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Injury Rehab With Resistance Bands Complete Ana... [UPDATED]

Our Certified Trainer works with patients to strengthen weak areas that pose the threat of current of future injury. Lasting 30 minutes, personal training sessions are to show how to properly exercise problem areas. Working with the doctor, We will develop a customized exercise program that incorporates strengthening with resistance bands, foam rolling, exercise balls, and body weight.

Injury Rehab with Resistance Bands Complete Ana...

A committee of international knee experts created the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), which is a knee-specific, rather than a disease-specific, measure of symptoms, function, and sports activity. IKDC-SKF is a reliable and valid knee-specific measure of symptoms, function, and sports activity that is appropriate for patients with a wide variety of knee problems. Outcome is related to the severity of the injury and the functional rehabilitation possible.[16]

The first three grades are the same as for every ligament injury. Grade I is sprained, grade II is a partial tear, grade III is a complete tear of the ligament. Some surgeons describe a grade four injury, also called a medial column injury, to the MCL. It occurs when the injury affects more than just the medial collateral ligament (MCL) and may require surgery. Injuries commonly seen in combination with medial collateral ligament injuries are anterior cruciate ligament (ACL) injuries, bone bruises, lateral collateral ligament injuries (LCL), lateral and medial meniscus tears but also posterior cruciate ligament injuries (PCL). ACL disruptions are most commonly associated with high =-grade MCL tears.

Most of the isolated grade III injuries are based at the femoral site, and do not require surgery. An important test to see if surgery is needed is to see whether the posterior oblique ligament (POL) and posterior capsule are damaged. Surgery also should be considered when the pes anserinus tendons are damaged. Situations with injury over the whole length of the superficial layer are a complete injury of both the superficial and deep MCL from the tibia are typical injuries that are better treated with an operation. Grade III injuries that are unstable in 0-degree extension do also fall into the category where an operation is recommended[3][21]. In addition, we should note that a surgical reconstruction is recommended for isolated symptomatic chronic medial-sided knee injuries[3].

The treatment of a medial collateral ligament injury rarely requires surgical intervention. The extracapsular, the medial collateral ligament, appear to have a fairly robust potential to healing[8]. In cases where instability exists after nonoperative treatment, or instances of persistent instability after ACL and/or PCL reconstruction, the MCL tear may be addresses through surgical repair or reconstruction[23]. The most isolated MCL injuries are successfully treated non-operatively with bracing or immobilization. Some simple treatment steps, together with rehabilitation, will allow patients to return to their previous level of activity. The most treatment protocols focusing on early range of motion, reducing swelling, protected weight bearing, progression toward strengthening and stability exercises. The general goal is to have an athlete or patient return to full activities[21].

For a grade II/III injury-treatment it is important that the ends of the ligament are protected and left to heal without continually being disrupted. One should avoid applying significant stresses to the healing structures until three to four weeks after the injury to ensure that the injury can heal properly. The treatment for grade III injuries depends on whether the injury is isolated or combined with other ligamentous injuries[21]. For a grade III medial knee injury combined with another injury, for example, an ACL tear, the general protocol is the rehabilitation of the medial knee injury first so it can allow healing according to the guidelines for an isolated medial knee injury. When there is good clinical and/or objective evidence of healing of the medial knee injury, mostly 5 to 7 weeks after the injury, the reconstruction of the ACL can begin.[21] .

A medial collateral ligament (MCL) injury is a stretch, partial tear, or complete tear of the ligament on the inside of the knee. A valgus trauma or external tibia rotation are the causes of this injury. This injury is categorized in 3 grades: I, II and III. The category depends on the degree of pain or degradation of the knee joint. The therapist can use the valgus stress test to see if the diagnosis is correct. There are several rehabilitation methods for an MCL injury, rest is the most important though. While resting, the MCL has time to recover. There are other rehabilitation techniques as well, like patellar/soft tissue mobilizations and frictional massage, gait training, cold therapy etc. In rare situations, surgical intervention is necessary.

When it comes to strength training, your injury or disability may limit your use of free weights and resistance bands, or may just mean you have to reduce the weight or level of resistance. Consult with your doctor or physical therapist for safe ways to work around the injury or disability, and make use of exercise machines in a gym or health club, especially those that focus on the lower body.

