Progressive Systematic Functional Rehabilitation

&
Strength and Conditioning
By: Qindeel Fatima (318-T-102)
Progressive Systematic Functional
Rehabilitation
 Rehabilitation:

Rehabilitation is a complex process demanding the attention

and knowledge of a range of issues and applications.

Successful rehabilitation of sports injuries is dependent on a

progressive plan that addresses and accommodates the
injury/pathological issues and conditions.

Components of rehabilitation including flexibility, the

restoration of muscular strength & endurance and enhancing
proprioceptive control; must be managed effectively to ensure
injury management within the context of physical activity &
return to sport.
 Understanding progressive rehabilitation, assessment
and observation
 On initial observation of an injury it is essential to perform an injury screening.
 Following two acronyms provide an effective method of gathering information relating to
possible trauma
 SINS (severity, irritability, nature and stage) and
 SOAP notes (subjective, objective, assessment and plan)
 Systematic, functional and progressive rehabilitation involves the process of carefully
considering the key components of musculoskeletal trauma. This involves adequate
management of the injury in order to prevent further soft tissue trauma and enable a progressive
treatment protocol to be implemented effectively.
 1. Inflammation and pain management

 Application of an early stage rehabilitation program with restoring full pain-free functional range of motion
as a main objective, is beneficial and can result in a rapid attainment of pre-set functional tasks.
 Following protocol of Intermittent application of ice may enhance the therapeutic effect of ice in pain relief
after acute soft tissue injury.
“10 minutes ice/water submersion (approx. 0°) on 10 minutes off (room temperature) 10 minutes on
ice/water submersion (approx. 0°)”.
 The sport rehabilitator is advised to adhere to prescribed guidelines for the use of cryotherapy within
progressive injury rehabilitation. These could include the responsible use of cryotherapy, to prevent ice
burns that may be caused by direct application or prolonged exposure to cryotherapy.
 Early intervention of the use of cryotherapy helps speed recovery and return to sport.
 2. Range of motion and flexibility
 During an initial musculoskeletal evaluation the clinician may have to take the athlete through
active and passive range of motion.
 Active range of motion is when the athlete moves the affected joint through its range without
any external influence. This is done as a measure of pain through a functional range and also
provides the sports rehabilitator with the information about whether to perform a passive range
of motion assessment at that joint.
 Passive range of motion occurs when the clinician takes the affected limb through its range in
order to provide information regarding the integrity of joint or ‘end feel’. This usually provides
important information regarding the client’s condition and informs the clinician about future
action, assessment and intervention.
 3. Flexibility training
 The aim of a flexibility program should be to achieve and maintain an optimum ROM at each
joint that is specific to the athletes sport.
 Three modalities that are universally employed during a flexibility program to obtain an
increase in joint ROM are:
1. Static stretching
2. Proprioceptive neuromuscular facilitation (PNF)
3. Self-myofascial release (SMR)
 4. Proprioception/neuromuscular control

 Rehabilitation programs should include a proprioceptive component that addresses the following three levels of motor
control:
 Spinal reflexes
 Cognitive programming
 Brainstem activity
There are different proprioceptive states that are important to consider in the design of a progressive rehabilitation program.

1. Static proprioceptive development involves exercises with the maintenance of a stable base, while allowing for only
minimal movement. The athlete should focus on control of posture and be able to perform a number of modifications of
static proprioceptive training.
2. Dynamic proprioceptive training should only be introduced when the athlete has demonstrated a sufficient level of
balance and coordination during the static proprioceptive exercise phase of the neuromuscular control program. Dynamic
proprioceptive exercises involve greater levels of instability and require a higher demand for accuracy, strength and speed
of motion, balance and coordination.
 5. Strength endurance and maximal strength

It is imperative to ensure athletes progress through the rehabilitation process establishing an adequate
level of muscular endurance and then strength as required by their individual sport.
 Isometric strength training needs to be considered in the initial rehabilitation phase, and is often
implemented 3–7 days post injury, usually with a focus on preventing muscle atrophy and/or a loss of
strength. Frequency, duration and intensity are limited by the patients’ pain. Some therapists advocate
three sets of 10 repetitions using 5–10 second holds to begin with at intensity within pain tolerance.
These then are undertaken at multiple angles, beginning in mid range then progressing to inner range
(shortened position) then outer range (lengthened position).
 5. Strength endurance and maximal strength

