DEVELOPING TREATMENT

PATHWAYS FOR INJURED ATHLETE

Riza Pahlawi
The Body Response To
Effect Of Immobility
Injury

Muscle athropy ; strength General Deconditioning

decreases 0,5% to 2% per (reduce strength production
day of in activity and endurance capacity)

Structural changes in
articular capsule connective Degenerative of articular
tissue causing decreased cartilage
ROM

Reduce stimulus for bone

mineral deposition, possibly
contributing to diminished
bone density
Key Component Of
Physical Examination
Component Minimizing swelling
Of
Rehabilitation Controlling pain
Program
Reestablishing neuromuscular control
Enhancing core stability
Improving ROM
Increasing muscle strength and endurance
Regaining balance and postural control
Maintaining cardiorespiratory endurance
 MINIMIZING SWELLING
 The injured area cannot return to normal Swelling is caused by any number of factors; including
until all the swelling is gone bleeding, the production of synovial fluids, edema, or
combination of several factors.

CONTROLING PAIN  Use appropriate therapeutic modalities,

When an injury occurs, the patient will
including cryotherapy, ice, or various
experience some degree of pain. Persintent pain medication.
can make strengthening or flexibility exercise
more difficult
ENHANCING
CORE STABILITY
The core is defined as the lumbo-pelvic-hip
complex. The core is where the centre of
gravity is located and where all movement
begins. A weak core is a fundamental problem
of inefficient movement that leads to injury.

 Repetition of the same movement through step-by-
step progression from simple to complex movement.
 Reestablishing proprioception and kinesthesia.
 Proprioception : the ability to determine the position
of a joint in space (joint motion sense)
 Kinestesia : ability to detect movement (movement
sense)
REESTABLISHING
NEUROMUSCULAR
CONTROL
After injury and subsequent rest and
immobilization, the central nerveous system
“forget” how to put together information
coming from muscle and joint, visual, and
vestibular input. Neuromuscular control is the
mind’s attempt to teach the body conscious
control of specific movement.
REGAINING BALANCE  Patient who show a decreased sense of balance or
AND POSTURAL lack postural control after injury may lack sufficient
CONTROL proprioceptife and kinaesthetic information or
muscular strength, either of wich may limit the
Postural control involves the integration of muscular, patient’s ability to generate an effective correction
neurological, and biomechanical information. response
INCREASING MUSCLE
STRENGTH AND IMPROVING ROM
ENDURANCE Injury to a joint will always be associated with
some loss of motion. That loss of movement
A major goal in performing strengthening exercises is for the patient may attributed to contracture of connective
to work through a full, pain-free range of motion. tissue.

 Isometric exercise : commonly performed in the

early phase of rehabilitation when a joint is
immobilized for a period time.
 Can also lessen swelling by causing a muscle
pumping action to remove fluid.
 Progresive resistance exercise
 Isokinetic exercise
 MAINTAINING
 Substitute alternative activities that allow the
individual to maintain existing levels of CARDIORESPIRATOR
cardiorespiratory endurance during rehabilitation
period Y ENDURANCE
When injury occurs and the athlete is
forced to miss training time, level of
cardiorespiratory endurance may decrease
rapidly.
 Acute Phase Subacute Phase Chronic
Phase

Effect of
4 – 6 days after
inflammation Return to Sport
injury
decrease

STAGES OF REHABILITATION
ACUTE PHASE

Occur from the moment that

tissue sustains injury until the time that
inflammation become controlled
Protection of the part affected by
inflammatory process is necessary
during 24 to 48 hours.
SUBACUTE
(INTERMEDIATE) PHASE

Starts when the effect of inflammation

decrease. The pain is no longer constant, and
active movement can begin.
Subacute phase is a transition period
during which active exercises within the pain-
free range of motion
Strengthening sould also be increased
progressively during subacute phase.
Prepare for the athelete for the complex
activities that occure in the return to sport.
CHRONIC PHASE

Individuals returning to high-

intensity activities. The intensity of the
strengthening exercises increases in this
phase.
RESISTANCE EXERCISE FOR IMPAIRED MUSCLE
PERFORMANCE

Overload Principle

Focuses on the progressive loading of muscle by manipulating, for example

the intensity or volume of exercise.

• In strength training program : the amount of resistance applied to the

muscle is incrementally and progressively increased
• For endurance training, is placed on increasing time a muscle
contraction or the number of repetition
THE LOW RESISTANCE, HIGH
REPETITION METHOD
The best regimen for athlete with injuries during the early post operative
period. Exercise with high resistance could potentially cause the supporting
structure to break down and exacerbate the infalamation.
THE DELORME AND
WATKINS PROGRAM
Based on the amount of weight that
could be carried throught a full range
of motion for 10 repetition

Not generally applicable to athletes

in the early postoperative stages.
THE OXFORD
TECHNIQUE
This technique decreases
intensity with each new set
to accommodate fatiguing
muscle.
 If soreness is present and doesn’t
If soreness is present but recedes
If no soreness is present, advance recedes with warm-up, decrease
with warm-up, stay at the same
the level of exercise exercise to the level before
level
progression

THE SORENESS RULES

 Pain-free full range of movement
 No persistent swelling
 Adequate strength and endurance
RETURN TO SPORT
 Good flexibility
 Good proprioception

 Adequate cardiovascular fitness

 Good regional skill
 No persistent biomechanical
abnormality
 Athlete physiologically ready
 Persistent recurrent swelling
RELATIVE
 Joint instability
CONTRAINDICATIONS
 Loss of joint range of motion TO RETURN TO SPORT
 Lack of full muscle strength