After rest and activity modification recommendations have been initiated and symptoms have been reduced (and possibly eliminated), an attempt at rehabilitation can be initiated. Physiological deficits and/or impairments (strength, flexibility, endurance, etc.) identified on physical examination may be addressed; however, a progressive program should be employed. This often begins with increasing mobility to assure the scapula and humerus move fluidly throughout arm motion (Figures 2-Figures 6). Next, avoiding maneuvers that will excessively load, stress, or move the compromised AC joint is recommended. This can be achieved using short-lever exercises that can be performed with the arms in an adducted position (i.e., the arms positioned against the thorax) (Figures 7-Figures 9) rather than positions that require the arms to be in the forward elevated or abducted positions (i.e., long-lever exercises). Examples of exercises and the rationale for their use have been provided in Table 3. Although short lever by design, maneuvers such as scapular shrugging or elevation and scapular proprioceptive neuromuscular facilitation should be avoided in the first two phases of rehabilitation (approximately the first 3-6 weeks) because of the excessive movement and stress that occurs at the AC joint during their performance. Once the patient has demonstrated that the initial exercises can be performed without exacerbating the previous symptoms, progression into more dynamic motions that require some degree of arm elevation or abduction (approximately 30-45) may be added to the treatment progression (see short-lever and long-lever intervention examples in Table 2) (Figures 10-Figures 11). The authors suggest patients be provided an exercise regimen that begins with 1-2 sets of 5-10 repetitions with no external resistance. Additional sets and repetitions can be added based on symptoms and exercise tolerance, with a goal of 5-6 sets of 10 repetitions being able to be performed without an increase in symptoms.

Resistance may be added next beginning with light free weights (2-3 pounds maximum) and then progressing to elastic resistance. Although effective at increasing scapular muscle activity103, elastic resistance has high variability when used by patients, especially when arm position is progressed throughout a treatment program.104 Elastic resistance can be monitored and progressed when using perceived exertion scales105; however, the authors recommend beginning with free weights as those devices allow for more stability and fulfillment of isotonic contractions. Longer lever maneuvers can then be incorporated into the treatment program in the later phases of rehabilitation but only when the previous maneuvers have been mastered by the patient and have demonstrated little to no symptom exacerbation (Figures 11a-11h).

It is important to appreciate that the moderate to high degree of AC joint instability that is often associated with traumatic high-grade injuries may not achieve complete symptom resolution with rehabilitation. Muscle optimization has a ceiling effect, as the loss of skeletal stability of the scapula and clavicle and the resulting alteration of optimal SHR can be an obstacle too difficult to overcome with conservative measures. The likelihood of regaining higher degrees of function is greater in cases where only one set of ligaments has been compromised (Rockwood/ISAKOS Types I-IIIA) rather than both sets of ligaments (Rockwood/ISAKOS Types IIIB-V),1 yet it is still possible to have lingering symptoms with all types of low-grade and high-grade injuries. This confounding concern should be discussed with patients prior to initiating a conservative treatment program.

One of the challenges with rehabilitating the upper extremity following injury is selecting interventions that optimally prepare the patient for return-to-activity. Progression of the treatment plan for AC joint injury to higher-level/demanding exercises can be difficult due to: 1) the anatomical disruption has not been restored following supervised treatment, 2) AC joint injuries primarily occur via traumatic mechanisms and despite best efforts to prepare individuals for the risks of physical activity, traumatic events cannot be completely prevented, and 3) the literature being void of empirical studies that provide a detailed therapeutic approach and a summation of the results of that approach for its effectiveness for returning patients to activity following AC joint injury. The existing return-to-activity literature has mostly focused on the rate of return following surgical intervention with a recent meta-analysis on the topic identifying a 94% return for a variety of sports for patients who sustained a Rockwood Type III or higher injury.106 However, the authors noted that methodological heterogeneity resulted in low quality evidence for the studies retained in their review. Two recent reports centered on nonoperatively managed AC joint injury noted return-to-activity time frames ranging from three to four weeks (professional hockey players)107 and five to seven weeks (professional soccer players).108 However, the treatment details were not reported in either study and the classification of the AC injuries sustained in the soccer players was not reported.108 Due to the lack of key information surrounding treatment of the AC injuries from those works, there is a need for research aimed at identifying higher intensity sport-specific movements and exercises in athletic populations who have sustained AC joint injury. 041b061a72

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