Curriculum Vitae

Name : Dr. dr. Tirza Z Tamin, Sp.KFR(K)

Place and Date of Birth : Medan, March 14th 1964
Home Address : Jl. Tanimbar Blok H No. 228 Cinere Megapolitan, Depok
Cellphone Number : 081212160835
Department : Medical Rehabilitation, Faculty of Medicine, University of Indonesia/
Cipto Mangunkusumo National General Hospital, Jakarta
Phone Number/ Fax : 021 3907561 / 3915593
 Curriculum Vitae
Formal Education:
• 1983 – 1989 : General Practitioner, North Sumatera University, Medan
• 1994 – 1998 : Physical Medicine and Rehabilitation Specialist, Faculty of Medicine University of Indonesia, Jakarta
• 2006 – 2009 : Doctoral Program, Faculty of Medicine University of Indonesia, Jakarta
• August 2018 : Fellowship in National Taiwan University in Specialty: Ultrasound, Taiwan
• June 2019 : Fellowship in Department of Rehabilitation Medicine Hiroshima University Hospital in Specialty: Sports Medicine Rehabilitation, Japan
Professional Experience and Involvement:
1989 – present Member of Ikatan Dokter Indonesia (IDI) Association
January 2002 – 2020 Head of Sport Injury Division and Obesity Clinic, Physical Medicine and Rehabilitation Department, Cipto Mangunkusumo National General Hospital, Jakarta

November 2007 – 2013 Secretary of Specialist Program Physical Medicine and Rehabilitation, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, University of Indonesia
2009 – present Lector of Physical Medicine and Rehabilitation Department, Cipto Mangunkusumo National General Hospital, Jakarta
December 2013 – 2017 Coordinator of Vocation and Undergraduate (S0–S1) Program, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, University of Indonesia
2015 – present Treasurer of Perhimpunan Osteoporosis Indonesia (PEROSI)
December 2017-2019 DEPUTY CHAIRPERSON II of Indonesian Physical Medicine and Rehabilitation (PERDOSRI)
November 2019-2022 CHAIRPERSON of Indonesian Physical Medicine and Rehabilitation (PERDOSRI) Association
January 2021 – present Consultant Staff of Musculoskeletal Division, Physical Medicine and Rehabilitation Department, Cipto Mangunkusumo National General Hospital, Jakarta
2024 - 2026 President Elect of Perhimpunan Osteoporosis Indonesia (PEROSI)
Symposium/ Workshop Experience:
• March 2013 : Participant of "Basic Musculoskeletal Ultrasound Hands-On: Upper and Lower Limbs” Workshops, National Taiwan University Hospital
• June 2013 : Outstanding Lecturer of 7th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2013), Beijing, China
• March 2017 : Speaker of “Musculoskeletal, Nerve and Spine C-arm and Ultrasound-guided Interventional Pain Management Hands on Mannequin and Real Patients” Workshop, Jakarta
• July 2018 : Oral Presentation “The Efficacy Of Land Versus Water Exercise Program on Body Composition in Obese Patient with Knee Osteoathritis” at International Congress, Paris
• July 2018 : E-poster presentation “The Effect of Elastic Taping vs Sham Taping and Control Group on Quadriceps Strength and Knee Functional Disability Index in Knee Osteoarthritis
Patients with Obesity” at International Congress, Paris
• September 2018 : Participant of ESSD 8th International Congress Dysphagia “Shaping the Future” Dublin, Ireland
• November 2018 : Participant of The 7th IOF (International Osteoporosis Federation) Asia Pacific Osteoporosis Conference, Sydney, Australia
• March 2019 : Participant of Special Olympic World Games 2019, Abu Dhabi
• June 2019 : Speaker of The 13th International Society of Physical and Rehabilitation Medicine World Congress (ISPRM 2019), Kobe, Japan
 Therapeutic Exercise and
Modalities Prescription to
Get Ultimate Sport
Performance
Dr. dr. Tirza Z Tamin, Sp.KFR(K)

Medical Rehabilitation Department, Cipto Mangunkusumo General

Hospital / Faculty of Medicine, University of Indonesia
 Definition of Sport Injuries

