Rehabilitation of Dislocations


Rehabilitation program for dislocations
The process of rehabilitation begins immediately after injury. The rehabilitation program will incorporate the following:
Phase 1: The acute injury phase
1. Reduce/ minimising inital swelling in dislocation. If the swelling can be controlled initialy in the acute stage of injury, the time required for the rehabilitation is likely to be significantly reduced. Once swelling has occured, the healing process is significantly retarded. The injured area cannot return to normal until swelling has gone. [ Arnheim.D/ Prentice.W, 2000].Therefore the RICER procedure will be applied to the injury to prevent further inflammation.


ricer.jpg









[ America Academy of pedeatrics, 2011]

Phase 2: The repair stage
2. Controlling the pain. This will make the athlete most comfortable, and will help catalyse the rehabilitaion process. The extent of the athlete's pain will determine the severity of the injury. Persistant pain can make strengthening and flexibility exercises more difficult and therefore interfere with the rehabilitation treatment session. The athletic trainer can modulate acute pain by using the RICER process. Also, Using appropriate theraputic modulates including various techniques of cryotherapy, thermotherapy, and electrical stimulating currents, will help modulate pain throughout the rehabilitation process[ Arnheim. D/ Prentice.W, 2000].


cryotherapy.jpgthermotherapy.jpg
^^^^^^Cryotherapy ( cold therapy); Thermotherapy (application of heat)^^^^^^
[ Adler.J,2011/Phama boutique, 2011]

Phase 3: The remodeling phase
3. Restoring range of motion. Injury to a joint will always be associated with some loss of motion. That loss can be attributed to contracture of connective tissue ( i.e. ligaments, joint capsules); resistance to stretch of the musculotendinous unit ( i.e. muscle, tendon, and fascia); or some combination of the two [ Arnheim.D / Prentice.W, 2000]. In restoring motion of a dislocation, the rehabilitation program will incorporate stretching activities mobilization techniques to improve the range of motion.

shoulder.jpg
[Intergrated Publishing, 2011]
Range of movement exercises for shoulder


4. Restoring muscular endurance, strength and power. Muscular strength is one of the most essential factors in restoring the function to re-injury status. Isometric, isotonic, isokinetic, and plyometric exercises can benefit rehabilitation. A major goal in performing strengthening exercises is for the athlete to work through a full pain-free range of motion. Progressive resistance exercises is the most commonly used strengthening technique in a reconditioning program. This exercise may be done using free weights, exercise machines, rubber tubing or manual resistance. Besides engaging in specific exercises, the athlete can practise sports skills, using the water's buoyancy and resistance to advantage. Rhythmic initiation consists of a progressive series. first of passive movement, then of active assistive movement, followed by an active movment through an agonist pattern. This approach helps athletes with limited movement progressively regain strength through the range of motion [ Arnheim. D / Prentice.W, 2000].
Picture: Below: rubber tubing, Right: Water buoyancy exercises.
rt.jpg stretches to strengthen shoulder muscles. 0910waterfitness.jpg
[ Health.com, 2011/ Aquatics International, 2011]

5. Re-establishing neuromuscular control. Neuromuscular control is the mind's attempt to teach the body concious control of a specific movement. Successful repition of a patterned movement makes its performance progressively less difficult and therefore requires less concentration; eventually the movement becomes automatic. Re-establishing neuro-muscular control requires many repetitions of the same movement throught a step-by-step progression from simple to complex movements. Strengthening exercises, particularly those that tend to be more funtional, such as closed kinetic chain exercises, are essential for re-establishing neuro-muscular control.

shoulder-external-rotation2.jpg

Example: Strengthening Shoulder rotation exercises. These strengthen muscles and tendons around joint to keep joint in place, reducing future occurences.



6. Re-gaining balance.The ability to balance and maintain postural stability is essential to an athlete who is acquiring or reacquiring complex motor skills. Athletes who show a decreased sence of balance or lack of postural stability after injury, may lack sufficient proprioceptive and kinesthetic information or muscular strength, either of which may limit the athlete's ability to generate an effective correction response to dis-equalibrium. A rehabilitation program must include functional exercises that incorporate balance and proprioceptive training to prepare the athlete for return to activity. Failiure to address balance problems may predispose the athlete to re-injury and failure [Arnheim .D / Prentice.W, 2000].

stability.jpg
[College of Education and Human Development, 2011]
Balance exercises


7. Maintaining cardio-respiratory fitness. Relatively little consideration is given toward maintaining levels of cardio-respiratory fitness. An athlete spends a considerable amount of time preparing the cardio-respiratory system to handle the increased demands made on it during a competitive season. When injury occurs, and the athlete is forced to miss training time, the levels of cardio-respiratory endurance may decrease rapidly. Thus the athletic trainer must design or substitute alternative activities that allow the individual to maintain exsisting levels of cardio-respiratory fitness during the rehabilitation period. Depending on the nature of the injury there are a number of possible activities are open to the athlete [Arnheim .D / Prentice.W, 2000]. For example, training on a stationary exercise bike.


