CSCS Chapter 22: Rehabilitation and Reconditioning

CSCS Study Guide Chapter 22

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Chapter Goals

  1. Find the members of the sports medicine team and the responsibilities they have during rehab and reconditioning.
  2. Know the types of injuries in athletes.
  3. Understand Timing and events of tissue healing.
  4. Know the goals of the phases of tissue healing.
  5. Discuss the roles of strength and conditioning professionals in rehab and reconditioning. 

Sport Medicine Team Members

  • All team members are responsible for educating the coaches and athletes about risks of injuries, treatments and the precautions.
  • The team physician is a person who provides medical care for organizations, schools, or teams.
  • The athletic trainer is the person responsible for day to day physical health of athletes. They are certified typically by the National Athletic Trainers’ Association Board of Certifications as an ATC (Certified Athletic Trainer).
  • The physical therapist is the person who studied orthopedics or sports medicine and plays a vital role in reducing pain and restoring function to athletes with injuries.
  • The Strength and Conditioning professional is the person certified as a CSCS by the NSCA to make sure they have the knowledge and background for rehabilitation.
  • The exercise physiologist is a person with a background in exercise science that designs conditioning programs with considerations for the body’s metabolic response to exercise and the ways that reaction can aid the process of healing.
  • The nutritionist is the person with a sports nutrition background that provides the guidelines for proper food choices for optimal recovery. The person is ideally a registered dietician.
  • The Psychologist or Psychiatrist is a licensed person with a background in sports that gives strategies to help injured athletes cope with mental stress from injuries.

Principles of Rehabilitation and Reconditioning

  • Healing tissues can’t be stressed too much.
  • Athletes need to meet criteria to progress to the next phases in rehabilitation.
  • Rehabilitation programs are based on actual research.
  • Programs must be adaptable to people specific to their goals.
  • Rehabilitation is a team process for all the sports medicine team.

Communications

  • Strength and conditioning professionals need to know diagnosis of injuries, forms of treatment required, and activities or practices prohibited due to injuries.
  • They also need to inform the whole sports medicine team about exercises done by the athlete along with their response to it.

Types of Injuries

  • Macrotrauma is the specific and sudden episodes of overload injury to tissues that result in disruptive integrity of the tissue.
    • Bone trauma can lead to fracture or contusion.
    • Trauma to joints is shown as a dislocation or subluxation and can lead to laxity or instability of the joint.
    • Ligament traumas are known as sprains and give classification based on severity.
      • First degree sprains are partial tears without joint stability.
      • Second degree sprains are partial tears with minor joint instability.
      • Third degree sprains are complete tears with full instability of the joint.
    • Musculotendinous trauma is either a contusion or a strain and has three degrees of severity, too.
      • First degree is partial tears of individual fibers and strong painful muscle activity accompanies.
      • Second degree strains are partial tears with weak and painful muscle activity.
      • Third degree strains are complete tears of fibers and shown by weak painless muscle activity.
  • Microtrauma happens from repeated abnormal stress on tissues from continuous training, or training without resting enough.
    • The most common bone injury from overuse is a stress fracture.
    • Tendinitis is the inflammation that occurs in a tendon.

Tissue Healing

  • Inflammation is pain, swelling, redness, decreased collagen synthesis, and increased inflammatory cells. This is the body’s reaction to injuries and is necessary for healing. Edema inhibits contractile tissues and may limit function.
    • This can last 2 – 3 days after acute injury but can be longer if there is a compromised blood supply or more severe damage.
  • Fibroblastic repair is shown with collagen fiber production, less collagen fiber organization, and fewer inflammatory cells. When inflammation ends, tissue repair begins and allows tissue replacement that isn’t viable after injury. This phase can start 2 days after injury and may take 2 months.
  • Maturation Remodeling has proper collagen fiber alignment and increased tissue strength. Weakened tissues that are produced during repair is strengthened during remodeling. Collagen fiber production shifts to type I collagen. This allows the new tissue to improve structure, strength, and function. This may last months or years following injury.

Goals of Rehabilitation and Reconditioning 

  • Healing tissues cannot be overstressed.
  • Inflammation Response Phase
    • Treatment Goal is to prevent the disruption of new tissues.
      • Rest includes RICE components and electrical stimulation to minimize damage to tissues and pain.
      • Power, Strength, and Endurance of uninjured tissues along with the cardiorespiratory system need to be kept up.
    • Exercise Strategies
      • Not recommended to involve the injured area.
  • Fibroblastic Repair Phase
    • Treatment goal is to prevent excessive atrophy of muscle and deterioration of the injured area.
      • New weak collagen fibers should be protected by avoiding active resistive exercise.
    • Exercise Strategies
      • Should follow consultations with the team physician, the athletic trainer, and/or the physical therapist.
        • Submax isometric exercise.
        • Isokinetic exercise
  • Maturation Remodeling Phase
    • Treatment goal is to optimize function of tissues while transitioning to return to activity.
      • Progress activities done in repair phase and add more sport specific exercise.
      • Progressively loading tissues improves collagen fiber alignment and hypertrophy of fibers.
    • Exercise Strategies
      • Need to be functional and mimic the demands of activity.
      • Should also resemble the speed during sport.

Closed Kinetic Chain

  • Exercises where the terminal joints meet considerable resistance prohibiting free motion.
    • A squat or a push up.

Open Kinetic Chain

  • Exercises using successively arranged joint where the terminal joint can move. They allow more concentration on isolated joints or muscles.
    • A seated Knee extension.

Resistance Training

  • Programs have been designed for assisting program design for injured athletes.
  • DAPRE allows us to manipulate intensity and volume more.
  • Sport demands determine training goals.

Daily adjustable progressive resistance exercise (DAPRE) system

  • First set require 10 reps of 50% 1 RM.
  • Second set require 6 reps at 75% 1 RM.
  • Third set require max reps of estimated 100% 1 RM.
  • These reps in the third set estimate the adjustments in resistance for the fourth set.

Aerobic and Anaerobic Training

  • Research hasn’t determined the best aerobic training program for to use for rehabilitation. The programs need to mimic the sport and metabolic demands.

Reducing Risk of Injury and Reinjury

  • Previous injuries are one of the greatest risk factors in active people.
    • Decreased shoulder strength, scapular dyskinesis, and decreased glenohumeral range are the greatest risk factors for upper body injury.
    • Decreased lower extremity strength, Decreased control during jumping, and decreased balance are some of the greatest risk factors for lower body injury.
  • The side to side differences in functional and strength performance less than 10% can be ok.

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