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Key points to consider planning a rehabilitation program

1. How do we determine the relative amount of resistance for an individual?.

2. How many repetitions should be done?.

3. How much rest period is necessary?.

4. How do we determine the factors limiting exercise performance clinically?.

5.How do we determine which components of rehabilitation are appropriate targets?.

6. Where is the transition between rehabilitation and conditioning?.

7. What is the difference between physiotherapy prescribed exercise and sport   rehabilation / fitness instructor?.

8. How do the principals of strength and conditioning apply to rehabilitation?.

9. What do we need to know about the structures we are rehabilitating?.

10. How do we improve exercise compliance?

Selecting variables to modify in a rehabilitation program can prove challenging. Most therapists are familiar with the obvious variables of LOAD & REPETITION but there are numerous other factors that can be manipulated.

Speed

Range of Motion

Base of Support

Plane of Motion

Combining different elements of these components allows progression or regression as required. It is essential that therapists are competent in applying these principals in a clinical setting

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Many of you will be familiar with the concept of functional training in rehabilitation, so a brief review of historical aspects will suffice here.

Functional training from a rehabilitation perspective has been used for many decades with the obvious goal of returning an individual to their pre-injury functional status. The astute reader will note that this implies a degree of individuality and specificity in rehabilitation strategies depending on the individual’s response to the injury in question and the planned functional goals to be achieved. In this discussion we are concerned with a return to playing sport, which has different functional requirements depending on the sport of choice. Most rehabilitation specialists would agree that the fundamental measure of success is the ability to “perform at maximal function”. The issues of debate usually centre around:

1. Whether to use functional exercise as an initial priority.

2. Whether to place prerequisite criteria for progressing to functional exercise e.g. base line flexibility measures, stability measures, agility, coordination and power.

3. The use of over load / external resistance to achieve progressive increases in power output.

4. Key variables to manipulate in exercise progression e.g. load, speed, plane of motion, movement sequence.

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No doubt many of you are aware of the competition amongst health professionals for the the mantle of key exercise prescribers.

Many therapists feel that their undergraduate training is insufficient.

Some feel that the boundaries of practise are at best “blurred” which creates confusion with the public regarding choice of therapist.

This has led to an explosion of interest in “functional training” - which is fast becomming a by-word for strength and conditioning. Understandably, physiotherapists core training does not provide these skills. This can make physiotherapists feel “inadequate” but we need to consider the type of caseload we see and whether strength & conditioning principals are the nesessary tools or whether other parameters are more relevant.

What do you think? Post your comments

David

Given the multifactorial nature of shoulder impingement pain how can we determine the dominant mechanism to plan intervention?
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Some folks have asked for a list of references.
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As promised here is the link to the accompanying slide presentation from last week’s audio download

 http://www.physioseminars.com/public/presentations/shoulder-impingement-slides/player.html

Instructions for use:

1 Double click on link

2 Slides will play automatically

3. Pause, forward, rewind from the control panel at the bottom of the player screen.

4, Can skip to slides from the left hand side slide menu.

5 Suggestion - if you downloaded the audio previously you can use your MP3 player whilst viewing the slideshow.

Hope you enjoy

David

Welcome to all of you who were at the sports rehabilitation seminar in UCD, Dublin on Saturday 29 th March. As I mentioned after my presentation I have now made the Audio of this lecture available as a free MP3 download for attendees. Many thanks to Garrett Coughlan and his team at Sports Managment Ireland for organising the event and inviting me to speak. I hope you got some useful clinical information - the ultimate objective of the day!! I will post the slides I used on the day shortly but in the meantime you can listen/download the audio to playback on your PC or iPod as you prefer. (click here to download) This is a big file and will take time depending on your internet connection speed.

Key Points

Mechanisms of Impingement

Clinical Algorithm’s

Testing

Differential Diagnosis

Treatment Selection

(click here to download) This is a big file and will take time depending on your internet connection speed.

Alternatively, to play the audio now click on the play arrow below.

 

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See the preview slide presentation for overview of this complex clinical  problem. (Click here to view).

Please leave your comments. We will be running a series of internet seminars on this topic and the content will be determined by the questions you have. Look forward to hearing your thoughts