Exercise-Bike.jpg

[ The exercise bike, 2011]
Keeping up cardiovascular fitness on exercise bike.



Issues involved in rehabilitation
- Large amount of time spent on rehabilitation, therefore it's a while until athletes can get back into their sport/ activities.
- Keeping patients on track, that undergo treatment.
- Athlete/ patient wanting to get back into viagorous activity too early, ignoring instructions of physican
- Athletes/ patients not doing exercises given.
- Hard keeping track of progress in some cases.
- Rehabilitaion may not work and surgery may need to be undertaken.
- Athlete/ patient may not get full motion back in site, and may never get the same amount of motion as before the injury.

Modern techniques, alternative treatments/ programs used by medical practitioners
The modern techniques, alternative treatments/ programs utilised today play a very significant role in catalysing the athlete's return to sport.
Cryokinetics
Cryokinetics is a technique that combines cryotherapy ( application of cold) with exercise. The goal of cryokinetics is to numb the injured part to the point of analgesia and then work toward achieving normal range of motion through progressive active exercise [ Arnheim.D / Prentice.W, 2000] . E.g Ice massage, ice packs,and cold and ice water immersion.

Vapocoolant sprays
Vapocoolant sprays are being used for treatment of musculskeletal conditions attributed to sports activity. The value of a vapocoolant spray is its availability to reduce muscle spasms and increase range of motion. It is also a major treatment for myofascial pain and trigger points. However, care must be taken to avoid frost bites
[ Arnheim.D / Prentice.W, 2000].

PNF Stretching Techniques
Proprioceptive neuromuscular facilitation (PNF) is an approach to the theraputic exercise that uses proprioceptive, cutaneous, and auditory input to produce functional improvement in motor output and can be a vital element in the rehabilitation process of many sport-related injuries[ Arnheim.D/ Prentice.W, 2000].

Aquatic therapy
Aquatic therapy incorporates stretches and exercises in a pool. It is a great rehabilitation program, as it allows for resistance with motion without load bearing [ Arnheim.D/ Prentice.W, 2000].

Mobalization and Traction
Mobilization and traction are manual therapy techniques used to improve joint mobility or to decrese joint pain by restoring accessory movements to the injured joint, which allows full, pain-free range of motion[ Arnheim.D/ Prentice.W, 2000].

Possible impact/ outcomes that dislocations have on future perfomance
The possible impacts or outcomes that dislocations may have on future performance include:
- Athlete vulnerable to re-occuring dislocations.
- Makes it harder for athlete to be selected into teams/ sports due to particular injury reoccuring.[ Caring medical.com, 2011]
- This type of injury is more complex than others and will take longer to rehabilitate, therefore it will take longer to get back into the sport /activites.
- If rehabilitaion has not been adhered to then the athlete may not have the same range of motion, and strength as they did pre-injury.


Injury Prevention and Risk Managment/ Policies Employed By Netball

Good preparation is important
  • Conduct simple fitness testing prior to competition to ensure readiness to play.
  • Undertake appropriate fitness programs to develop strength, co-ordination and flexibility, especially of muscles around the ankles and feet.
  • Seek pre-participation screening by a professional to identify potential musculo-skeletal problems that may contribute to overuse injury.
  • Warm up and stretch adequately before competition and training to ensure the body is prepared for play
Good technique and practices will help prevent injury
  • Incorporate training focusing on enhancing body balance, control on landing, moving forwards and catching passes.
  • Coaches should undergo regular re-accreditation and education updates to ensure they have the latest information about correct playing techniques.
Use appropriate equipment
  • Ensure goal posts are firmly fixed to the ground with no parts of the post protruding onto the court surface posing a trip hazard.
  • Ensure goal posts are padded.
  • Check and maintain netball surfaces regularly to eliminate hazards (e.g. loose gravel)
  • Avoid playing netball on slippery surfaces.
  • Choose footwear carefully, preferably with professional advice.
Modify rules and equipment for children
Encourage children to play Fun Net and Netta as a means of developing good skills and technique and reducing injuries.
Other safety tips
  • Encourage players to drink adequate water before and during play to prevent dehydration.
  • Encourage use of a broad spectrum sunscreen in high UV conditions and discourage play in extreme weather conditions (e.g. humid, hot or wet and slippery).
  • Ensure that there are qualified first aid personnel at all events
  • Enforce and adhere to a strict blood rule as set out by Netball Victoria.
[Sport and Recreation Victoria, 1998]