 Early phase strengthening exercises, involve an isometric contraction of the

agonist muscle with no movement at the joint. The contraction should be
performed at different joint angles to initiate muscle fiber activation in
different planes of motion. The stabilizing force surrounding the joint is the
antagonist muscle.
 During isotonic exercise the athlete must provide a force powerful enough to
initiate concentric and eccentric muscle actions, whilst coping with a
constant external load. There are different isotonic exercises that could be
embedded into the rehabilitation process. These can include use of
dumbbells, machine weights, and resistance bands.
Strength and Conditioning
 Strength & Conditioning
 Training for Strength
Strength attributes can be enhanced by a number of different training methods including:
 Heavy resistance training
 Plyometric
 Complex training
 Assisted and resisted training
 Explosive isometrics
 Eccentric training

Olympic style lifting
Each of these methods produces adaptations that are specific to the attributes trained.
  Explosive force production:
Few sports rely exclusively on maximal strength.
In contrast, success in most other sports depends on explosive force production, or power, which in turn depends on
both the magnitude of force produced (strength) and the rate at which it is applied (speed). Of these, it is often the
rate of force development that is more important to sporting success than the magnitude of force developed.

 Rate of force development:

Sporting movements occur quickly, often between 30 and 200 ms. The
length of the contact time during maximal sprinting is between 70 and 125
ms, which is not long enough for athletes to produce their maximum force.
Therefore, prior to competition, training should focus on maximising the
force that can be developed quickly (increasing rate of force development).
The quicker a sprinter can generate force then the faster they will be.

Force-time characteristics of two athletes.

 Training to maximize RFD
 Slow heavy exercises increase strength, but do not increase the force development within the
first 200ms of contraction, required by sport in conditioned athletes.
 Explosive-ballistic training is effective at improving rate of force development and strength in
the initial stages of muscle action (up to 200ms).

For example, during a sprint, ground contact times, and therefore the time over which an
athlete can generate useful force, change throughout the race. At the beginning of the race, when
the athlete drives out of the blocks and accelerates for the first few strides, the ground contact time
can be greater than 340 and 200ms respectively (Mero 1988), whereas when the athlete reaches
peak running velocity, the contact time is nearer to 70–125ms.
This knowledge is crucial to help athletes focus training more specifically on their strengths and
weaknesses.
 Representation of the change in ground contact time during a 100m race.
RepreIsometric rate of force development characteristics of Training should be tailored to the relative strengths and weaknesses of each
untrained, heavy resistance trained, and explosive-ballistic athlete.
trained athletes.
 1. Short response training – reactivity training
 Short response (reactivity) training is specifically designed to help athletes accept and produce
forces over very short periods (typically 75–200ms). The best type of training for reactivity is
plyometrics, focusing on those with a short ground contact time.
 Plyometric training involves very quick, light, yet powerful activities like quick feet, skips and
low amplitude jumps. Emphasis should be placed on speed, maximizing the rate of stretch,
minimizing ground contact time, and good technique, rather than height jumped, the height of
the box jumped from and the length of the bound.
 2. Long Response Training
 Long-response training refers to the training of powerful explosive movements with a contact or
application time of more than 200ms.
 Long response movements include activities ranging in speed from faster activities of around
200ms (bounding, tire pulling, single leg hopping and depth jumping) to longer activities of up
to 500ms (unweighted squat jumps, one legged jump-squats and weighted jump squats).

 This type of training can enhance force production,

acceleration from a standing start and height jumped.
 It is essential that the training program meets the
physiological, biomechanical and metabolic
requirements of the sport;
 3. Isometric Training

