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STAGES of
INFLAMMATION and REPAIR
Acute Stage / Inflammatory Stage
Subacute Stage / Repair
Chronic stage / Remodelling
OTPT 130 : Medical Rehabilitation Lectures 2
University of the Philippines Manila , College of
Allied Medical Professions
REHABILITATION of
SOFT TISSUE and
SPORTS INJURIES
MICHAEL D . MAGPANTAY ,
PTRP
Physiotherapist
Moro – Splash Foundation Inc .,
moro Sports Clinic
SPORTS MEDICINE TEAM
Family physician
Physiotherapist
Sports physician
Massage therapist
Orthopedic surgeon
Radiologist
Podiatrist
Dietician / Nutritionist
Psychologist
Sports Trainer / Athletic Trainer
Other professionals such as
Occupational Therapist, orthotist
and nurses
Coach
SPORTS MEDICINE TEAM
There may be a
considerable amount
of overlap between the
different practitioner
“Multiskilling” is
particularly important if
the practitioner is
geographically isolated
or is travelling with
sports team
SPORTS MEDICINE MODEL
Trainer
Physician Physiotherapist / OT
Psychologist Podiatrist
Others
SPORTS MEDICINE
The secret of success
is to take a broad view
of the patient and his or
her problem
Diagnosis and
treatment
SPORTS MEDICINE
Diagnosis
History, physical
examination and
investigation
SPORTS MEDICINE
Treatment
Treatment of presenting
injury and treatment to
correct the cause
Combination of different
forms of treatment will
usually give the best result
Evaluate effectiveness of
treatment constantly
SPORTS MEDICINE
Meeting Individual Needs
It is essential to know
and love the sport
It is essential to be on
site
SPORTS INJURY REHABILITATION
Primary goal is to enable the
athlete to return to sports with
full function in the shortest
possible time
Inadequate rehabilitation
Prone to reinjury of the
affected area
Incapable of performing at
pre-injury standard
Predisposed to injuring other
part of the body
SPORTS INJURY REHABILITATION
Keys to a successful rehabilitation
Explanation
Provide precise prescription
Make the most of the available
facilities
Begin as soon as possible
SPORTS INJURY REHABILITATION
Components of Rehabilitation
Muscle conditioning
Flexibility
Neuromuscular control,
balance and propriception
Functional exercises
Sports skills
Correction of abnormal
biomechanics
Maintence of CV fitness
Psychology
Return to
Sport
Skill Aquisition
Proprio-
Strength Flexibility
ception
Motor Re-education
and
Muscle Activation
SOFT TISSUES LESIONS
(Mechanism of Injury or Onset of Symptoms)
ARTICULAR CARTILAGE
JOINT
MUSCLE
TENDON
BURSA
BONE
Acute Injuries Overuse Injuries
Fracture Stress Fracture
‘Bone Strain’,
‘Stress Reaction’
Perisosteal Ostitis,
Contusion Periostitis
Apophysitis
ARTICULAR CARTILAGE
Acute Injuries Overuse Injuries
Osteochondral / Chondropathy
Chondral Softening
Fractures Fibrilation
Fissuring
Chondromalacia
Minor
Osteochondral
Injury
JOINT
Acute Injuries Overuse Injuries
Dislocation Synovitis
Sublaxation Osteoarthritis
LIGAMENT
Acute Injuries Overuse Injuries
Sprain / Tear Inflammation
MUSCLE
Acute Injuries Overuse Injuries
Strain / Tear Chronic Compartment
Syndrome
Contusion Delayed Onset
Muscle Syndrome
Cramp Focal Tissue
Thickening /
Fibrosis
Acute Compartment
Syndrome
TENDON
Acute Injuries Overuse Injuries
Tear Tendinopathy
BURSA
Acute Injuries Overuse Injuries
Traumatic Bursitis
Bursitis
JOINT
Dislocation / Sublaxation
Management:
Protection Phase
Restore Functional
Control
Return to maximum
function
LIGAMENT
Sprain
Ankle – Anterior
Talo Fibular
Ligament
Inversion
LIGAMENT
Sprain
Ottawa Ankle Rules
LIGAMENT
Ankle Sprain
Management:
Protection Phase
Educate the Patient
Decrease Inflammation
Use Gentle Joint Mob to maintain joint
integrity
LIGAMENT
Ankle Sprain
Management:
Management:
Management:
Protection Phase
Educate the Patient
Decrease Inflammation
Meniscectomy
Management:
Management:
• Chronic Inflammation
• repetitious movements over a prolonged period of
time originating from the body part results in micro-
trauma of the area
• Pain is the primary
Manifestation
•Characterized by increased
collagen production and
resorption of mature collagen
•Efforts to stretch the inflamed
tissue perpetuate the irritation
•
Tendinopathy
Tennis elbow
Typical Movements Typical Job Activities
flexion and extension small parts assembly
meat cutting
playing tennis
bowling
Golfers Elbow
•Rare
•
Tendinopathy
Tennis Elbow
Golfers Elbow
•
Tendinopathy
• Tennis and Golfers Elbow
• Treatment is consistent with stages
• Ergonomic modifications
Tendinopathy
De Quervains Disease
• Stenosing tenosynovitis
• APL and EPB tendon
•
•
Tendinopathy
De Quervain’s
Typical Movements Typical Job Activities
combined forceful gripping and sawing
hand twisting use of pliers
a motorcycle
inserting screws in holes
• Control of inflammation
• Focus on non-stressful activities /
non-stressful intensities
Subacute and Chronic
• Pallative treatment
Tendinopathy
ITB tendinitis
• ITB Friction syndrome
• Pain at insertion (Gerdys
Tubercle)
• Treatment
consistent with stages
Tendinopathy
Patellar Tendinitis
• “Jumpers knee”
• Inferior pole of the patella
Sinding Larsen Johansson
• Osteochondritis of proximal
attachment
Osteochondritis Dissecans
•
Tendinopathy
Tib Post
• Pain in the navicular bone
• Resisted ankle inversion
Achilles tendinitis
• Pain in calcaneus
• Plantarflexion
Plantar fasciitis
Tib Post
Achilles
Tendinitis
Plantar
Fasciitis
Bursitis
Subacromial /
Ischiogluteal bursitis Subdeltoid bursae
“Weavers bottom”
Superficial infrapatellar
bursitis Pes anserine bursitis
“Nun’s Knee”
Bursitis
• Clinical Feature
• Pain present in all motions
• Leads to secondary complications
(wekaness, LOM)
• Continued use willl lead to erosion,
rupture, adhesive pericapsulitis
ACHILLES TENDON REPAIR
Athletes in 30s or 40s
Location of rupture is
associated with the
“watershed” area.
ACHILLES TENDON REPAIR
Rehabilitation Guidelines: Maximum Protection Phase