SPORTS REHABILITATION

tion of oedema with focal compression than with uniform compression. An example of focal compression of the ankle can be seen in figure 1.

The reduction in sensorimotor control resulting from tissue damage, swelling and pain can be further compounded by periods of prolonged immobilisation. A number of authors have observed a reduction in motor cortex activity, increased muscle inhibition and reduced proprioception following joint immobilisation, which when considered in addition to mechanical consequences of immobilisation such as increased muscle wasting, weakening of ligament insertion sites and increased capsular stiffness, it is recommended that controlled mobilisation of the affected area is commenced as soon as possible.

Early controlled mobilisation can increase ligament strength and collagen content as well as minimising the reduction in neuromuscular function outlined above. One way in which early mobilisation can be successfully achieved is through the use of cryokinetics, which involves the application of ice to the affected tissues while gentle therapeutic exercises are

TABLE 1: SPORT – TENNIS Injury

Traumatic shoulder

injury affecting joint capsule

Muscle inhibition- scapular stabilisers

Capsular contraction Muscle wasting

Altered recruitment patterns

Reduced joint ROM Muscle weakness

Reduced microcirculation Reduced muscular endurance

www.sportex.net Motor control training

ROM Enhancement Strengthening

Upper limb endurance training

2

3 4 5

Impairment

performed. The application of ice results in the dis-inhibition of muscle activity with a concomitant reduction in pain and swelling (8-10).

In contrast to common perceptions, the application of ice during rehabilitation has been shown to have no adverse effect on joint positional sense, sensory perception (11-13), agility (14), balance (15), muscle strength endurance (16, 17) or ground reaction force (18).

Once pain and swelling are under control and there has been adequate tissue healing to tolerate progressive loading, rehabilita- tion may be progressed. Functional biome- chanical deficits such as muscle weakness, reduced range of motion, scar tissue formation and reduced sensorimotor control, all of which result in altered movement patterns and reduced performance, should be addressed. At this stage the physiotherapist must also give some consideration to the relative impor- tance of elements such as flexibility, strength,power and aerobic fitness to the athlete's given sport.

Traditionally functional rehabilitation of Functional deficit

the injured athlete has been described in terms of interventions during the acute phase, recovery phase and functional/ sport-specific phase. While this model is extremely useful in helping the therapist to prioritise interventions over time, it should be recognised that rehabilitation is a dynamic continuum during which the nature and difficulty of exercises are pro- gressed in response to tissue healing and the functional abilities of the athlete.

As a result, the content and progression of a rehabilitation programme may vary sig- nificantly between athletes. For example, it may be necessary to place particular emphasis on motor control stability training with one athlete throughout the duration of rehabilitation whereas another athlete may only require minimal input in this area but need more work on strength training. Therefore, it may be beneficial to consider rehabilitation in terms of the appropriate integration and progression of the following five broad categories: ■ sensorimotor training ■ motor control stability training ■ strength training ■ range of motion (ROM) enhancement ■ fitness/endurance training.

Reduced afferent input Reduced positional sense Sensorimotor training

Proposed intervention Relative importance 1

11