Sports Rehab

What are the 5 stages of rehabilitation in sport?

Stages of Rehabilitation

• Phase 1 – Control Pain and Swelling.
• Phase 2 – Improve Range of Motion and/or Flexibility.
• Phase 3 – Improve Strength & Begin Proprioception/Balance Training.
• Phase 4 – Proprioception/Balance Training & Sport-Specific Training.
• Phase 5 – Gradual Return to Full Activity.

Rehabilitation is the restoration of optimal form (anatomy) and function (physiology).

Rehabilitation Plan

The rehabilitation plan must take into account the fact that the objective of the patient (the athlete) is to return to the same activity and environment in which the injury occurred. Functional capacity after rehabilitation should be the same, if not better, than before injury.

The ultimate goal of the rehabilitation process is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate altogether the disability.

Principles

Principles are the foundation upon which rehabilitation is based. Here are seven principles of rehabilitation, which can be remembered by the mnemonic: ATC IS IT.

A: Avoid aggravation. It is important not to aggravate the injury during the rehabilitation process. Therapeutic exercise, if administered incorrectly or without good judgment, has the potential to exacerbate the injury.

T: Timing. The therapeutic exercise portion of the rehabilitation program should begin as soon as possible—that is, as soon as it can occur without causing aggravation. The sooner patients can begin the exercise portion of the rehabilitation program, the sooner they can return to full activity.

Following injury, rest is necessary, but too much rest can actually be detrimental to recovery. Athletes can however rest the portion of the body that is actually injured and work the rest of the body – often referred to as “relative rest”

C: Compliance. Without a compliant patient, the rehabilitation program will not be successful. To ensure compliance, it is important to inform the patient of the content of the program and the expected course of rehabilitation.

Setting goals and including athletes in decision making works as a motivation factor to continue the rehabilitation process. Thus goals working as a motivating factor, increases the effort to reach the goal, and thereby increases focus, endurance, and direction for the athletes to continue, which is an important part of rehabilitation after an injury

I: Individualization. Each person responds differently to an injury and to the subsequent rehabilitation program. Even though an injury may seem the same in type and severity as another, undetectable differences can change an individual’s response to it. Individual physiological and chemical differences profoundly affect a patient’s specific responses to an injury.

S: Specific sequencing. A therapeutic exercise program should follow a specific sequence of events. This specific sequence is determined by the body’s physiological healing response.

I: Intensity. The intensity level of the therapeutic exercise program must challenge the patient and the injured area but at the same time must not cause aggravation. Knowing when to increase intensity without overtaxing the injury requires observation of the patient’s response and consideration of the healing process.

T: Total patient. Treating the Whole Patient. It is important for the unaffected areas of the body to stay finely tuned. This means keeping the cardiovascular system at a pre-injury level and maintaining range of motion, strength, coordination, and muscle endurance of the uninjured limbs and joints.

The whole body must be the focus of the rehabilitation program, not just the injured area. Providing the patient with a program to keep the uninvolved areas in peak condition, rather than just rehabilitating the injured area, will help to better prepare the patient physically and psychologically for when the injured area is completely rehabilitated.

Components

Regardless of the specifics of the injury, however, here are fundamental components that need to be included in all successful rehabilitation programs:

Pain Management

Medications are a mainstay of treatment in the injured athlete – both for their pain relief and healing properties. It is recommended that they need to be used judiciously with a distinct regard for the risks and side effects as well as the potential benefits, which include pain relief and early return to play.

Flexibility and Joint ROM

Injury or surgery can result in decreased joint ROM mainly due to fibrosis and wound contraction. Besides that, it is common for post-injury flexibility to be diminished as a result of muscle spasm, inflammation, swelling and pain. In addition to impacting the injured area, this also affects the joints above and below the problem, and creates motor pattern issues.

Flexibility training is an important component of rehabilitation in order to minimise the decrease in joint ROM. Also, a variety of stretching techniques can be used in improving range of motion, including PNF, ballistic stretching and static stretching.

Strength and Endurance

Injuries to the musculoskeletal system could result in skeletal muscle hypotrophy and weakness, loss of aerobic capacity and fatigability. During rehabilitation after a sports injury it is important to try to maintain cardiovascular endurance.

Thus regular bicycling, one-legged bicycling or arm cycling, an exercise programme in a pool using a wet vest or general major muscle exercise programmes with relatively high intensity and short rest periods (circuit weight training) can be of major importance.

Proprioception and Coordination

Proprioception can be defined as ‘a special type of sensitivity that informs about the sensations of the deep organs and of the relationship between muscles and joints’. Loss of proprioception occurs with injury to ligaments, tendons, or joints, and also with immobilisation.

Coordination can be defined as ‘the capacity to perform movements in a smooth, precise and controlled manner’. Rehabilitation techniques increasingly refer to neuromuscular re-education. Improving coordination depends on repeating the positions and movements associated with different sports and correct training.

It has to begin with simple activities, performed slowly and perfectly executed, gradually increasing in speed and complexity. The technician should make sure that the athlete performs these movements unconsciously, until they finally become automatic.

Functional Rehabilitation

All rehabilitation programs must take into account, and reproduce, the activities and movements required when the athlete returns to the field post-injury.

The goal of function-based rehabilitation programmes is the return of the athlete to optimum athletic function. Optimal athletic function is the result of physiological motor activations creating specific biomechanical motions and positions using intact anatomical structures to generate forces and actions.

Psychology of Injury

Injury is more than physical; that is, the athlete must be psychologically ready for the demands of his or her sport. Sports Injuries do threaten athletes’ career and success and can end a career and have various consequences on athletes’ quality of life.

The most immediate emotional response at the point of injury is shock. Its degree may range from minor to significant, depending upon the severity of the injury. It is important to note that denial itself is an adaptive response that allows an individual to manage extreme emotional responses to situational stress.

Many individuals assist athletes through the recovery process and can foster psychological readiness, but they can also identify those who are physically recovered but require more time or intervention to be fully prepared to return to competition. Thus, rehabilitation and recovery are not purely physical but also psychological.

When an athlete is injured, it does not affect his physical capabilities exclusively, but also contextual and psychological aspects. In fact, in given situations, injuries can deprive athletes of their compensation increasing life-stress, and determine fear to reinjury, sensation of loss, negative emotions, and other mood disturbances.