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