 Isometric training results in an increase in RFD, power and vertical jump height, which is
attributed to increases in tendon stiffness. This training must be performed with the intention of
explosive movement, and should not be the sole method of training.
 Parameters of Strength and Conditioning Program
 INTENSITY:
 Overload
This is usually referred to as ‘progressive overload’. More often, however, a form of ‘fluctuating overload’ is applied as part of a
periodized training program.
 Overload and super-compensation
For adaptations to occur, the training stimulus must be at a level beyond that normally encountered. Training at a level or intensity
that is beyond that normally encountered is called overload, and it is this overload that stimulates the adaptations that allow the
athlete to tolerate an increased level of training stress.
Once training has finished, recovery begins. This process involves restoration of physiological and biochemical balance, repair of
tissue and replenish and liver fuel stores. Depending on the type, intensity and duration of the training – and the quality of rest and
nutrition – full recovery can take from a few hours to several days (or weeks, depending on the intensity and duration of training).
Once pre-exercise levels have been restored, recovery is still not complete. The body continues to adapt, rebuilding and remodeling
itself until a higher state of readiness is reached. For a short period of time, an athlete’s fitness is enhanced. This is known as super-
compensation (adaptation).
The time period during which super-compensation occurs provides a window of opportunity during which the athlete should train
again. If the athlete trains during this period of super-compensation, the cycle is repeated and fitness continues to improve. If, the
athlete does nothing during this key period then the body will re-adapt to the current, lower activity level.
 Parameters of Strength and Conditioning Program
 TIMING:
The timing of the next training session is vital and varies according to the recovery abilities of the athlete and the demands
imposed by the previous session. For example, a well-conditioned athlete can recover from a long training run within 24 hours,
whereas the same athlete may take 10 days to recover from a heavy resistance training session involving rapid eccentric activities
and supra-maximal loads.
Once an athlete has adapted to a specific training load or stimulus (for example running five miles, three times per week at a
constant pace), then further gains can only be made if the training load is increased. This is known as the principle of
progressive overload.
It should be noted that there are times when athletes may perform successive hard training sessions in a block, without
allowing full recovery. For a few days, the athletes accumulate fatigue. This shocks the system and gives an opportunity – with
sufficient recovery later – to stimulate further adaptations. This is an advanced training method known as shock training
(planned Overreaching) and should only be used by athletes who already have a solid training base.
 Parameters of Strength and Conditioning Program
 ADAPTATION POTENTIAL:
An athlete’s adaptation potential (or capacity for improvement) is a function of
both their genetic makeup and their current level of fitness. Genetic makeup, an
athlete’s ultimate potential for success, is fixed and therefore not responsive to
training. The major factor determining an athlete’s adaptation potential then is their
current state of fitness relative to their genetic ceiling.

 Rate of Adaptation:
  ADAPTATION POTENTIAL:
 Training parameters:
 Parameters of Strength and Conditioning Program

 DETRAINING:
What an athlete can gain with training, they can lose with detraining. When athletes stop or reduce their training, their body
systems adjust accordingly. This presents as a loss of strength and power, a decrease in maximal aerobic capacity and a loss of
coordination.
The de-training effects of a short-term break (1–2 weeks) are relatively small, especially if physical activity levels remain high.
Longer or more frequent periods of inactivity have a greater cumulative impact on overall fitness. Thus, when athletes resume
training after a layoff or injury, they cannot start at the level at which they left off.
 Parameters of Strength and Conditioning Program
 SPECIFICITY:
The principle of specificity dictates that training should match the demands of the sport. Given that sport consists of many
components – with successful athletes needing to start, stop, twist, turn, run, jump, land, shuffle, push, pull, hit, bend, throw,
catch, hop, accelerate, decelerate, slide, block, and barge, all within the fluid, dynamic, and unpredictable environment of sport,
and all without getting injured – we are presented with a complex problem.
Training that does not relate directly to the movements and activity patterns found in sport, is a waste.
Mechanical demands
The mechanical demands of sport determine the movements that athletes should train. Exercises that mimic the actual
movements encountered in sport should be prioritized. By focusing on movement pattern specificity athletes can reinforce and
condition the actual motor programs used in skilled performance. These programs control the precise order, timing, velocity, force
application and muscle action to enable the muscles to produce a predetermined movement. The more practiced and efficient
these programs, the better the performance of the skill.
 Injury Prevention
 Avoidable versus Unavoidable Injuries
Integrating Strength & Conditioning into a Rehabilitation
Program
 Strength, endurance, and mobility are important factors in rehabilitation but are
only effective for performance and injury prevention when combined with
adequate proprioception and neuromuscular control, and integrated into the
complex and coordinated movement patterns and skills that characterize sport.

 Sport specific rehabilitation provides a framework for athletes to bridge the

gap between these traditional rehabilitation outcomes and the specific
demands of sport, and involves a sequential progression of ever more
challenging and specific exercises. Athletes begin rehabilitation as soon as
possible post-injury and continue until full functional capacity is restored.
Thank You!