Sports Rehabilitation :

A dictionary definition of rehabilitation is the restoration to a former capacity or standing, or to rank, rights and privileges lost or forfeited.  This is the essence of sports medicine rehabilitation. While the treatment described in may lead to an athlete becoming pain-free and able to return to activities of daily living, rehabilitation is required to return the athlete to the previous level of function.

All musculoskeletal injuries require active rehabilitation. Rehabilitation is also necessary following surgery. The primary aim of injury rehabilitation is to enable the athlete to return to sport with full function in the shortest possible time. If rehabilitation is inadequate the athlete is:

• prone to reinjury of the affected area.
• incapable of performing at pre-injury standard.
• predisposed to injuring another part of the body.

The Rehabilitation Program

Although sports medicine is readily classified as a science, devising a successful rehabilitation program should be considered an art. Skilful rehabilitation cannot be replaced by a recipe approach as each athlete is an individual who brings very different personality and lifestyle factors to the therapy room. Furthermore, each athlete has different post-injury sporting goals, levels of skill and degrees of competitiveness, all of which influence the rehabilitation program. Several general principles should underpin every rehabilitation program.

Every Athlete is an Individual

To prescribe rehabilitation requires high-level people skills as the psychological make-up of each athlete is different. As some athletes are highly motivated and become overzealous, they may need to be held back throughout rehabilitation. Other athletes are hesitant and lack confidence and require considerable psychological support and encouragement.

Each athlete has a different lifestyle. Some have considerable career or job commitments whereas others are full-time professionals. Some athletes have good support from their family and peers, whereas others are loners. The therapist must establish a caring, trusting relationship with the patient and be aware of the psychological effects of the patient’s injury throughout the rehabilitation period. It may also be appropriate for the therapist to communicate regularly with the athletes coach or parent and keep them informed of progress.

Because of the individual differences between athletes, and also to improve compliance, the therapist must customize each rehabilitation program. The program should be monitored and may need to be modified throughout the rehabilitation period, based on subjective and objective assessment findings.

Once the diagnosis has been made and initial therapy instituted, the therapist performs a comprehensive baseline assessment from which to measure progress. An appropriate, individualized rehabilitation plan is then formulated.

Keys to a Successful Rehabilitation Program

Explanation

The rehabilitation plan should be explained to the patient with realistic, approximate time frames. It should be emphasized that the time frames are only approximate and not promises It is important to set short-term goals, for example, the removal of a brace or the commencement of jogging, and long-term goals, such as a return to sport.

It is also important to explain the rationale behind the program .This is only possible if the therapist has first formulated a hypothesis as to why the injury occured.  For Example, if lack of flexibility contributed to injury, the therapist should include an ongoing program to gradually improve the athlete’s flexibility beyond the pre-injury level. If dynamic joint instability was a precipitating factor, or a precipitating factor or a result of injury, rehabilitation should emphasize muscle control and strengthening. If incorrect biomechanics and poor muscle control were important factors in the etiology of the injury, these components should be addressed.

Provide Precise Prescription

During the rehabilitation program, the therapist must emphasize correct exercise technique and carefully apply principles for the progression and limitation of exercises and activities. The therapist must also constantly monitor and, if necessary, modify the program as required. This requires one-to-one attention, and cannot be ‘supervised‘ while attending to several other patients.

Make the Most of the Available Facilities

If facilities such as a gymnasium, pool or biofeedback devices are available, the program may take advantage of these facilities. If sophisticated equipment is not available, however, simple equipment, such as an exercise bike, rubber tubes, steps, free weights, and the use of appropriate functional exercises incorporating body position and body weight, can all be incorporated in the program.

Begin as soon as possible

The rehabilitation program should start as early as possible following injury or surgery. Pain, inflammation swelling or joint effusion must be controlled in the early stages as they inhibit optimal function. Rest from aggravating activities, ice, electrotherapeutic modalities and anti-inflammatory medications will help reduce these factors.

In the past, it has been customary to begin rehabilitation with range of motion exercises (e.g. stretching) and introduce strength training later. A variation to this approach has recently been presented in acute hamstring strains, indicating that a rehabilitation program consisting of progressive agility and trunk stabilization exercises is more effective than a program that consists of hamstring stretching and strengthening in regards to promote return to sport and preventing recurrence of injury. This approach may well be the way of the future, but more research is required into this area.

The Important Components of Rehabilitation are:

• Muscle conditioning
• Flexibility
• Neuromuscular control (balance, proprioception)
• Functional Exercises
• Sport Skills
• Correction of abnormal biomechanics
• Maintenance of cardiovascular fitness
• Psychology
• These components are incorporated into the overall rehabilitation program.