Principles of Rehabilitation
Rehabilitation is a generic term for the comprehensive treatment of injury and/or medical conditions. It has active and passive elements. It focuses upon the whole person not just the injury and aims to restore the greatest possible degree of function in the shortest possible time. The factors implicated in the cause of injury should be addressed to prevent injury recurrence.
Three concepts help with the understanding of the rehabilitation process these are impairment, disability and handicap.
Injury causes an individual an impairment. This is the injury at the tissue level e.g. ruptured medial collateral ligament of the knee.
Impairment usually causes a disability This is a loss of function e.g. walking with a limp and unable to run. This in turn may cause a handicap this is an individuals inability to perform tasks or engage in activities.
e.g. the professional footballer is unable to compete for the rest of the season due to the knee injury which causes loss of playing time, reducing his income and prematurely ending his career. This causes some reactive depression.
From this example the need for the physician to consider the medical, physical, psychosocial, vocational and leisure requirements of the injured athlete is apparent.
The areas covered in this article and further articles are
- the principles of rehabilitation
- treatment modalities
- specific examples
- complications of inadequate or incorrect
- rehabilitation prevention
Principles of rehabilitation
The process of athletic injury rehabilitation aims to minimize tissue damage and allow a safe return to activity. It is based on the science of tissue healing, knowledge of joint biomechanics, physiology of muscular strength and endurance, and the neurophysiological basis of skill retraining. Successful programs are based on an understanding of these constraints, which, when properly applied, permit the progressive activity of joints and muscles. Muscular strength, endurance and power are redeveloped while flexibility and cardiovascular fitness are maintained. Precipitating factors are identified and addressed to minimize reinjury.
To understand, grade and treat injuries the physician needs to identify the tissues involved. This chapter focuses on muscle-skeletal injury and rehabilitation of bone, ligament, muscle, tendon, connective tissue and neuromuscular structures combining to produce coordinated, purposeful movement. The treatment of other injuries is covered in relevant chapters.
The healing process involves inflammatory, repair and remodeling phases. There are detrimental effects of immobilization, muscle wasting and weakness and subsequent joint damage. This leads to further immobilization and reflex inhibition ‘a vicious circle’. Early mobilization is usually indicated.
Lack of motion of joints results in shortening of capsular and other connective tissue structures supporting the joint, loss of lubrication and alternating compression between joint surfaces deprives articular cartilage of nutrition.
There are detrimental systemic effects of immobilization, these begin within hours and become clinically important within days. They include cardiovascular deconditioning, nervous system depression, skin sores gastrointestinal complaints (constipation), thromboembolic genesis, bone resorbtion and respiratory impairment.(3) Thus the expression ‘MOVE IT OR LOSE IT’
An understanding of the sport or activity is required, many injuries are sport specific and communication is enhanced if the physician has some basic knowledge of the sports requirements. ‘Profiling’ is a concept that matches an individuals physiognomy with the type of athletic activity and in team sports their role.