Key Concepts of Rehabilitation
Team Approach
Rehabilitation is facilitated by a team approach. The basic team comprises in order of importance
- The injured athlete.
- The physical therapist- physiotherapist have the most scientific training (other types include masseuse)
- The doctor.
- Others; orthotist, brace maker, strapper, coach, exercise trainers, dietitian, psychologist, dentist, nurse, first aid personal, peer group, family and friends.
Diagnosis
History
present injury, past, athletic, social, family and psychological histories where required
Examination
including measurement of impairment and function, comparison with unaffected limb and review of biomechanical factors.
Investigations
this may include specific functional tests, pathology, radiology and nuclear medicine investigations where appropriate
Problem list
particularly if the injury is complex or severe.
Acute injury management
Begins immediately and can be performed by the athlete or any other capable person. This phase lasts the first 24-48 hours.
It consists of protecting the individual from further harm, resting, and icing the injury. Compression and elevation are used to minimize edema and haemorrhage and drugs are used for analgesia, anti-inflammatory properties and muscle spasm relief.
Acute injury management is summarized by the acronym P R I C E. Occasionally more extensive treatment or surgery is required.
Drugs
In general the authors feel that drug use should be minimized and the other components of injury management emphasized.
Drugs used in rehabilitation of sports injuries are of four main groups.
1. Analgesics - paracetamol, codeine, opiates and local anesthetic agents.
2. Anti- inflammatory medications are used extensively and have analgesic properties as well as causing moderation of the inflammatory response to injury. A short course of 3-7 days can be useful. Compliance is better with once or twice daily dosing. Topical and parental antiinflammatory medications are now available. Gastric ulceration, hypertension and renal impairment are among the side effects.
3. Anti spasmodics and sedatives are utilized to reduce muscle spasm and consequent pain, stiffness and immobility in the first 48 hours. They also induce drowsiness and can aid sleep. Benzodiazepams are used with caution as they affect balance, coordination and judgment.
4. Corticosteriods are usually used in chronic injuries. They have anti inflammatory, immunological and metabolic effects. They are injected intra-articularly or into connective tissue around tendons e.g. in subacromial bursitis. Their efficacy has been established. There are severe potential complications such as septic arthritis and tendon rupture these agents should be used by experienced practitioners only. Do not use on the Achilles tendon.