ALLOWED FOR PROPER HEALING

Healing Rates for Various Tissue Types

Time to Return to (approxiamately)
Tissue 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
HEALING PROCESS – LIGAMENT SPRAIN

1. Inflammatory phase : 72 hours-6weeks

2. Proliferation phase : 6 weeks-12 months
3. Remodeling phase : more than 12 months
GOAL OF REHABILITATION

1. Decrease pain

2. Reduction or elimination of edema

3. Restoration of unrestricted range of motion

4. Regain strength necessary for the specific sport

5. Improve gait pattern and close kinetic chain motion

6. Minimize risk of reinjury

7. Sports-specific agility drills

STAGES OF REHABILITATION
Stage Functional Sport Management
level
Initial Poor Nil RICE
Substitute activities Electrotherapeutic modalities
(e.g. swimming, cycling) Stretch/range of motion exercise
Isometric exercise

Intermediate Good Isolated skills (e.g. Electrotheraphy (less)

basketball shooting) Stretch/range of motion exercises
Strength
Proprioception

Advanced Good Commence agility work Strength, especially power

Skills Proprioception
Game drills Functional activity
Return to sport Good Full Continue strength/power work, flexibility
PHASES OF REHABILITATION

 Acute phase/ inflammatory stage

 Reparative phase/ intermediate stage
 Return to sport/ remodeling stage
 Prophylaxis stage
ACUTE PHASE

 Moment the injury occurs to the moment the edema is

controlled.
 Goal in this phase include:
1. Preventing excess edema
2. Preventing excess hematoma formation
3. Increasing tensile strength
4. Controlling pain
MEDICAL REHABILITATION PROGRAM IN ACUTE PHASE
 MANAGEMENT
o

P Protection Taping

Bracing fungsional

Removable cast
boot
R Rest Crutches

I Ice Cryocuff ice

machine
Ice bags

N NSAID

C Compression Elastic (Ace) wrap

Vasopneumatic
pump
E Elevation Foot position is
higher than the
heart
CRITERIA FOR PROGRESSIVE OUT
THE INITIAL/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
Manual muscle test strength in non pathologic area 4+ to 5
Control of the particular regions
Continued kinetic chain function
REPARATIVE/ SUB-ACUTE PHASE
 This phase starts once the edema is controlled
 The focus of this phase is to regain flexibility and strength of
the injured site, all while maintaining some type of
cardiovascular fitness
 The goals :
 Regain strength
 Regain range of motion
 Prepare the athlete for the physical demands of the

return to sport phase

 Continue to maintain conditioning of the noninjured area

(cross-training)
MEDICAL REHABILITATION PROGRAM IN SUB-ACUTE PHASE
 Management
Therapeutic Exercise Modality
- AAROM • Ice /contrast bath
• TENS
all direction, circular • USD
movement, alphabet, aqua
ankle in cool water
-Strengthening exercise Weight-
Isometric, Toe curl with towel, bearing
take the things with toes
-Proprioceptive exercise
(WB)
Graded as
circular tilt board,
tolerance
Wobble board
controlled by
-Stretching exercise
pain.
PROM except inversion &
eversion, Achilles stretching,
joint mobilization
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
RETURN TO SPORT PHASE

This phase starts when the patient has regained full range of motion and muscle strength as well as appropriate
propioception.

The goals :
 Sports-specific demands
 Sports-specific skills
 Adequate range of motion
 Symmetry
 Agility drills
 General conditioning
 Management
1 Thera-Ex 2 Modalitas as needed
A Stretching 3 Taping Bracing
Ortosis
B Strengthening WB exercises :
• Walk on toes & walk on heel
• Stairs
• Quarter squat
Eccentric/Concentric (with thera band/cuff
weights)
Isokinetic
C Proprioceptive Circular tilt board,
Wobble board
Single leg stance (on even/uneven surface,
with/without perturbation)
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
RETURN TO SPORT
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

PHASE 4 (Prophylaxis Phase)

Thera-Ex • Functional exercise

• Exercise with balance board,
multidirection
• Muscle strengthening, especially evertor
• Ankle and foot protector
PSYCHOLOGY AND REHABILITATION OF INJURY

The factors that effect rehabilitation:

 Type of injury
 Circumstances of the injury
 External pressure (eq: fear of

losing position on the team)

 Pain tolerance
 Psychological attributes of the player
 Player-player and coach-player support system
TAKE HOME MESSAGES

Rehabilitation of the injured athlete requires carefull assessment

and subsequent correction of the athlete’s deficit
The rehabilitation program should be individualized for the
athlete’s need
Functional and sport-specific activities should form a major part
of the program
The injured athlete should be able to return to sport without
functional deficit and with any predisposing factors to injury
corrected