Principles of muscle rehab following acute injury
- Relative rest
- Early mobilization
- Early strengthening
Principles of muscle rehab: relative rest
- avoid tensile stress
- maintain health of uninjured tissues through other forms of PA
Principles of muscle rehab: early mobilization
- progressive, controlled ROM exercises performed in a pain free range
Purpose of early mobilization
- promote collagen deposition along usual lines of stress
- minimize risk of cross linking, adhesions or contractures
- maintain CT, joint and muscle mobility
- assist circulation
Types of early mobilization
- PROM
- AAROM
- AROM
Best practice recommendations for early mobilization
- begin with muscle in its inner range (shortened)
- slowly mobilize towards outer range (stretched)
- stop prior to pain
General principle for prescribing early mobilization
F: 3-5x /day
I: pain free
T: PROM, AAROM, AROM
V: 1-3 x 5-10 reps
P: increase volume, increase frequency, outer range
Principles of muscle rehab: early strengthening
- progressive, controlled strengthening exercises performed in a pain free range
Purpose of early strengthening
- avoid disuse muscle atrophy
- maintain bone mineralization, circulation, connective tissue tensile strength, functional activity tolerance, muscular fitness
neuromotor control - contribute to whole body adaptations
Advantages of isometrics
- develop strength in pain free position
- re-establish neuromuscular control
- minimize atrophy
- promote circulation
- may be done with or without equipment
Disadvantaged of isometrics
- strength changes are angle specific
- possible difficulty objectifying effort
- possible breath holding during exertion
- may not replicate function
Advantages of isotonics
- develops strength through full ROM
- produce large amount of force (eccentric>concentric)
- ease of objectifying effort
- contributes to whole body adaptations
Disadvantages of isotonics
- greater metabolic cost (concentric>eccentric>isometric)
- may require close supervision
- may require equipment
- risk of muscle soreness
Best practice recommendations for early strengthening for isometrics
- begin with muscle in inner range
- voluntarily tense muscle
- stop prior to pain
General exercise prescription for isometrics
F: 1-3 x/day
I: %MVC without pain
T: isometrics
V: 5- 10 reps x 5-10 s
P: increase volume, multiple angles towards outer range
Best practice recommendations for early strengthening for isotonics
- begin with endurance FIT-VP
- see chart from last week
Emerging evidence
- Criteria based rehab vs time based rehab
- Value of eccentric loading for injury prevention
