CSCS Study Guide Chapter 22: Rehabilitation and Reconditioning

Chapter 22 of the Essentials of Strength Training and Conditioning covers rehabilitation and recovery from injury. What is too much too soon? This study chapter answers this and other strength training questions for the CSCS exam.

Chapter 22 of the Essentials of Strength Training and Conditioning is about rehabilitation and reconditioning from injury.

There are distinct requirements for each of the three phases in healing. The sports medicine team should be very communicative in making decisions that primarily focus on the needs and concerns of the athlete.

Rehabilitation and Reconditioning

  • The strength and conditioning professional plays a unique role in the final stages of a rehabilitation program designed to return athletes to competition from injury.
  • The goal of this chapter is to explain the physiological events that follow an injury to allow the strength and conditioning professional to set optimal goals and improve outcomes.

Sports Medicine Team

  • The sports medicine team provides healthcare to athletes. Their primary focus is on the needs and concerns of the athlete.
  • Team Physician - typically a medical doctor or a doctor of osteopathy, the team physician provides medical care to an organization, school or team. Not responsible for rehab but, often makes the final decision on whether an athlete is ready to return to competition.
  • Athletic Trainer - responsible for the day-to-day health of the athlete. Responsibilities mainly include evaluating injuries, providing injured athletes with exercises that help the rehabilitation process, treating injuries, administering the sports medicine team and the application of prophylactic equipment including tape and braces.
  • Physical Therapist - highly educated. An orthopedic or sports medicine specialist that can play a valuable role in reducing pain and restoring function to athletes using an individualized plan.
  • Physiotherapist - another term for physical therapist.
  • Strength and Conditioning Professional - tasked with improving the strength, power, endurance and athletic performance of the athlete. In the sports medicine team, uses an understanding of proper technique and several types of exercise to develop a plan aimed at reconditioning the athlete for a return to sport. May possess advanced knowledge of biomechanics that may allow the suggestion exercises for advanced rehabilitation and reconditioning.
  • Exercise Physiologist - someone with an intimate knowledge of the bodies metabolic response to training and ways that reaction aids the healing process.
  • Nutritionist - someone who may possess a background in sport nutrition, ideally a registered dietician. Can provide guidelines for food choices that help optimize the body's tissue healing response.
  • Counselor - a person who gives advice or guidance on personal, psychological or social problems. May help an athlete mentally recover from injury.
  • Psychologist - an expert in psychology, the study of mental process and behavior. May help diagnose and treat emotional and behavioral problems stemming from injury by using talking as a form of therapy.
  • Psychiatrist - a trained medical doctor that can prescribe medication, like a psychologist can use psychotherapy to diagnose and treat emotional and behavioral problems.
  • Communication is important as an athlete may disclose different details or injuries to different professionals on the sports medicine team or even the coaching staff.
  • Indication - a condition that makes a form of treatment necessary for the rehabbing athlete.
  • Contraindication - an activity or practice that is inadvisable during rehab from a particular injury.

Types of Injury

  • Macrotrauma - injuries from a specific single traumatic event.
  • Dislocation - injury caused when the normal position of a joint is disturbed, a complete displacement.
  • Subluxation - partial dislocation or displacement of a joint or organ.
  • Sprain - an injury to a ligament. Can range from a first degree partial tear without joint instability or complete tear with full joint instability.
  • Contusion - a region of injured tissue where blood capillaries have been rupture causing a bruise to appear. Direct trauma to the area.
  • Strains - tearing of muscle fibers or the tendons that attach muscle to bone. Can range from first degree partial tearing to a complete third degree tear.
  • Microtrauma - an overuse injury from repeated stress.
  • Tendinitis - an inflammation of a tendon, a result of overuse.

