FUNCTIONAL REHABILITATION

FIGURE 3: SIMPLIFICATION OF THE LOWER LIMB REHABILITATION PROCESS

Traditional rehabilitation

(eg. modalities, manual therapy, open kinetic chain muscle strength training, etc.)

Functional rehabilitation

(eg. closed kinetic chain muscle strength training, balance drills, plyo- metric drills, etc.)

Functional (performance) testing

(eg. sit-to-stand, step-down, jump tests, hop tests)

Discharge (eg. return-to-work, return-to-sport)

Functional testing is defined as quantitative measurement of the ability of the lower limb to produce force, absorb force, and sta- bilise in a CKC. Such tests include the maximum distance achieved for a vertical jump, the ability to eccentrically control a landing from a single hop for distance, and total time to maintain a sin- gle leg 1/4 squat, respectively. It is important to remember that functional testing is performed throughout the entire functional rehabilitation process (9,16,18), and is often employed to deter- mine whether a patient is able to safely move from one stage of the functional progression to another (9,16,18).

CONCEPTS UNDERLYING LOWER LIMB FUNCTIONAL REHABILITATION Several concepts underlie the functional rehabilitation process. These concepts relate to the unique ability of the human body to adapt to the nature of the activity imposed upon it, and include (16): Wolff’s law, Davis’ law, sensorimotor control, and the speci-

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ficity of muscle training. Collectively these concepts can be referred to as the ‘SAID principle’ (19), which is an acronym for ‘specific adaptation to imposed demands’ (16, 19).

Wolff’s law Wolff’s law states that bone remodels according to the forces imposed upon it (20,21). Increasing the force transmitted through bone (eg. weight-bearing, exercise) causes it to increase its density and mechanical ‘strength’, whereas decreasing the force transmitted through bone (eg. immobilisation, bed-rest) causes it to decrease its density and mechanical strength (20,21). A principle of Wolff’s law is the ‘specificity’ principle (20). This states that the effect of exercise on bone density is site-specific (20) - to increase the density of a specific bone site (eg. neck of femur) controlled force must be imposed on that bone site by weight-bearing or the action of muscles which cross it (20). For example, axial loading of bone, which occurs with CKC exercise

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