Acute/traumatic
injury

Chronic/overuse
injury

Alfredson H, Jarvinen T, Jarvinen M, et al. The IOC Manual of Sports Injuries: An Illustrated Guide to Management of Injuries in Physical Activity. John Wiley & Sons. 2012;1-2.
Peters M, et al. What is Sport Injury. In: Everyday Sport Injuries: The Essential Step-by-Step Guide to Prevention, Diagnosis, and Treatment. Dorling Kindersley Limited. 2019;1:6-7.
 A dynamic,
multifactorial
model of sport
injury etiology–
adapted from
Meeuwisse
(1994)
 Pathophysiology of Sport Injuries

Mangine B. Physiologic Factors in Rehabilitation. In: Physical Rehabilitation of the Injured Athelete. Elsevier Saunders 2012;2:11-27.
 Example of
Sports Injury
Assessment
International
Classification of
Functioning,
Disability, and
Health (ICF)
 Definition of Pain

Raja et al. The Revised IASP Definition of Pain: Concepts, Challenges, and Compromises. 2020.
 deep, in terms of its duration as acute and chronic, and a quality of cutaneous sensation closely related
even with respect to the site of perception as local or [25].
Characteristic of Pain in Athletes
generalized. Figure 2 provides partial insight into this
complex subject.
Feeling of pain and factors that al
sensation in sport
Pain is a very subjective sensation tha
with the action of noxious stimuli a
nociceptors. The gentle electrical c
of membrane potential induced th
lead to local depolarization, generate
potentials, and then action potential
c in Fig. 1A, respectively). Function
effective stimulus exceeds the sen
threshold of peripherally localize
sensors”. The threshold of the noc
to noxious stimuli is neither uniform
all nociceptors nor constant in a
nociceptor. As a consequence, pain th
defined as the current amplitude that
pain in 50% of stimuli [26] is subjec
differs from person to person. In p
the assessment of pain threshold
complicated than that of other s
thresholds because of the subjective
of pain. Other useful terms whic
Figure 2. Classification of pain according to different criteria (site, describe the concept of pain includ
Pawlak M. Aspects of pain in sport. Trends Sport Sci.2013, 3(20): 123-134.
Tsagareli M. Pain Perception in Athletes: A Briefperception, origin,
Review. Georgian and 2016;10:259.
Medical News duration). Acute pain indicates impending experience” and “pain tolerance”, w
 Pain and Athlete Performance

ATHLETE PERFORMANCE???

Palmer-Green D. The Injury/Illness Performance Project: A Novel Epidemiological Approach for Recording The Consequences of Sport Injuries and Illnesses.
Journal of Sports Medicine. 2013;9:1-10.
The Healing Process Following Muscle Injury
 Proper Healing Process

Healing Rates for Various Tissue Types

Tissue Time to return to normal strength
Bone 12 weeks
Ligament 40 – 50 weeks
Muscle 6 weeks up to 6 months
Tendon 40 – 50 weeks

Depends on the athlete’s age, health, and nutritional

status and the magnitude of injury

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Regeneration in Response to Exercise
Kurosaka et al. 2012, Snijders et al. 2009
• Resistance and endurance exercise
training enhances the satellite cell pool
in humans
Qaizar et al. 2016
• Exercise training is one of the prime
modulators of muscle plasticity as it
triggers a series of intracellular signaling
pathways which mediate muscle growth
and adaptation.
Valero et al . 2012
• Have found that eccentric work is an
effective promoter of repair and recovery
because of its ability to stimulate the
release of mesenchymal stem cells.
Ambrosia et al. 2009
• Exercise in humans can induce the activation
and proliferation of satellite cells.
• Induced release of inflammatory subtance or
growth factors
• Increased secretion of VEGF
• Increased nutrient and mitogen that
accompanies increased blood flow
Garg K and Boppart MD. Influence of Exercise and Aging on Extracellular Matrix Composition in
The Skeletal Muscle Stem Cell Niche. J Appl Physol. 2016. 121:1053-1056
 Increase in Satellite Cells
Satellite cells (SCs) are resident skeletal muscle stem cells and play an important role in:

Early Formation of
postnatal new fibers
muscle
growth
Maintena
nce of
muscle
mass