Tissue Healing

  • Inflammation - the initial necessary response to injury.
  • Inflammatory Response - pain, swelling and redness present themselves. Redness is a result of changes in vascularity, blood flow and the permeability of capillaries in the area. Swelling is caused by excess fluid surrounding the area. Pain may result from the inflammatory substances present during the healing phase.
  • Edema - the medical term for swelling.
  • Repair - restoring tissue structure and function following injury.
  • Fibroblastic Repair - scar tissue is formed and collagen fibers are deposited along the injured tissue to serve as the framework for regeneration.
  • Maturation-Remodeling - during this phase, weakened tissue produced by the body during the repair phase is strengthened. Strength improves but, the tissue is not as strong as the tissue it replaced.
  • Remodeling - the reorganization of existing tissues after the repair phase.

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Goals of Rehabilitation and Reconditioning

  • Each athlete heals differently so, plans must be individualized. The athlete should hit certain sports medicine team established objectives before being progressed during healing. Healing tissue should not be overstressed but, tissue must be stressed in order to optimize collagen matrix formation.
  • Inflammation is a necessary part of the healing process but, it is also important that this be managed so that it will not postpone the restoration process. The goals of exercise in this phase are maximal protection of the injured area and assuming this is met, general aerobic and anaerobic training of the uninjured areas.
  • Physical Agents-treatment modalities including ultrasound, hydrotherapy, ice, compression, elevation, electrical stimulation, traction, electromagnetic radiation and thermal agents. Results on success have been mixed with these modalities.
  • The treatment goal during the fibroblastic repair phase is to prevent excessive atrophy of the injured area. Low stress must be applied to prevent loss of joint motion but, stress cannot be too high as this will cause disruption.
  • Neuromuscular Control-the ability of muscles to maintain joint stability in response to sensory neurons.
  • Proprioception-the unconscious perception of movement in space. After injury these are often impaired.
  • The primary goal during the maturation-remodeling phase is to optimize tissue function while returning to play. The athlete can be tempted to try and do "too much too soon" as there may not be any more pain but, tissues are not fully healed.
  • Closed Kinetic Chain-exercises where one joint is fixed in position in space and cannot move like the feet in the squat. Provide several advantages including increased joint stability and functional movement patterns during sport activity.
  • Open Kinetic Chain-exercises where the hand, foot or terminal joint is free to move in space. These exercises often allow more concentration on an isolated joint or muscle.
  • Activities can be both open and closed kinetic chain at different points. For example the foot in the sprint can be closed when in contact with the ground but, open when traveling through the air.

Program Design

  • There are resistance training programs designed for recovering from injuries but, they often do not incorporate sport-specific program design variables.
  • Daily Adjustable Progressive Resistance Exercise (DAPRE)-a system developed by Kenneth Lee Knight. Four sets of varying repetitions are used with as few as 1 being accomplished in the final set.
    • The first set is performed at 10 reps of 50% of the estimated 1RM.
    • The second set is 6 reps at 75% of the estimated 1RM.
    • The third set is the maximum number of reps that can be accomplished at 100%. This third sets provides adjustments to the load that is used in the fourth. 0-2 reps result in a 5-10lb decrease. 3-4 reps result in a 0-5lb decrease. 5-6 reps result in the resistance remaining unchanged. 7-10 reps result in a 5-10lb increase. 11 reps result in a 10-15lb increase.
    • This protocol has been shown to be effective for strengthening but, might not be appropriate for athletes in various sports.
  • There is not an optimal aerobic training program for a rehabilitative setting developed but, the strength and conditioning professional can design one based on the specific demands of the sport. This program should be designed with contraindications in mind.
  • Exercise that targets the uninjured limb can improve strength in the injured area. This has been termed cross education, or the cross-training effect.

Reducing Risk of Injury and Reinjury

  • Research findings can be implemented to reduce risk for injury and reinjury. Structured programs for this are often sports specific.
  • Previous injury is one of the most considerable risk factors for future injury. Others risk factors include decreased range of motion, a change in normal resting or active position of a joint, decreased strength and decreased neuromuscular control during specific sport activity.
  • A side-to-side difference in strength and function performance of less than 10% may be deemed acceptable.

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Steven Mack is founder and a Certified Strength and Conditioning Specialist at the private training studio, Simple Solutions Fitness. He consults for Stronger by Science, a leader in fitness research dissemination, and is a former Mizzou football walk-on. Steven dedicates his professional life to helping people through his writing, speaking, and role as a personal trainer.