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How is injury rehabilitation managed? - Coggle Diagram
How is injury rehabilitation managed?
REHABILITATION PROCEDURES
Progressive
Mobilisation
Encourage painless movement reducing the likelihood of seizing and development of scar tissue and reducing recovery time. Gentle to begin with and progressively increase as confidence builds along with strength.
Continue to apply ice and compression to help reduce swelling and to prevent waste, like fluid from building up. Gently lengthen muscles to improve mobility as joints become stiff and muscles around the joint tighten.
The gradual increase in the joint range of motion/movement. Involving both passive and active movement. Utilising dynamic, static and PNF stretching with slow passive movements at the start and active faster ones at the end.
For a sprained ankle
1.Trace the alphabet with your toe, encouraging ankle movement in all directions,1 to 3 times.
2.Sit in a chair with foot flat on the floor. Slowly move knee side to side while keeping foot pressed flat, for 2 to 3 minutes.
Graduated
Exercise
Stretching
Loss of flexibility due to lack of use and reversibility of training. Regain elasticity, increasing flexibility beginning 72 hours after injury occurs, allowing time for swelling to reduce and active movement can begin.
Reduces tension in muscles, increases tendon and muscle strength, increase range of motion, allowing greater blood flow and circulation. PNF is the most appropriate method for athletes who want to recover their range of movement. Stretching after using heat and massage stimulates blood flow into the area.
Static = least intense and least gain
PNF = most common and most beneficial, promotes recovery, ROM, prevent joint stiffness
Dynamic = used towards end of rehabilitation as it requires more control
For a sprained ankle
1.Sit with legs extended and knees straight.
2.Place a towel around foot just under toes.
3.Hold each end of the towel in each hand, with hands above knees.
4.Pull back with the towel so that foot stretches toward you.
5.Hold the position for at least 15 to 30 seconds.
Conditioning
Activates and increases the size and endurance of muscles, improving strength and endurance. Without conditioning muscles will remain passive and decrease in size (reversibility). Athletes should perform gentle strengthening exercises including isotonic, body weight holds and exercises, or gentle static holds, performed without pain. As pain and swelling reduces additional activities such as weight bearing can be added.
Process of strengthening muscles and getting them back to pre-injury levels. In relation to muscular strength, muscular endurance, speed and power. Conditioning is specific to injury, muslces will need to be strengthened again due to reversibility. Further loss will occur in muscular endurance and speed, and muscular strength combined with speed produces muscular power.
For a sprained ankle inversion and eversion movements of the ankle, as well as plantar, and doors flexion. These types of movements can progress to becoming calf raisers with weights or begin to include low impact movements such as cycling or swimming. Conditioning will progress to becoming weight bearing, jogging, running, and then changing direction and jumping at the end.
Total Body Fitness
Use of progressive overload principle (FITT) applied to muscle groups and energy systems. If this is not completed reversibility may occur after 2-3 weeks causing a loss of total body fitness.
Each aspect of both the health and skill related components of fitness, ensuring complete recovery so that weakness is not present. Athlete should be doing any exercise possible when injured, for example upper body training when recovering from an injured ankle.
For a sprained ankle activities that can be done include, cycle ergometers, swimming with minimal or no kicking to begin.
Training
Once the athlete is confident that they have regained strength, fitness and flexibility around the injured site, modified training can resume. Athlete should only commence training under recommendation and supervision of a doctor or physio, and progressively physical demands. Training simulation can be used after rehabilitation to psychologically prepare for competition.
For a sprained ankle the athlete is likely to be required to tape and/or bandage their ankle to help provide support, restrict movement, add stability, and reduce swelling.
Use of Heat
and Cold
First 72 hours injury should be iced to aid the removal of waste products and reduce swelling. After 72 hours heat can be applied to increase blood flow and remove the build up of waste products, preventing scar tissue occurring and relaxing muscles.
Heat - Increases blood flow, decreases pain, increases flexibility decreases joint stiffness, increases tissue repair.
Cold - Reduce pain, blood flow/bleeding, inflammation. Should be applied immediately after injured, treatments and exercise.
RETURN TO PLAY
Indicators of
Readiness
Undergo testing to ensure athlete is physically and psychologically prepared. Developed improved strength and flexibility, able to push recovered part to to high intensity in competition.
