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Therapeutic Exercise:Basic Concepts
Definitions
Therapeutic exercise is the systemic performance or execution of planned physical movements, postures, or activities intended to:
Displays of anger, depression, confusion, apathy“When will I be able to play again?”DenialHistory of coming back too fastExaggerated storytelling/braggingDwelling on minor complaints
Petitpas & Danish, 1995
Adjustment Problems (con’t)
Remarks about letting the team down or feeling guiltyDependence on ATCWithdrawal from teammates, coaches, or friendsRapid mood swingsFeelings of helplessness to impact recovery
Petitpas & Danish, 1995
Developing a Social Support System
Confidence in your competence
Coach
Teammates
Family
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Adherence and Recovery
Motivation
Goal Setting
Visualization / Imagery
Self Talk
Roles & Responsibilities
AthleteFeel understoodAccept the reality of the injuryUnderstand the rehab programAdhere to the rehab program
ATCBuild rapport EducateTeach coping skillsID and help develop social support system
Sport-specific demandsProphylactic strapping, bracing, paddingResponsibility of the athletePredisposition to injuryPsychological factorsEducationPreventative maintenance program
Prentice, 2006
RELEVANCE
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Needs Analysis
What muscles need to be trained?Joint(s) involvedROMPattern of ResistancePattern of VelocityTypes of muscle action
Fleck & Kraemer, 1997
Needs Analysis (con’t)
What energy systems need to be trained?Competition model criteriaNature and scope of tactical eventsAthlete or “hero?”Idealistic or realistic conditions?
Plisk and Gambetta, Strength & Conditioning, 1997
TIME – BASED
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Tissue Response to Injury
AcuteInflammation
FibroblasticRepair
Maturation –Remodeling
4-5 21-24 365Days
Phases of Rehabilitation
Pre-injury
Pre-surgery
Post-surgery
Maintenance
Advanced StrengtheningPhaseRTP Phase
Maturation /Remodeling
Subacute(Intermediate) Phase
FibroblasticRepair
Acute PhaseAcute Inflammation
Wilk et al., Am J Sports Med, 2002
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Goals During the Acute Phase
Control inflammation
Minimize effects of immobilization
Reduce joint effusion
Maintain condition of non-inured areas
Kinser & Colby, 2002
Goals During the Sub-Acute Phase
Control inflammation
Increase mobility
Strengthen muscles
Maintain condition of non-injured areas
Kinser & Colby, 2002
Goals During the Chronic Phase
Decrease pain from adhesions
Increase extensibility from other structures
Strengthening of affected and supporting musculature
Neuromuscular control, coordination, agility
Kinser & Colby, 2002
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0
2
4
6
8
10
12
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0 2 4 6 8 10 12
Months
A rough timeline to “normal”
Bone
Muscle /Cartilage
Ligament /Tendon
Houglum, 2005
PROGRAM DESIGN
Principles
AdaptationOverloadMinimum IntensityProgressionWindow of AdaptationLimits of Ability Development