Skeletal muscle hypertrophy

Garg K and Boppart MD. Influence of Exercise and Aging on Extracellular Matrix Composition in The Skeletal Muscle Stem Cell Niche. J Appl Physol. 2016.
121:1053-1056
 Improves Growth Factors
• The extracellular matrix (ECM) contains growth factors that become
active when tissue is damaged.
TGF-β
(transforming
growth HGF
IGF-2 (insulin-
factor-β) (hepatocyte
like growth
growth
factor-2)
factor)

IGF-1 (insulin- TNF-α (tumor

like growth necrosis
factor-1) factor-α)

Garg K and Boppart

MD. Influence of Activate
Exercise and Aging on FGF
Extracellular Matrix (fibroblast the IL-6
Composition in growth satellite (interleukin-6)
The Skeletal Muscle factor)
Stem Cell Niche. J Appl cell
Physol. 2016. 121:1053-
1056
 Sport Performance

Mental Control
Neuromuscular Enviromental
and Psychological
Factors
Factors
conditions

Coaching and
external support
for the athlete

Kisner C, Colby A. Resistance exercise for impaired muscle performance. In: Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Exercise Testing

NK Table Isokinetic EN Tree

Astrand-Rhyming
Stress Test Stress Test Stress Test Cycle Ergometer
Test
Perdosri. Asesmen kekuatan otot. In: Wirawan RP, Wahyuni LK, Hamzah Z (editors). Asesmen & prosedur kedokteran fisik dan rehabilitasi
Muscle Strength Measurements

Dynamic

Static
ACSM’s. Guidelines for Exercise Testing and Prescription 9th edition, 2014..
Flexibility and Speed Reaction Testing

Flexibility Testing Speed Reaction

Testing

ACSM’s. Guidelines for Exercise Testing and Prescription 9th edition, 2014..
 Power Testing

Vertical Power Test Standing Board Jump Medicine Ball Throw

ACSM’s. Guidelines for Exercise Testing and Prescription 9th edition, 2014..
 Coordination Testing

Hand Eye Coordination Test Reaction Light Board Test

ACSM’s. Guidelines for Exercise Testing and Prescription 9th edition, 2014..
 Therapeutic Exercise

Therapeutic exercise is the systematic,

planned performance of bodily
movements, postures, or physical activities
intended to provide a patient with the means
to:
• Remediate or prevent impairments.
• Improve, restore, or enhance physical
function
• Prevent or reduce health-related risk
factors
• Optimize overall health status, fitness, or
sense of well-being

Kisner C, Colby L. Therapeutic exercise. 5th ed. Philadelphia: F. A. Davis Company; 2002. 147-223 p.
 Principles Of Training

Overload SAID Reversibility

Principle Principle Principle

Kisner C, Colby A. Resistance exercise for impaired muscle performance. In: Kisner C, Colby LA. Therapeutic exercise: foundations and
techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Exercise Prescription
The length of time in
which an activity or
exercise is performed
(minutes)
The Rate at which the
Type
activity is being performed
or the magnitude of the Time
effort required to perform
an activity or exercise
Intensity The mode of participation in
physical activity (aerobic,
strength, flexibility, balance)

Frequency
ACSM’s
Guidelines for The number of times an
Exercise Testing exercise or activity is
and performed (sessions,
Prescription. episodes, or bouts per
10th ed. 2018 week)
 Developing a Rehabilitative Plan

• Must be carefully designed

• Must have complete
understanding of the injury :
▪ How it was sustained
▪ Major anatomical structures
involved
▪ The grade of trauma
▪ The severity of injury
▪ Stage or phase of healing

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Program Design

The following must be taken into account:

• The union of the graft into the bony tunnels
• The graft is dead and must undergo revascularization
• The dead collagen cells in the graft must be slowly replaced by new
living cells to be functional again
• Graft “stretch-out”
• Return to sport depends on surgical outcome & confidence in the
knee
• The type of ACL graft
• No one protocol is satisfactory for all players

Holt K. Rehabilitation after ACL reconstruction. Perth orthopaedics and sports medicine centre. 2019
 Factors Affecting Rehabilitation Program

Factors to consider revolve primarily around :

