Rehabilitation After Sports Injuries

Sports-related injuries (SRI) is a term that refers to diffuse injuries sustained during recreational activity. This often includes acute injuries to the musculoskeletal system. However, the term is not all-inclusive and can often include injuries seen in chronic degenerative pathologies and overuse conditions. When evaluating SRIs, attention must be paid to the history and mechanism of injury alongside physical and functional examination to ascertain the severity of the damage. There are many causes and types of SRI. This article will discuss rehabilitation management principles for SRI.

Rehabilitation after SRI is viewed as a three-stage model encompassing the acute/onset stage, the recovery stage, and finally, the return to previous activity level. The duration of each stage varies by injury severity, initial management needs as well as expected recovery needs. The acute phase typically lasts from 24-72 hours. During this time, the injured tissue is allowed time to heal with a reduction of pain and improvement of range of motion. Specific movement precautions are noted by the assessing/intervening medical team and are conveyed to the patient. Supportive medical devices are fabricated and dispensed if needed. The management of mnemonic PRICE (protection, rest, ice, compression, and elevation) is often employed. Medications, injections, manual therapy, and physical modalities are also used. Specific therapies are aimed toward mobilization of fluid, reduce pain, and improve range of motion within the precautions instated.

The recovery stage follows and is often the longest aspect of rehabilitation. Therapies are directed toward the restoration of strength, endurance, range of motion, and function. Pain reduction is less of a goal and participation in the rehabilitation process is encouraged to maximize gains. Tissue healing still occurs in this stage and will determine the types of treatments recommended. Treatment is directed by a medical professional (e.g., sports medicine physician) through coordination with physical and occupational therapists. Therapies start initially in the passive category and then transition to active treatments. Strength exercises advance from isometric to isotonic; exercises start in closed-chain to protect the injured segment before advancing to open-chain exercises. Emphasis is placed on correcting erroneous movement patterns rather than creating new movement patterns.

The final phase of rehabilitation after SRI is maintenance and progression towards a recovery of the previous activity level. During this stage, treatment is focused on addressing remaining functional movement and kinetic chain abnormalities. Strength, balance, power, endurance, and range of motion are addressed further in this stage with an emphasis placed on proper technique and reintroducing pre-injury activities. Example activities can include modified sport-specific drills, including sports practice. Full return to activity is achieved when the activity can be repeatedly performed without pain and when there is an acceptable level of strength, flexibility, strength, and proprioception. Termination of this phase often becomes the patient’s “maintenance program.”

SRI are often seen as pathologies of the musculoskeletal system that occur after acute, chronic or overuse injuries in recreational activity. Key to assessing SRIs are obtaining a thorough history and mechanism of injury as well as examination of the damaged area to determine severity. Initial assessment and management will guide the resulting rehabilitation process. There are three phases of rehabilitation with goals directed towards the return to prior activity level. It is important to note that SRI encompasses a wide variety of pathologies. The above discussion serves as an overall rehabilitation structure, but specific management of each phase should be under the coordinated care of medical and rehabilitation professionals.

References

1. Kibler, WV, Herring, SA, Press, JM et al: Functional rehabilitation of sports and musculoskeletal injuries. Aspen, 2005, Pro-Ed.
2. McMullen, J, Uhl, TL: A kinetic chain approach for shoulder rehabilitation. J Athl Train 35(3): 327-337, 2000.
3. Frontera, WR, Micheli, LJ, Herring, SA, et al: Clinical sports medicine: medical management and rehabilitation. Philadelphia, 2007, Saunders/Elsevier.
4. Braddom, RL, Chan, L, Harrast, MA: Physical medicine and rehabilitation. Philadelphia, 2011: Saunders/Elsevier.