at least 6 RM and no more than 8 RM
when the muscle spindle becomes stretched, an ____ response is produced and transmitted to the _____
afferent sensory; CNS
stretching techniques
ballistic: bouncing movement of repetitive contractions of agonist work to stretch antagonist muscle static: stretch to discomfort then hold (15-30s) dynamic: uses controlled function movements to enhance neuromuscular system ability to control movement PNF: involves alternating contractions and stretches
Plyometric Prerequisites
biomechanical eval-> identify poor landing biomechanics, eccentric strength is critical stability testing (static, SL stretch and stability) dynamic movement testing (explosive & coordinated) flexibility (begin with warm-up and routine)
fibers ratio in muscle
both fibers types exist in individual muscles ratio varies by muscle and by individual postural muscles: primarily type I fibers power, explosive strength muscles: type II fibers
isometric exercise
capable of increasing muscle strength at a specific joint angles no corresponding increase at other joint angles widely used in rehab can be useful to enhance lift or activity at "sticking point" in range of motion
variable resistance
change in force required at different angles to move a particular resistance effectiveness is debatable
strength and endurance are ____
closely related; as one improves, the tendency is for the other to do the same
clot formation
collagen is exposed by disrupted vessel walls platelets adhere to vascular wall with leukocytes forming a plug plug obstructs local lymphatic fluid drainage results in localization of the injury precipitated by fibrinogen-> fibrin conversion clot formation begins 12 hours after injury and complete within 48 hours
What is plyometric exercise?
combination of speed and strength training quick powerful movement involving pre-stretching muscle and activating stretch-shortening cycle for stronger concentric contraction
force production
combined effects of stored elastic energy and myotatic (stretch) reflex increased force production is dependent on transition from eccentric to concentric contraction amortization phase (delay between and concentric contractions)
mechanical characteristics
contractile component: concentric contraction->force production through sliding filament theory series of elastic component: eccentric contraction, SEC lengthens and contributes to overall force output; stored elastic energy-> used for force production parallel elastic component
reciprocal inhibition
contraction of agonist elicits antagonist to relaxion
as the muscle ____, the stretch on the muscle is ______, ______ the original stimulus
contracts; relieved; removes
neural tissue flexibility
develops tightness as a result of compression, chronic repetitive microtrauma, muscle imbalances, joint dysfunction or morphological adaptations due to posture could stimulate nociceptors and pain
dislocation vs subluxation
dislocations present with total disunion of bone apposition between articular surfaces requiring manual or surgical realignment subluxations are partial dislocations causing incomplete separation of two bones reduction should NOT occur w/o an x-ray (rule out fx)
biomechanical principle
eccentric pre-stretch -> concentric contraction goal is to decrease amount of time between eccentric leading contraction and concentric force producing contraction
the primary injury
either chronic or acute macro traumatic or micro traumatic injury secondary injury: inflammatory or hypoxia response
rehabilitation adherence
extent to which an individual follows directions of treatment plan necessary for full and timely recovery adherence vs non-adherence
AT should always ____ with the patient
follow-up
Model of stress and athletic injury (MSAI)
foundation for psychosocial injury theory and research assumes that risk of athletic injury is amplified as a result of an unwanted psychophysiological response to a potential stressful situation
Importance of flexibility
full ROM is essential to normal daily living lack of flexibility can create uncoordinated movement patterns
what is responsible for stretch reflex?
golgi tendon organs: detect tension muscle spindles: detects stretch
ROM assessment tools
goniometer (most common) digital inclinometer (more precise with high reliability)
circuit training
group of exercise used to increase strength or endurance move from one station to the next, performing exercise for a given period of time or # of reps
IRP chemical mediators
histamine: vasodilation and increased cell permeability leukotrienes & prostaglandins: margination (seal wound) and increased permeability cytokines: attract leukocytes and phagocytic activity facilitated
muscle hypertrophy
hyperplasia: increase in number of muscle fibers NO new capillaries; increase in dormant capillary activity to meet needs of muscle
degree of muscle fiber elongation
length of proportional to amount of stretching force applied ability of muscle spindle to produce a neurophysiological response
if the length of the surrounding muscle fibers is ____ that of the spindle, the frequency of the nerve impulse from the spindle is ____
less than; reduced
what cells are delivered during inflammatory response?