• Each athlete, recovery time is different
• Extent of injury
• Surgical techniques and graft selection
• Physical performance factors
• Occupational demands
• Athlete’s characteristics (age, body mass index, etc)
• Athlete’s goals / expectations
• Presence of concomitant procedures

Holt K. Rehabilitation after ACL reconstruction. Perth orthopaedics and sports medicine centre. 2019
 Generic Goals of Sport Injury Rehabilitation

✓Decrease pain
✓Decrease inflammatory response to trauma
✓Return of full active & pain-free range of motion
✓Decrease effusion
✓Regaining balance and postural control
✓Return full muscular strength, power & endurance
✓Maintaining cardiorespiratory endurance
✓Return to full asymptomatic functional activities at the pre-injury level

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Integrated of Individual Components Into A
Progressive Rehabilitation Program

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Stages of Rehabilitation
Stage Functional level Sport Management

Initial Poor Nil PRINCE

(Acute) Substitute activities (e.g. Electrotherapeutic modalities
swimming, cycling) Stretch/range of motion exercise
Isometric exercise
Intermediate Good Isolated skills (e.g. basketball Electrotherapy (less)
(Sub-acute) shooting) Stretch/range of motion exercises
Strength
Proprioception
Advanced Good Commence agility work Strength, especially power
(Chronic) Skills Proprioception
Game drills Functional activity
Return to sport Good Full Continue strength/power work, flexibility

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Acute Phase (Up To 1 Week Post-Injury)
• Duration of symptoms, precaution and
Educate the patient contraindication
• What to expect when the symptoms lessen

• PRINCE
Control pain, edema,
spasm • Immobilize the part
• Avoid position of stress to the part

• Appropriate dosage of passive movements

Maintain integrity and
mobility

• Provide protection
Reduce joint swelling • May require medical intervention if swelling is rapid
(blood)

• Active-assistive, free, resistive, and/or aerobic

Maintain integrity and Kisner C, Colby LA. Therapeutic exercise: foundations
exercises
function and techniques. 6th ed. 2012. Philadelphia: FA Davis
• Adaptive or assistive devices as needed Company.
 Therapeutic Exercise for Acute Phase
Directed to the structure involved to
prevent abnormal adherence and avoid
disruption of scar

Tissue Specific
Movement

Gentle isometric muscle Too much movement to

contractions intermitently, Muscle Setting Intensity soon is painful and
low intensity with several reinjures the tissue
position

Distraction and glide Passive ROM improving

techniques to connect Low-dosage joint
Range of Motion fluid dynamics and
tissue injury mobilization
maintain nutrition.
Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Modalities for Acute Phase

Cryotherapy Transcutaneus Low Level Laser Taping ACL (Akut)

Electrical Nerve Therapy (LLLT)
Stimulation (TENS)

Starkey Chad. Injury respon and Treatment Planning. Therapeutic Modalaities 4th Edition. 2013
 Study
Author Population Intervention Outcome
Design
Takenori A, RCT Participants were Participants in the laser Low-level laser therapy
et al. 2016 32 college athletes group received LLLT from was effective in 75% of
with motion pain at laser therapy equipment the laser group, whereas
a defined site. (Softlasery JQ-W1, Minato it was not effective in the
Participants were Medical Science Co., Ltd, placebo group, indicating a
randomized into two Japan) with an output of significant difference in
groups in which the 180 mW, irradiation time of favor of the laser group
tested or placebo 30 s, and total irradiation (p < 0.001). Pain relief
laser therapy was time of 10 min. rate was significantly
administered to Participants in the placebo higher in the laser group
determine pain group received placebo than in the placebo
intensity from painful therapy from a placebo group (36.94% vs. 8.20%,
action before and device (detuned laser) with respectively, p < 0.001),
after laser an output of 0 mW, with the difference in pain
irradiation, using the irradiation time of 30 s, relief rate being 28.74%
Modified Numerical and total irradiation time
Rating Scale. of 10 min

1. Bublitz C, Medalha C, Oliveira P, Assis L, Milares LP, Fernandes KR, Tim CR, Vasilceac FA, Mattiello SM, Renno AC. Low-level laser therapy prevents
degenerative morphological changes in an experimental model of anterior cruciate ligament transection in rats. Lasers Med Sci. 2014 Sep;29(5):1669-78.
 Criteria for Progressive Out of Acute Phase

