विवरण
The field of sports physiotherapy, sports medicine, and orthopedic surgery has evolved into one where rehabilitation following sports injuries is handled by specialists. A cause for worry is the shifting nature of sports-related injuries and the dearth of facilities for rehabilitation in many parts of India. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding.
सारांश
- The speaker emphasizes the importance of understanding the specific sport an athlete engages in to build trust and rapport, enabling a more effective treatment plan. Understanding the athlete's goals, ambitions, competitive level, team position, and emotional/financial support systems are key to tailoring an individual approach.
- A thorough subjective assessment, or interview, is critical to identifying the cause of the problem, not just the site of the pain. This includes understanding the mechanism of injury, loading history, pain distribution, presence of hypermobility/instability, and potential yellow flags (psychosocial factors). Special questions regarding medications (quinolones, antidepressants) and comorbidities (diabetes, COPD) are vital.
- Objective testing should be minimized, focusing on understanding the value of each test and its relevance to the athlete's functional limitations. Observing the athlete's movement patterns, posture, and assessing hyper/hypomobility are essential. Dynamic loading tests are crucial for persistent or recurrent injuries to identify the source of the problem.
- Postural overload is highlighted, emphasizing that osteos rightis is a normal response to abnormal loading. Various examples of postural dysfunctions and their potential impact on different areas of the body are discussed, stressing the need to normalize posture and load distribution. Maintaining proper knee alignment during functional movements is crucial for preventing injuries.
- Clinical reasoning is essential to develop a working hypothesis and plan a tailored rehabilitation program. There is no one-size-fits-all approach; each athlete requires a prescriptive management plan that considers pre-season, in-season, or post-season needs. In-season management may involve damage control using azimetric exercises for analgesia and symptom control.
- The rehabilitation process is broken down into early, intermediate, and late stages. Early rehabilitation focuses on protecting damaged tissues, pain relief, reducing swelling, and introducing isometric contractions. Intermediate rehabilitation incorporates neuroplastic training, flexibility exercises, strengthening endurance training, and balance/proprioception exercises.
- Late rehabilitation aims to return the athlete to pre-injury condition and sport-specific activities, focusing on power, functional loading patterns, agility, and replicating the fatigue of competition. This stage involves more formal functional loading and high-load exercises.
- Exercise compliance can be improved by limiting programs to 4-6 exercises per day and 15-20 minutes in duration. For tendon injuries, avoid compressive or tensile loading initially. Pain should be used as a guide, allowing for a 1-2/10 pain level in the upper quarter and 4/10 in the lower quarter, provided there is no increased pain after 24 hours. The loading program should progress from stabilization to strength and then power.
- Isometrics are an often overlooked and underutilized tool for reducing pain. Athletes should concentrate during exercises, not be distracted by TV. Avoid splinting and guarding and encourage movement within limits. Open communication and patient involvement in decision-making are important.
- The speaker emphasizes that practice doesn't make perfect, practicing perfectly makes perfect. They encourage educating, reassuring, and empowering athletes, as well as collaborating with other experts in the field. Adaptability and awareness of psychosocial factors are critical, and that rehabilitation back to full competition must consider both physical and psychological elements.
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