leukocytes, phagocytic cells, and exudate(pus) are delivered to injured tissue
planned proactive referrals
made when the athletic patient wants to learn and build existing and new mental skills in the absence of an acute mental health concern
planned reactive referrals
made when there is an acute psychosocial and/or mental health concern, and the AT is responding to this concern
behavioral responses
may exhibit a range of emotions sleep-wake disturbances poor social functioning social isolation communication difficulties behavioral disinhibition avoidant coping aggression verbal outbursts illness behaviors substance abuse suicide
proprioceptive stretch reflex
mechanoreceptors detect stretch resulting in alterations in muscle tone, motor execution and kinesthetic awareness
important to note that ____ and ____ may be higher in patients with concussions
mood disturbances and depression
progressive resistive exercise
most popular and commonly used work through full ROM isotonic or isodynamic contractions
IRP vascular reaction
vascular spasm: clot formation and fibrous tissue growth vasoconstriction occurs 5-10 min following injury causes anemia followed by hyperemia due to dilation initial effusion of blood lasts 24-36 hours
______, ____, and ______ induce significant improvement in explosive actions, balance, and intermittent endurance capacity
vertical, horizontal, and combined vertical and horizontal jumps
Plyometric Program Design
weight speed of execution (quality over quantity) external load intensity (progress simple to complex) volume (# of foot contacts) frequency (2-3 days between sessions) training age recovery implementation (proper technique)
4 areas to consider for resistance training
weight amount # of reps # of sets frequency of training
biopsychosocial model of sport injury rehabilitation
to demonstrate interrelated, bidirectional relationships between biological, psychological, and social/contextual factors assumes these factors influence both intermediate and overall rehabilitation outcomes (short and long term) model can be useful for designing and evaluating injury rehabilitation interventions
overload principle
to improve strength, muscle must be worked at a level higher than it is accustomed to effective training requires a consistently increasing effort against progressively more resistant loads
Econcentric contraction
Controlled concentric and eccentric contraction of same muscle over 2 separate joints
Maturation-Remodeling Phase
Realignment of collagen Continued breakdown and synthesis of collagen Increased stress and strain results in increased collagen realignment Nonvascular, contracted, strong, firm scar present after 3 weeks Maturation may require several years to complete
use of stored energy affected by
Time Magnitude of stretch Velocity of stretch
oxford method
Used during early, intermediate and advanced levels of rehabilitation Percentages of maximum was reversed in 3 sets
Role of Progressive Controlled Mobility
Wolff's law: bone will respond to physical demands (Davis' law: same but with soft tissue) remodeling and realignment enhances scar formation, revascularization, tensile properties, muscle regeneration and fiber reorientation brie period of immobilization is recommended during IRP
integrated model of psychological response to sport injury and rehabilitation
incorporates the model of stress and athletic injury in its conceptualization the model assumes that after injury, the injury ITSELF becomes a stressor thoughts, emotions, and behaviors create the dynamic core, which are influenced by a number of personal and situational factors model DOES NOT incorporate biological aspects
plyometrics in athletics
increased power translates into improved athletic performance research has shown that plyometric training can improve speed, agility, balance, jumping ability, strength and power
physiological performance improvements
increased speed of stretch reflex increased intensity of subsequent muscle contraction w/ recruitment of additional motor units force-velocity relationship plyometric training desensitizes GTO increasing threshold level of inhibition
central hypothesis of the model of stress and athletic injury
individuals with personality characteristics that tend to intensify the stress response will appraise a stressful situation as more intense leading to a greater risk of injury
Phases of the healing process
inflammatory (acute INF) fibroblastic-repair (proliferation) maturation-remodeling
GTO has an _____ effect on the muscle by contributing to a ______
inhibitory; tension-limiting reflex
psychosocial responses to musculoskeletal injury
injured athletic patient typically makes a primary cognitive appraisal of injury and implications -> irrelevant, benign positive, stressful primary vs secondary vs appraisal vary greatly
Inflammatory Response Phase (IRP)
injury results in altered cellular metabolism and chemical mediators macroscopic characteristics: swelling, redness, increased temp initial response is critical to the healing process!
Graston Technique
instrumented assisted soft tissue mobilization used to break down scar tissue and fascial restrictions uses stainless steel instruments for scanning and treatment of the injured area uses lubricant and multi-directional cross friction
isokinetic exercise
involves muscle contractions where length of muscle changes while contraction occurs at a set velocity max resistance throughout full ROM used as a conditioning tool and for rehab
hold relax
isometric contraction of antagonist followed by concentric contraction of agonist with light pressure facilitates stretch of antagonist effective with muscle tension on one side of joint
Isometric vs Concentric vs Eccentric
isometric: contraction that produces muscle tension but no change in muscle length concentric: contraction that causes muscle shortening while tension increases to overcome some resistance eccentric: resistance is greater than the muscular force bring produced and muscle lengthens while produces tension
slow reversal hold relax
isotonic contraction of agonist follow with isometric contraction of antagonist during relax phase antagonist is relaxed while agonist contracts in agonist pattern useful to stretch antagonist
why is the integrated model regarded as the most comprehensive theoretical model?
it explains the psychosocial process of injury occurrence, rehabilitation, and return-to-play participation has been used extensively by sport psychology researchers