The purpose of rehabilitation is to 

• Enhance recovery time

• Enhance the return to pre – injury fitness levels (strength and flexibility in particular)

• Reduce scar tissue formation

• Reduce the likelihood of re-injury

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Progressive mobilisation

 

The purpose of progressive mobilisation is to gradually bring the athlete back to their full range of movement. The longer the athlete keeps their injured limb/muscle tissue mobilised, the harder it will be to regain movement potential. This form of rehabilitation can be used quite early on (generally 48 hours after a trauma, or when bleeding has ceased i.e. from a head injury or laceration). Injury can restrict the movement of a joint and can potentially have implications on its movement in the future. Joint mobilisation is important to reduce scar tissue and ensure full ROM is gained. Mobilisation should be progressive. For example, increasing people’s weight when weight training. By doing this, we are slowly increasing the strength of the muscles to restore them to their fullest potential.

 

Progressive mobilisation can be completed through passive or active exercise. 

Active mobilisation involves the athlete as they complete various activities to move the joint/muscle themselves. However, sometimes we can limit ourselves due to pain and discomfort as we complete these exercises. 

Passive mobilisation involves taking the injury to a trained professional (physio or doctor). The physio is able to manipulate and move the athlete through a range of motion that is unattainable or risky for the individual to complete by themselves. This is the best option.

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Graduated exercise

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This is a vital aspect of the rehabilitation process and is be completed in a 3 – step progression, working on flexibility, conditioning and total body fitness. Total body fitness is important as when injury occurs, the athlete is likely to have been stationary and absent from physical activity for an extended period of time. Therefore, their aerobic fitness will have deteriorated, not just the movement quality and strength of the particular limb.

 

Stretching

The first stage involves stretching. Flexibility will improve with progressive mobilisation (trying to move the limb to regain some flexibility). Stretching improves the elasticity of muscles and tendons and so if there is a chance of injury because the muscle is tight, we are mitigating this.

 

Stretching is justified as an important part of the rehabilitation process as it assists in the re-development of the athlete’s range of motion and reduce the chance of re-injury or further damage to the limb, tissue or ligament.

 

PNF stretching is a highly recommended form of stretching in the rehabilitation process. It does not demand extensive movement and it stimulates the proprioceptors. (Proprioceptors are responsible for the contraction of muscles, limiting ROM). PNF stretching is most effective with a partner i.e. a physio or trainer. The word ‘PNF’ stands for Proprioceptive Neuromuscular Facilitation. It is given this name as it stimulates the proprioceptors (as aforementioned). PNF stretching involves stretching and contracting a muscle group to form isometric contraction against a resistance i.e. a bench or person. For example, PNF hamstring stretching. The goal of this stretch is to move just past the point of comfort in the stretch (for example, a 90-degree angle in a hamstring stretch). Once this point is reached, the althele will resist against an opposing force for a count of 8, before relaxing deeper into the stretch.

 

Conditioning 

The second stage of graduated exercise is conditioning. This involves preparing the entire body (surrounding muscles and tissues) for full – functioning movement. Muscle degeneration is common after an injury. The technical term for this is ‘atrophy’, meaning the muscle has become smaller. For example, an athlete returning from a fractured tibia will notice a difference between the size of the injured and uninjured limb. The muscles surrounding the injured limb deteriorate with immobilisation and therefore need to be redeveloped. Isometric exercises are important in the process of re-gaining strength. Isometric exercises are those that involve holding the muscle in a contraction without moving the limb. Examples include planking and yoga poses such as the child pose. Once the athlete is able to comfortably complete a series of isometric exercises, a graduated weight program can be implemented in which the athlete works to regain muscular strength and endurance.

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Total body fitness

The final stage of graduated exercise is total body fitness. This aims to restore the athlete to the optimal level of fitness. The athlete must not wait until their injury has healed to begin this stage of the conditioning program as they need to continue working their uninjured muscles, avoiding further stress to the injured limb or muscle tissue.

 

Cardiorespiratory endurance can be enhanced through activities such as swimming, bike riding etc. Power, speed and agility also need to be redeveloped in accordance with the specific requirements of the athlete’s sport. For example, slings and small hurdles can be used to support an injured athlete as they train to regain power. 

 

All components of fitness must be targeted in this stage of graduated exercise. Exercises should be focused on strength, endurance and flexibility with reference to the specifics of the sport. The work should also be focused on confidence – building and the mental preparation of the athlete upon their safe return to training and competition.

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Training

 

Just because the athlete has completed treatment and a rehabilitation program, this does not mean they are ready to return to full competition. Graduated exercise assists in preparing the athlete to return to a normal training regime however the completion of this program does not indicate complete readiness. Readiness to return to play is indicated when the athlete is able to participate in a full training session without experiencing pain.

 

Commonly asked questions - with answers:

 

• Why might an injury re – occur? Movement and game – specific skills are not fully developed. A lack of confidence.

 

• What aspects of performance are affected by rest from competition? Timing, coordination and speed.

 

• What may happen is the athlete ‘favours’ the injured part? Re – injury or injury to a new site.

 

• What should training before recommencement of competition be aimed at? Stimulated games.

 

• How should some athletes be required to resume play after an injury? At a lower level/grade.

 

• What helps to determine the athlete’s readiness to return to competition? Fitness and skills test.

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The use of heat and cold

 

Heat increases blood flow, providing more blood and nutrients to the injured area to assist healing. This is not to be done before 48-72 hours after injury as it may increase inflammation and prolong recovery time. After this time however, it can relieve pain and decrease stiffness.

 

Cold is an integral part of RICER and holds particular benefit in the first 24-48 hours of an injury occurring. The use of cold reduces inflammation and swelling as it restricts blood flow to the injured site. 

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Ice

 

When to use: Immediately after injury.

How to use: Ice packs, Ice massage or Ice bath.

How long? 20 minutes on, every 2 hours.

Why? Reduces swelling, relieves pain and limits injury.

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Heat

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When to use: Not until at least 48 hours after an injury has occurred.

How to use: Heat packs, Hydrotherapy, Infra - red lamps or Ultrasound.

How long? Up to 30 minutes.

Why? Decreases pain, relaxes muscles, decreases spasms, aids stretching and increases healing.

 

 

 

Injury rehabilitation 2020, Edrolo, viewed 1 November 2020, <https://edrolo.com.au/class/913036/lesson/24267/1/>.