Include :
• Progression of tissue healing where the tissue is healed or
sufficiently stabilized for active motion

• Passive range of motion to 75% of the opposite side

• Minimal pain or tenderness less than level II

• MMT strength in non pathologic area 4+ to 5

• Control of the particular regions

• Continued kinetic chain function

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Sub-acute Phase (Up To 3 Week Post-Injury)

Therapeutic Exercise
-AROM (all direction, circular movement, alphabet,
aqua ankle in cool water)
-Strengthening exercise (Isometric, Toe curl with
towel, take the things with toes)
-Proprioceptive exercise (circular tilt board,
Wobble board)
-Stretching exercise (PROM except inversion &
eversion, Achilles stretching, joint mobilization)
-Weight-bearing (WB) (graded as tolerance
controlled by pain)

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Modalities for Sub-acute Phase

Microwave Shortwave Low Level Laser Taping ACL

Diathermy Diathermy (SWD) Therapy (LLLT) (Subakut)
(MWD)

Starkey Chad. Injury respon and Treatment Planning. Therapeutic Modalaities 4th Edition. 2013
 Criteria for Progressive Out the
Intermediate/Recovery Phase

Include:
• Full, non painful active and
passive range of motion of
the joint
• No pain on tenderness
• Strength at 80% of the
opposite site with good
force couple balance
• A normal kinetic chain

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Chronic Phase (> 3 Week Post-Injury)

Instruct patient in safe progression of exercise and

stretching

Stretching techniques specific to tight tissue

Progress aerobic exercises using safe activities

Continue using supportive and/or assistive devices until

ROM and strength is adequate

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Modalities for Chronic Phase

Therapeutic Extracorporeal Shock Taping ACL

Ultrasound (US) Wave Therapy (ESWT) (Kronik-Return to
sport)
Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles
Ligaments Tendons J. 2012 Jun 17;2(1):33-7
 Study
Author Population Intervention Outcome
Design
Wang et al, RCT Fifty-three patients ESWT immediately • ESWT group better Lysholm
2014 underwent single- after ACL surgery score at 1 and 2 y
bundle hamstring under the same postoperatively (P < 0.001 and
autograft ACL anesthesia1500 0.001, respectively).
reconstruction impulses of ESWT at • The KT-1000 values were
randomized into two 20 kV (equivalent to better in ESWT group 2 y
groups 0.298 mJ/ mm2 energy postoperatively (P = 0.027).
flux density) was The tibia tunnel on X-ray
administered to the smaller in ESWT group at 2 y
middle third of the tibia (P = 0.018).
tunnel in a single • The bone mineral density
session values showed no discernable
difference between the two
groups at 6 mo and 2 y (P =
0.522 and 0.984, respectively).
• On magnetic resonance
imaging, ESWT group
decrease in tibia tunnel
enlargement at 6 mo and 2 y
compared (P = 0.024 and
<0.001, respectively).

1. 2. Wang CJ, Ko JY, Chou WY, Hsu SL, Ko SF, Huang CC, Chang HW. Shockwave therapy improves anterior cruciate ligament reconstruction. J Surg Res.
2014 May 1;188(1):110-8. 42
 Return to Sport Phase

• This phase starts when the patient has regained full range of
motion and muscle strength as well as appropriate
proprioception
• Thegoalsof this phaseare :
▪ Sports-specificdemands
▪ Sports-specificskills
▪ Adequate range of motion
▪ Symmetry
▪ Agility drills
▪ Generalconditioning
▪ Bench mark test

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Criteria for Progressive Out Advanced/ Functional
Phase into Full Competition

• Normal arthrokinetics and multiple-plane

activities
• Isokinetic strength balance and work at
90% of normal
• Completion of functional progressions
and satisfactory clinical examinations

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Return to Competition

▪ Time constraints for soft tissue healing have been observed

▪ Pain-free full range of movement
▪ No persistent swelling
▪ Adequate strength and endurance
▪ Good flexibility
▪ Good proprioception
▪ Adequate cardiovascular fitness
▪ Good regional skill
▪ No persistent biomechanical abnormality
▪ Athlete physiologically ready
▪ Coach satisfied with training form
 Study
Author Participant Intervention Outcome
Design

