INJURY MANAGEMENT
http://www.reflexportland.com/guest-blog-strengthening-to-help-manage-knee-pain/
|
REHABILITATION OBJECTIVES
|
http://www.recoverypt.com/knee-injury-physical-therapy/
|
Below are descriptions of the three phases of the healing process and how the rehabilitative objectives above are incorporated into injury management. It is important to understand that every injury carries its own unique characteristics and complications, and the plan of care for each injury has it's own limitations throughout the healing process.
ACUTE INJURY PHASE
This phase begins immediately at the time of injury and can last up to fours days post-injury. The primary goal in any acute injury is to control swelling and manage pain. A common technique used to initiate injury management during this phase is PRICE (protection, rest, ice, compression, & elevation). Although it is necessary to control swelling in a effort to prevent secondary hypoxia, the inflammatory response is normal and must occur for the healing process to begin. Therefore, immobilization during the first 24 to 48 hours of injury plays a major role in managing the swelling. Because knee and thigh injuries are in the lower extremity the injured person should avoid any weight-bearing activities within the first 24 hours of injury.
Proper amount of resting time during this phase is an important step in the recovery process. If the injured area is not given enough rest prior to beginning rehab exercises, the inflammatory process does not have a chance to accomplish all that is needed for proper healing to occur. Due to the inflammation and period of immobilization there is most often a significant loss of range of motion. Once the swelling begins to subside and pain decreases the patient can begin some range of motion exercises as long as they are pain free. However, it is important to assure that structural integrity allows for such exercises. Structural integrity will continue to improve as the healing process progresses although the clinician must be conscious of the amount of stress that the various exercises place on the injured structures.
Proper amount of resting time during this phase is an important step in the recovery process. If the injured area is not given enough rest prior to beginning rehab exercises, the inflammatory process does not have a chance to accomplish all that is needed for proper healing to occur. Due to the inflammation and period of immobilization there is most often a significant loss of range of motion. Once the swelling begins to subside and pain decreases the patient can begin some range of motion exercises as long as they are pain free. However, it is important to assure that structural integrity allows for such exercises. Structural integrity will continue to improve as the healing process progresses although the clinician must be conscious of the amount of stress that the various exercises place on the injured structures.
REPAIR PHASE
Once the inflammatory response phase has subsided, repairing of the injured structures begins. This phase can last up to several weeks depending the severity and nature of the injury. At this stage rehab objectives should initially be focused on gaining full pain-free range of motion, flexibility, muscle strengthening, and cardiovascular endurance. Cardiovascular endurance should be initiated as soon as possible to enhance the recovery time, however the inflammatory phase must be over before CV endurance is started. Exercises should also be targeted towards training the neuromuscular system to more easily transition the patient into integrated and coordinated movements later in the rehab process. As the healing process continues and the patient's range of motion is within normal limits they can begin concentrating more on muscular strength, endurance, speed, and power. These objectives will often blend together as most of the exercises will target several of these goals.
Once the inflammatory response phase has subsided, repairing of the injured structures begins. This phase can last up to several weeks depending the severity and nature of the injury. At this stage rehab objectives should initially be focused on gaining full pain-free range of motion, flexibility, muscle strengthening, and cardiovascular endurance. Cardiovascular endurance should be initiated as soon as possible to enhance the recovery time, however the inflammatory phase must be over before CV endurance is started. Exercises should also be targeted towards training the neuromuscular system to more easily transition the patient into integrated and coordinated movements later in the rehab process. As the healing process continues and the patient's range of motion is within normal limits they can begin concentrating more on muscular strength, endurance, speed, and power. These objectives will often blend together as most of the exercises will target several of these goals.
REMODELING PHASE
The remodeling phase is the longest phase of the healing process and may take up to several years. Physiologically all fibrous tissue has been laid in the effected area and realignment of the collagen tissues based on the stresses placed on them begins . During this phase the primary goal is to return to participation. Rehab exercises will continue to work on muscular power but will progress into integrated and coordinated movements and agility training. This is when sport specificity becomes important as functional skills are incorporated into the rehab routine. At this point the nature of the rehab is less related to the nature of the injury and more directed towards functional activities and return to play guidelines.
(Prentice, 2011)
(Prentice, 2011)