L33: Upper limb exercise

Question 1

What are 6 key steps in developing rehabilitation program?

Answer 1

1. Obtain a thorough history: Current injury, previous injury, available resources
2. Set long term goals
3. Aim for an accurate diagnosis (may be provisional and subject to supplementary investigations)
4. Identify key impairments in BF&S
5. Identify potential physiological, psychological and logistic barriers
6. Draft a realistic progress plan, including functional and measurable short -term goals

Question 2

What are the 4 phases of rehabilitation?

Answer 2

Question 3

What is Phase 1: Acute Management?

Answer 3

Question 4

What are the FITT for strength, endurance, power for Phase 2: Restore ADL?

Answer 4

1. Strength: 3-5 sets, 3-6 reps, 90-120 sec rest, 90-100%RM, controlled
2. Endurance: 1-2 sets, 15-30 reps, 45-60 sec rest, 50-70%RM, sport-specific
3. Power: 3-4 sets, 8-12 reps, 45-60 sec rest, 40-60%RM, explosive

Question 5

What are the features (FITT) for strength, power for Phase 3: Replicate Sport- Specific Demands?

Answer 5

1. Strengthening: Complex positions and movements
2. Power: 3-4 sets, 8-12 reps, 45-60 sec rest, 40-60% RM, explosive
3. Incorporate the whole kinetic chain (e.g. trunk rotation)
4. Gradual return to sports/activity. Can start when minimal pain, full ROM, adequate strength.

Question 6

What are the features (FITT) for strength, power for Phase 4: Prevent Re- Injury?

Answer 6

1. Continue to build power & endurance
2. Repetition of new motor patterns (e.g. throwing mechanics)

Question 7

Mitch the pitcher

• 17 year old baseball player & year 12 student
• Presents with acute onset pain in medial right elbow, which occurred during early pre-season training
• Right-handed thrower/ pitcher
• You diagnose him with a grade 2 MCL sprain

What are 3 goals of rehabilitation?

Answer 7

1. Restore function and performance level (ideally above pre-injury level) - ○ Make representative team again this year
   
   • US college scholarship
2. Return to baseball in a safe and timely manner
   
   1. Rep team selections in 4 months
3. Minimise the risk of re-injury
   
   1. Strengthen shoulder & elbow
   2. Improve throwing mechanics

Question 8

Mitch the pitcher

17 year old baseball player & year 12 student

Presents with acute onset pain in medial right elbow, which occurred during early pre-season training

Right-handed thrower/ pitcher

You diagnose him with a grade 2 MCL sprain

What are 3 educations?

Answer 8

1. Mitch +/- his coach or family may have unrealistic expectations of a rapid return to baseball
2. Give Mitch an early outline of expected progress, with specific short-term goals, and specific tasks to achieve these goals
   
   • Build confidence in the rehabilitation process
3. Communicate the expected progress plan to Mitch’s coaches and family
   
   • Fosters a collaborative environment

Question 9

Mitch the pitcher

• 17 year old baseball player & year 12 student
• Presents with acute onset pain in medial right elbow, which occurred during early pre-season training
• Right-handed thrower/ pitcher
• You diagnose him with a grade 2 MCL sprain

What are 6 features of Phase 1?

Answer 9

1. Rest from throwing for 2-3 months - depends on individual healing
2. Anti-inflammatories may impede healing
3. Ice 10 mins, 4x a day
4. Splint to limit ROM especially at night
5. ROM exercises: Wrist flexion & pronation (promote realignment of
6. collagen fibres)
   
   • Need full pain-free AROM before phase 2

Question 10

Mitch the pitcher

• 17 year old baseball player & year 12 student
• Presents with acute onset pain in medial right elbow, which occurred during early pre-season training
• Right-handed thrower/ pitcher
• You diagnose him with a grade 2 MCL sprain

What are 4 features of Phase 2?

Answer 10

1. Strengthen wrist flexors & pronators (improve medial elbow stability)
2. Hypertrophy: 2-3 sets, 8-12 reps, 60-75 sec rest, 70-90% RM, slow on eccentric
   
   • Can progress load, reps, isometric > concentric > eccentric
3. Progressive strengthening of shoulder & elbow muscles
   
   • General strength > functional strength > eccentric control
   • Single plane movements > multi-plane/functional movements
4. If period of immobilisation/inactivity, or if injured due to scapula, then must consider scapula

Question 11

Mitch the pitcher

• 17 year old baseball player & year 12 student
• Presents with acute onset pain in medial right elbow, which occurred during early pre-season training
• Right-handed thrower/ pitcher
• You diagnose him with a grade 2 MCL sprain

What are 10 Thrower’s exercises of Phase 2?

Answer 11

Question 12

Mitch the pitcher

• 17 year old baseball player & year 12 student
• Presents with acute onset pain in medial right elbow, which occurred during early pre-season training
• Right-handed thrower/ pitcher
• You diagnose him with a grade 2 MCL sprain

What are 4 features for Phase 3?

Answer 12

1. Strength training: Complex positions and movements
2. Power: 3-4 sets, 8-12 reps, 45-60 sec rest, 40-60% RM, explosive
3. Incorporate the whole kinetic chain (e.g. trunk rotation)
4. Gradual return to throwing ~3 months. Can start when minimal pain, full ROM, adequate strength.

Question 13

Mitch the pitcher

• 17 year old baseball player & year 12 student
• Presents with acute onset pain in medial right elbow, which occurred during early pre-season training
• Right-handed thrower/ pitcher
• You diagnose him with a grade 2 MCL sprain

What are 4 features of interval sport program for Phase 3?

Answer 13

1. 4-6 weeks
2. Start with short distance throwing + long rest + low reps
3. Go back a step if pain occurs
4. Progress to throwing off the mound (step 15) when pain-free

Question 14

Mitch the pitcher

• 17 year old baseball player & year 12 student
• Presents with acute onset pain in medial right elbow, which occurred during early pre-season training
• Right-handed thrower/ pitcher
• You diagnose him with a grade 2 MCL sprain

What are 2 features of interval sport program for Phase 4?

Answer 14

1. Continue to build power and endurance
2. Repetition of new throwing mechanics