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INTRODUCTION

OBJECTIVES

After completion of this chapter, the physical therapist should be able to do the following:

  • Outline the need for functional progression and testing.

  • Discuss functional testing research.

  • Define functional exercise progression.

  • Describe the continuum of functional progression for low- and high-level patients.

  • Outline a movement analysis that can be used during a functional exercise progression.

  • Describe the importance and implication of sport specificity when implementing a return to play functional exercise program.

The rehabilitation professional plays a vital role in returning a patient to his or her previous level of function post injury. The ultimate goal of any rehabilitation program is to return the individual to the preinjury level of function as quickly and as safely as possible. Decreasing pain and swelling and restoring normal range of motion (ROM), strength, proprioception, and balance are all part of the plan. These are all building blocks toward higher levels of function including power development, foundational athletic movement(s), and ultimately, the return to work/sport.

Functional tests are used to determine a baseline and help to decide if someone is ready to return to an activity or play (sport participation). A functional exercise progression breaks down complex movement patterns into simpler tasks while respecting the healing constraints of the injured tissue. This chapter will examine functional testing as well as functional exercise progressions, and offer suggestions for tailoring testing, and progression, often in the context of athletics and sport. Tailoring functional testing and progression depends on the sport the patient will be returning to, which will also be addressed in detail.

THE PERFORMANCE TRAINING CONTINUUM

When an athlete is injured, a quick and accurate diagnosis is required. The athletic trainer (AT) or the physical therapist (PT) may be the first person to see the injured athlete; however, the patient is often referred to the physician for further diagnostics and evaluation. Objective testing that may be completed by the physician includes some type of clinical exam and diagnostic tests, such as MRIs, CT scans, or X-rays (Figure 18-1).

Figure 18-1

The Performance Training Continuum

Once the structural diagnosis is confirmed by the MD, a rehab plan is created. Managing pain and swelling, regaining range of motion, and improving strength for activities of daily living (ADLs) are the initial priority. Foundational tissue-healing principles1–3 guide rehabilitation practice and exercise progressions and should be employed to guide the functional testing process as well. While the intricacies of tissue healing are beyond the scope of this chapter, it is absolutely critical that the health care professional understands the different healing properties of bone, tendon, ligament, muscle, fascia, and more in order to safely and effectively apply stress to the healing tissue.1,2,4,21,29,6,7 It is important that appropriate stress(es) be placed on the healing tissues in order ...

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