Chapter 16: Using Therapeutic Exercise in Rehabilitation

William E. Prentice

OBJECTIVES

When you finish this chapter you should be able to

• Explain how the athletic trainer approaches rehabilitation.

• Contrast therapeutic exercise and conditioning exercise.

• Describe the consequences of sudden inactivity and injury immobilization.

• Recognize the primary components of a rehabilitation program.

• Discuss the concept of open versus closed kinetic chain exercises.

• Explain the importance of incorporating core stabilization training into a rehabilitation program.

• Evaluate the value of aquatic exercise in rehabilitation.

• Identify the techniques and principles of proprioceptive neuromuscular facilitation.

• Demonstrate the use of mobilization, traction, and Mulligan techniques for improving accessory joint motions.

• Discuss how muscle energy, myofascial release, strain/counterstrain, positional release, active release, and biofeedback techniques can be incorporated into a rehabilitation program.

KEY TERMS

• therapeutic exercise

• neuromuscular control

• proprioception

• kinesthesia

• mechanoreceptors

• core stability

• Physiological movements

• accessory motions

• balance

• postural control

• functional progressions

• functional testing

• kinetic chain

• aquatic exercise

• buoyancy

• proprioceptive neuromuscular facilitation (PNF)

• muscle energy techniques (MET)

• joint mobilization

• traction

• Mulligan technique

• myofascial release

• Graston technique

• strain/counterstrain

• positional release therapy (PRT)

• active release technique (ART)

• structural integration

• postural restoration (PRI)

• biofeedback

THE ATHLETIC TRAINER'S APPROACH TO REHABILITATION

The process of rehabilitation begins immediately after injury. Initial first-aid and management techniques can have a substantial impact on the course and ultimate outcome of the rehabilitative process. Thus, in addition to possessing a sound understanding of how injuries can be prevented, the athletic trainer must also be competent in providing correct and appropriate initial care when injury occurs. In a sports medicine setting, the athletic trainer most often assumes the primary responsibility for design, implementation, and supervision of the rehabilitation program for the injured patient.

Designing programs for rehabilitation is relatively simple and involves several basic components: minimizing swelling, controlling pain, reestablishing neuromuscular control, establishing or enhancing core stability, restoring or increasing muscular strength and endurance, regaining or improving range of motion, regaining balance and postural control, and maintaining levels of cardiorespiratory endurance. Addressing each of these components is the easy part of supervising a rehabilitation program. The difficult part comes in knowing exactly when and how to change the rehabilitation protocols to most effectively accomplish both long- and short-term goals. Progression during the rehabilitation program should be based on specific criteria, and return to play decisions must be based on level of function and patient outcomes. Certainly, the athletic trainer plays a key role in return to play decisions.

The approach to rehabilitation in an athletic environment is considerably different than in most other rehabilitation settings. The competitive nature of athletics necessitates an aggressive approach to rehabilitation. Because the competitive season in most sports is relatively short, the long-term goal is for the patient to return to activity as ...