Rehabilitation of the Athlete:

Transcription

1 Rehabilitation of the Athlete: Introduction to Functional Medicine Dr. Craig Liebenson The goal of rehabilitation is to restore function: In athletes this may involve specific complex exercises with the goal of enhancing performance and reducing injury risk. The new paradigm is to get behind the symptoms and find the source of biomechanical overload in the kinetic chain. Janda found that tight muscles are easier to recruit and thus are over used in everyday activity causing further muscle imbalances. Functional medicine should not focus on isolated movements. Instead it should focus on improving the quality of movement in multiple planes. When evaluating a patient, begin with a functional assessment. (Assess, Correct, Re-assess) The Continuum of Care: by Falsone Injury Care and Rehab- diagnose, pain management, reassurance, manual therapy, stabilization, and recovery (MD, DC, PT) Athletic Development- agility, balance, coordination, strength, endurance, speed, power, and motivation (DC, PT, ATC, S/C coach) Performance- technique, strategy, psychology, equipment (skill coach) Pages: 1 of 5

2 Diagnosing through Functional Evaluation: MRI s often show positive disc findings in healthy individuals. Most debilitating LBP occurs in middle-aged individuals (40-50 years) when the spine is relatively healthy and the vertebral discs are hydrated. Functional tests should follow the patient history and basic orthopedic testing. If conservative care is ineffective or there is a red flag for an underlying disease, then further diagnostic testing and imaging is warranted. Stability is Essential for today s Athlete: Power is nothing without control. A stable core is crucial for athletic movement. The brain thinks in terms of movement, not individual muscles. The musculoskeletal system is the primary machine of life. Pain should not drive care: Pain is the body s warning of disturbed function. He who treats the site of pain is lost. The goal of treatment should go beyond pain and into restoring function on a case-by-case basis. Training Shortfalls: People today often have flexion biases that can be made worse with traditional exercises. Extension exercises are more often warranted. Pages: 2 of 5

3 Every exercise should be patient specific and take into account the patient s posture and functional state to attain optimal stability, balance, and performance. Many exercises require stability in order to avoid injury. Assess stability in the knees, ankles, low back, and neck before beginning a new exercise program. Time spent in assessment will save time during treatment. Joint-by-Joint Approach: Certain areas tend to be tight (short), and some tend to be unstable (lengthened) Assess capacity, take a history, test, and then reassess to predict injury risk. Ideal exercises increase muscle activity while keeping joint load at a minimum. Power: Stability is a prerequisite to prevent injury and increase power and improve performance. When we develop faulty movement patterns we develop new motor pathways that need to be reprogrammed sub cortically. After an injury, tissues heal, and muscles adapt to protect the CNS causing guarding that outlasts the injury. Gray Cook: Assess, correct, reassess Set a movement path baseline- Assess Pages: 3 of 5

4 Locate and observe the movement problem- Prioritize Use corrective measures for the problem- Correct Revisit the baseline- reassess Functional Movement Screens: 0 - pain 1 - can t perform movement 2 - performs movement w/ compensation (imperfect) 3 - movement performed w/out compensation (perfect) o Maximum possible score = 21 o Every Exercise is a Test Pain & Asymmetry most important If in doubt give the lower score Any test w/ a 0 score (pain) requires an orthopedic evaluation Any test w/ a 1 (painless dysfunction) requires functional correction o Stabilization o Mobilization Assess-Correct-Reassess What is Goal? According to Cook, the goal is fastest to 14, not 21. According to Lewit, the goal is not to teach perfect movement patterns, but to correct the key fault that is causing the trouble. Goal: All 7 tests should achieve a score of 2 A 15 or above w/ some 3 s (& 1 s or 0 s) is worse than a 14 w/ all 2 s Pages: 4 of 5

5 When ALL tests score at least a 2 then investigate more challenging or specific functional tests Triple Flexion: Begins at 3-5 months of age and is the precursor for the squat. To increase squat performance we must stabilize the back and mobilize the hips. Hip-Hinge Perching Dowels Pages: 5 of 5