M.F. RCT Recreational male 6-week (2 IG had significantly

Vidmar athletes (25 years sessions/week) higher improvements
et al, old) undergoing ACL quadriceps eccentric than CG (p < 0.05) for all
2019 reconstruction training program at muscle mass outcomes
* conventional the extensor chair or (+17-23% vs. +5-9%), as
group (CG; n = 15), at the isokinetic well as for isometric
isokinetic group (IG; dynamometer (+34% vs. +20%) and
n = 15) eccentric (+85% vs.
+23%) peak torques.

Vidmar M, et al. Isokinetic eccentric training is more effective than constant load eccentric training on the quadriceps
rehabilitation following partial meniscectomy: A randomized clinical trial. Physical Therapy in Sport. 2019;39:120-125.
 Indications for Interventional Pain
Management (IPM) Procedure

Specific patient selection criteria for advanced pain therapies :

• All more conservative modes of therapy have failed
• Psychological evaluation and clearance
• Further surgical intervention not indicated
• Successful trial screening
• No history of drug seeking, habituation, or addiction
• No contraindication to implant exists
• Pain complaint is consistent with an observable pathologic
process

Kisner C, Colby A. Resistance exercise for impaired muscle performance. In: Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 IPM Procedure

• Injection of Platelet Rich Plasma

• Injection of Prolotherapy
• Bone Marrow Concentrate

Kisner C, Colby A. Resistance exercise for impaired muscle performance. In: Kisner C, Colby LA. Therapeutic exercise: foundations and
techniques. 6th ed. 2012. Philadelphia: FA Davis Company.
 Rehabilitation After IPM

0-3 days
Pain control
Protection of the affected tendon
Knee rest
Partial weight bearing with crutches
Gently active range of motion exercises, out of the immobilizing device

Madison, WI. Platelet-Rich Plasma Rehabilitation Guidelines. Uw health sports rehabilitation. 2014;621:1-5
 Rehabilitation After IPM

3 to 4-10 days
Weight bearing as tolerated
No overstressing of the tendon through lifting
or impact activity
Continue with active range of motion exercises out of the
device, 3 times a day for 5 minutes a session.

Madison, WI. Platelet-Rich Plasma Rehabilitation Guidelines. Uw health sports rehabilitation. 2014;621:1-5
 Rehabilitation After IPM
14 days
Attain full range of motion
Improve strength and endurance
Improve balance and proprioception
Avoid high velocity / amplitude / intensity exercise such as throwing, running, jumping,
or heavy weight lifting
Stretching exercises for the affected muscle-tendon unit at least once a day, 3-4
repetition, holding for 20-30 seconds.
Strengthening with isometric and concentric activities initially, and with eccentric
progression as symptoms allow 3-4 sets of 6-12 reps at moderate intensity
Balance and proprioception activities
Madison, WI. Platelet-Rich Plasma Rehabilitation Guidelines. Uw health sports rehabilitation. 2014;621:1-5
 Rehabilitation After IPM
6-8 weeks
Continued strengthening of the affected area with increases in resistance,
repetition, and / or frequency
Impact control exercises with progression from single plane
to multi-planar landing and agility drills with progressive increase in velocity
and
amplitude
Sport/work specific balance and propioceptive drills
Continued core strengthening
Return to sport / work

Madison, WI. Platelet-Rich Plasma Rehabilitation Guidelines. Uw health sports rehabilitation. 2014;621:1-5
 Outcome Measurement
• VAS
Shoulder • DASH
• SPADI

• VAS
Knee • Tegner Lysholm Knee Scoring Scale
• KOOS, IKDC

• VAS
Ankle • FAOS
• FAAM
 Take Home Messages

• Healing process is the body’s natural response to injury repairs or

replaces tissue with the aim of restoration of body to a pre-injury
state
• Therapeutic exercise and modalities play an important role in the
development of regeneration
• Rehabilitation of the injured athlete requires subsequent careful
assessment and deficit correction of the athletes
• The injured athlete should be able to return to sport without
functional deficit and with any predisposing factors to injury
corrected
Thank You