rehab medicine
DESCRIPTION
some information on rehab medicineTRANSCRIPT
SPORTS REHABILITATIONmatthew rex acosta madayag, md
physiatrist
SPORTS REHABILITATION
- multi-disciplinary approach to treat injuries
sustained through sports participation so the
athlete can regain normal pain-free mobility
- Primary goal: return to pre-injury activities
• Phase I: Resolving pain and inflammation
• Phase II: Restoring range of motion
• Phase III: Strengthening
• Phase IV: Proprioceptive training
• Phase V: Sports/task specific activities
Phases of Sports Rehabilitation
• Control the inflammatory reaction
1. P – protection
2. R – rest
3. I – ice
4. C – compression
5. E- elevation
Phase I: Resolving pain and
inflammation
• Protection
– Splinting
– Bracing
– Taping/wrapping
• Rest
– Relative rest
• Affected area is rested, the remainder of the body is exercised
Phase I: Resolving pain and
inflammation
• Ice
– Control the initial inflammatory
response
– Facilitates pain control
– 20 minutes 4 to 5 times/day
• Compression
– Limit the edema
– Ice wrapping
– Compressive stockinette
Phase I: Resolving pain and
inflammation
• Elevation
– Control post injury swelling
– Above the level of the heart to optimally assist
with venous and lymphatic drainage
• NSAIDs and TENS can assist with both
inflammation and pain control
Phase I: Resolving pain and
inflammation
• ROM allows for controlled stress which will
stimulate proper collagen deposition.
• Pain free movement of a joint and stretching is
encouraged to prevent contracture.
Phase II: Restoring range of motion
• Early post-injury phase isometric
contractions
– 10 seconds contraction; 10 reps; 10x/day
• ROM recovers isotonic strengthening
• Resistance training
– Against gravity
– Weights
– Resistance tubing
Phase III: Strengthening
• Dynamic motor control
• Simple proprioceptive training
– Seated exercises with wobble board for LE injuries
– Loading exercises of the arm
Phase IV: Proprioceptive training
• Occurs as the athlete successfully meets the
challenges of the previous phases
Phase V: Sports/task specific activities
ACUTE phase: PRICE, TENS, protected ROM, static and closed kinetic chain exercises (isometrics), general conditioning ex, NSAIDs
RECOVERY phase: USD, TENS, HMP, AROM, PNF, dynamic strengthening, sports specific ex
FUNCTIONAL phase: plyometric exercise, flexibility strengthening, power and endurance, sport specific progression ex, return to sports
REHABILITATION OF INJURED ATHLETES:
SPORTS REHABILITATION
Most common sports injuries – SPRAINS and
STRAINS
SPRAIN- injury to the ligaments caused by
overstretching or tearing
STRAIN- injury or tear to the muscle and/or
tendon
Cervical Spine Injuries In Sports
• Results when the accelerating head
& neck strike a stationary object
• Associated with axial loading of
flexed cervical spine
• Burner or ‘stinger’- a transient
neurologic event characterized by
pain and paresthesia in a single upper
limb following a blow to the neck or shoulder
Cervical Spine Injuries In Sports
• May result from strain,
sprain or tetraplegia (SCI)
• Cervical Disc
- Most common: C5-C6
–Acute disc herniation
- Special tests:
Spurlings test : radiculopathy
Shoulder abduction test: relief
Cervical Spine Injuries In Sports
Treatment:
in acute injuries- immobilization (protection)
in severe cases: X-ray cervical spine
in recovery phase: modalities
stretching
Calliet neck ex
Cervical Spine Injuries In Sports
Rotator Cuff Injury= overuse syndrome
- baseball, tennis, swimming, etc...
- LOM, ms weakness, pain,
clicking sound
- if with tears,supraspinatus ms
- morphology of acromion in
relation to rotator cuff tear
- type 1= flat
- type 2= curved
- type 3= hooked
Shoulder
• Shoulder Impingement syndrome:
- most common cause of shoulder pain
- subacromial space narrowing causing
compression and inflammation on subacromial
bursa, biceps tendon and SITS ms
Shoulder
• Special tests for impingement syndrome
- Neer’s impingement sign- passively flex the
arm > 90 degrees, if with pain, supraspinatus
tendon is compressed between acromion and
greater tuberosity
- Hawkin’s sign- same as above but with IR of
shoulder. Supraspinatus tendon is compressed
against the coracoacromial jt
- painful arc syndrome- arm pain in abduction
60-120 degrees
Shoulder
• Special tests for rotator cuff tears
Drop arm test- passively abduct shoulder with
IR. Pt unable to maintain abduction due to
complete tear of rotator cuff. (deltoids will
initially hold abduction but fails eventually)
Shoulder
Shoulder Dislocation
Anterior dislocation:
excessive ER and
abduction
Posterior dislocation:
fall on the forward
flexed and adducted
arm
Shoulder
• Rehabilitation
– Pain control and inflammation reduction
– Restoration of motion: but limit movements that
would increase the chances of dislocation
– Strengthening
– Proprioceptive training
– Return to task
– in case of recurrent shoulder dislocation: refer to
orthopedic surgeon for closed reduction or
possible surgery
Shoulder
• Tendinitis
– Lateral epicondylitis: tennis elbow
• Extensor carpi radialis brevis and Extensor
digitorum communis
• Pain is 1-2 cm distal to the lateral epicondyle