Pain Free
Comfortable when performing skills required - Sprained Ankle is pain free when completing drills, mini games, and during actual competition simulation, if not pain free athlete has a higher chance of re injury.
Degree of Mobility
Amount of movement around injured area, movement should be smooth and show confidence through speed and power
Monitoring Progress
Comparing results from tests before injury to tests after the injury, revealing if progress has been made. Elite athletes will complete tests regularly of their physical fitness, if an athlete becomes injured these will become pre tests and compared to during and post rehabilitation tests. When post test results are similar to pres test results rehabilitation can stop.
Sports specific exercises need to be completed at the injured site, without pain and 100% effort to match a game situation. Tests are desinged to assess the power, strength, flexibility and proprioception.
For a sprained ankle - Tests determining range of motion of the ankle, fitness tests (beep test), agility testing (being able to change direction at speed) – midfielder, pushing off the ankle to dive – goal keeper
Psychological
Readiness
Confident is their abilities and have a positive outlook, mental attitudes contribute significantly to recovery and prevention of re injury. As well as pressures resulting in re-injury or further injury.
If the athlete is not confident they will shield the injured site causing poor technique and lead to injury somewhere else. As well as diminishing their performance as in contact sports the athlete may hold back from a tackle, also leading to injury. Trainers can help athletes psychologically prepare by providing frequent positive feedback during training.
Overconfident athletes will return to play before they are ready leading to a greater risk of re-injury. Appropriate professionals will be used to determine the athletes psychological readiness.
To compete agin the athlete will need to demonstrate a healthy balance of motivation, common-sense, and self-awareness
Specific Warm Up Procedures
Minimise risk of re-injury, focusing on the injured site to ensure there is adequate blood flow and is properly warmed up. As well as mental exercises to build confidence and reassurance. Mentally the athlete needs to know they have warmed up in a safe environment and pushed that particular muscle group past what it may be expected to go through in the game, reassuring the player they are ready to play.
Sports massages can also be used to increase blood flow through a passive way. Targeting the injured area and replicating competition demands can also prepare the athlete of the demands of the sport.
Specific warm up to sprained ankle - Rotate your feet in circles, changing direction a few times. Big circles, then little circles and then big again. Alternate between flexing and pointing feet.
Return to Play Policies
and Procedures
Impacted by the severity of the injury. Decisions will be made based on discussions with physiotherapists, trainer or doctor to ensure athlete is completely recovered.
Each sport has specific return to play policies and procedures many are very similar for common injuries and are developed in conjunction with academic organisations, followed by coaches and athletes to promote player safety and wellbeing.
Coaches may draw on their own experience to create specific criteria for individual athletes to determine if they are fit for play. This can include athletes returning to a less stressful environment putting less stress on the injured site, for example playing a reserve grade game. All documentation and information must be kept to cover liability in case of re-injury.
Ethical
Considerations
Pressure to Participate
External: Can come from coaches, teammates and fans, loosing financially, or a loss in sports ranking. Can be pressured because they are costing the club, teammates see them as a vital member and want to win, fans want to see their team win.
Internal: Most dangerous pressure comes from athlete themselves. They are very driven and motivated, want to succeed and not let teammates, coaches, or fans down. Their want to be involved can lead them to lie to medical staff about symptoms they have so they can return faster.
Painkillers
Pain exists to tell athletes when a movement is causing damage to the body and is an indicator of injury occurring or has occurred. Pain killers stop this feeling, causing greater injury.
It is ethical for athletes to take Panadol or Nurofen to relieve pain from a muscle spasm with no injury. However it is unethical for an athlete to take opiod drugs such as codeine, methadone or morphine for a torn hamstring of a young player early in the season, as it could destroy their career.
If an athlete is taking pain killers they should be measured and administered by a qualified medical practitioner. This decision to use painkillers will often be done if it is the players last game or grand final, high-pressure matches, when there is a long break after competition of 3-6 months to recover.
Greater pressure for individual sports as the athlete can not be substituted and is guaranteed the loss. For concussions documented procedures must be completed before returning, protecting the athlete from pressures leading to injury.
Athletes can not make the decision alone if they are ready to return to play or not and needs to be made in conjunction with appropriate medical professionals to benefit their health and wellbeing. Due to clearance needing to be given if there is a high risk of re-injury or the injury is large. Coaches can also give the athlete further traing, game exposure and psychological testing to ensure they are ready.