• Pain with resisted extension (Cozen’s test)
• Mgt= ice, rest, PT, counterforce brace
Elbow
– Medial epicondylitis: golfer’s elbow/ little
leaguer’s elbow in children
• Inflammation of the common flexor tendon’s origin
Elbow
• Wrist fractures
– Scaphoid-Most commonly fractured carpal bones
– Lunate- most commonly dislocated carpal bone
– Distal radius fracture
Wrist and Hand
• Ligamentous Injuries of the thumb
– Gamekeeper’s thumb
• Ulnar collateral ligament of CMC jt
• Grade
– I – pain and no increased motion
– II – increased opening with pain on stressing
– III – no pain from the absence of an intact ligament and
continued motion while stressing
Wrist and Hand
• De Quervain’s Stenosing Tenosynovitis
- Inflammation of the 1st dorsal compartment (APL
EPB tendons)
- Overuse gripped and wrist ulnar deviated
- Radial wrist pain is noted with resisted
thumb extension
- Finkelstein’s test
Wrist and Hand
• Injuries to the digits
- Mallet finger –rupture of extensor tendon
- Jersey finger- rupture of flexor tendon at its
insertion
Wrist and Hand
Hip Pointer
- Direct blow to the pelvic brim
or hip region which results in a
contusion to the soft tissues and
underlying bone ( bleeding in
hip abductors)
- Contact sports such as football
and hockey
- lasts for 1-6 wks depending on
the severity
- Tx: icing, active ROM, rest
Hip
• Patellofemoral Pain Syndrome (PFPS)
- biker’s or runner’s knee
- Most common anterior knee pain syndrome
- Overuse injury by repeated microtrauma
- due to vastus lateralis tightness
and medial weakness
Knee
• Patellofemoral pain Syndrome
– Vastus Medialis Obliquos ( VMO) Insufficiency
• Help maintain proper patella tracking during extension
of the knee
• Dynamic medial stabilizer
– ITB tightness
• Abnormal patellar tracking
– Hamstring tightness
• Increase patellofemoral joint reaction force in stance
Knee
• Patellofemoral pain Syndrome
– Treatment:
• Ice, NSAIDs
• Avoid kneeling, excessive stair climbing and prolonged
sitting
• Proper stretching (vastus lateralis, ITB and hamstrings)
• VMO strenghtening
• Patellar mobilization technique
Knee
• Anterior Cruciate Ligament Injury
- most common ligament injured in athletics
- MOI: knee hyperextension injury or deceleration
injury
- most commonly in landing flat on their heels
– Unhappy triad: ACL, MCL, medial meniscus
– Common with rotatory activity
– PE: anterior drawer test or
Lachmann test
Knee
Anterior Cruciate Ligament Injury
- women> men : due to general muscular strength, reaction time of muscle contraction and coordination, and training techniques
- Dx: MRI
- Sx: sudden popping sound, swelling, and instability of the knee
- conservative mgt: strengthening of hamstrings and knee braces
- surgery: ACL reconstruction
Knee
ACL - post operative rehabilitation phases
Phase 1: reduce pain and swelling while gaining ROM
Phase 2: 3-4 wks, mini wall sits and stationary bike, ROM upto 100 degrees flexion
Phase 3: 4-6 wks, controlled ambulation phase, flexion to 130 degrees, aim is to improve balance
Phase 4: 6-8 wks, moderate protection phase, full ROM with resistance training regimen
Phase 5: 8-10 wks, light activity phase, strengthening with balance and mobility
Phase 6: 10 wks ---, return to activity phase, jogging to return to sports
Knee
• Posterior Cruciate Ligament
- direct impact to the front of the tibia itself, usually
when the knee is bent
- (+) posterior drawer sign – most sensitive test for
PCL
- (+) posterior sag test
- Surgical
- Strengthening of quads
Knee
• Meniscal tear
- Direct blow to the knee/twisting type of knee
- Swelling, tightness
- Symptoms increase with
knee flexion & localized
to the joint line
- McMurray test
- Appley compression test
Knee
Meniscal tear
- Conservative mgt: RICE, NSAIDS, electrotherapy,
quadriceps strengthening, glucosamine sulfate
- Surgery: arthroscopic surgery
preserve as much of the meniscus cartilage as
possible
Knee
Medial and lateral Collateral ligament injuries:
- Medial > lateral
- (+) varus / valgus stress test
- (+) appley distraction test
Knee
• Achilles Tendinitis
– Inflammatory reaction
– Running is the most commonly associated activity
– Overuse – most common cause
– Treatment:
• Decrease inflammation
• Stretching of the gastrocnemius/soleus complex
• Eccentric strengthening
Ankle
Inversion ankle sprain
- Most common traumatic injuries
- Lateral ligament
- Grade:
• I – mild sprain of the anterior talofibular ; (-) anterior
drawer and talar tilt test
• II – disruption of the anterior talofibular with sprain of
the calcaneofibular, (+) ant drawer test , (-) talar tilt
• III – disruption of the lateral ligament complex with (+)
ankle drawer and talar tilt test
Ankle
• Deltoid Ligament Injuries
– Eversion injury
– Occur concomitantly with
inversion injury
• Treatment
– Ice, NSAIDs, relative rest, early mobilization
– Strengthening, proprioceptive exercises
Ankle
• Plantar Fasciitis
- Sudden loading of the feet
– Occur in both a pes planus foot and pes cavus foot
– Focal tenderness at the origin of plantar fascia
– Pain elicited by hyperdorsiflexion of the great toe
– Tightness of gastrocnemius comples
– Treatment
• Aggressive stretching
• Strengthening exercises
Foot
Thank you