Functional Rehab

Question 1

Functional Rehab

Answer 1

• Exercises that enhance true function.
• Exercises that mimic components of real-life activity.
• Exercises that train the body part to do what it is designed to do.

Question 2

Exercise to Mimic Components of Real Life Activity

Answer 2

• What do you see at the:
  ~ Hip
  ~ Spine
  ~ Shoulder
  ~ Forearm
  ~ LE

Question 3

Not So Good Rehab vs Functional Rehab

Answer 3

• Not so good
  ~ Non-functional
  ~ Lab-like
  ~ Isolated
  ~ Gravity Confused
  ~ Boring
  ~ Back yard
  ~ Protocols
• Good
  ~ Functional
  ~ Life-like
  ~ Integrated
  ~ Gravity User
  ~ Fun
  ~ Front yard
  ~ Thinking and adapting

Question 4

Causative Cures

Answer 4

• Ultimate goal of rehab is to return the individual back to the activity that directly contributed to the injury.
  ~ A component of the rehab program
  should be the actual causative activity
  ~ “Causative Cure” describes the
  relationship, as the cause becomes a
  part of the cure
• Rehabilitation must transform the injured tissue into tissue that successfully deals with the loads and motions of the causative activity.

Question 5

Integrated Isolation

Answer 5

• Identification of the specific, injured tissues.
  ~ What joints and motions does the
  tissue decelerate, stabilize and/or
  accelerate?
  ~ With what other joints and tissues
  does it function?
• Design a program to appropriately stress tissue as part of the kinetic chain rather than stress tissues in isolation

Question 6

Integrated Isolation: Piriformis Syndrome Example

Answer 6

• What joints and motions does the tissue control?
  ~ Piriformis slows IR at the hip, during
  functional loading and speeds ER at
  the hip during functional unloading
• With what other tissues does the piriformis function?
  ~ Works with the other small hip
  rotators (obturators, gemarti,
  gluteus maximus at the hip.
  ~ Works with the core muscles to
  generate rolation and momentum in
  the transverse plane.
  ~ What about the UE?
  > depending on athlete, the UE
  needs to work with LE

Question 7

Piriformis Example

Answer 7

• According to “causative cures” what should the rehab program do?
  ~ Ask the Piriformis to help with
  functional loading and unloading at
  hip (especially in the transverse plane)
• According to “integrated isolation” how should the tissue be stressed.
  ~ By moving the hip (especially in the
  transverse plane) along with the rest
  of the lower chain as well as the core
  and UE

Question 8

Pretty Ugly Compensations

Answer 8

• Compensations during function can be “pretty” (allowing function) or “ugly” (leading to injury)
• Must determine the cause of the ugly compensation and correct it.
• Compensations can be caused by a number of factors.
  ~ Gravity - Inability to load and unload
  ~ Extrinsic Factors
  > Equipment
  > Footwear
  > Orthotic
  > Terrain
  ~ Intrinsic Factors
  > Structural
  > Connective Tissue/Muscle
  > Neurological Deficits
• Must watch people move to get a feel for the compensations present.
  ~ Determine the cause of the “ugly”
  through examination and testing and
  address it first

Question 9

Caution with Causative Cures

Answer 9

• If part of the cause is an ugly compensation then the compensation must be addressed or the cure probably will not work.
• Highly abnormal injury mechanism shouldn’t be used
• Directly bombarding injured tissues isn’t indicated if it causes pain or ugly compensation
  ~ Functional Feeding - Initially utilizing
  movements/techniques that do not
  replicate the mechanism of injury, or
  ask the involved tissues to be
  emphasized, but do stimulate the
  tissues or related systems to a
  certain degree.
  > Progression of functional
  feeding should be driven by
  symptoms and the ability to
  produce normal functional
  movements.
  > The ability to produce normal
  functional movements is
  determined through trial &
  error/functional testing.
• Use Davis’s Law

Question 10

LE Functional Profile

Answer 10

• Set of measurable tests to assess lower extremity function.
• Remember that the test is the exercice and the excereise is the test
• Rules
  ~ Test sub-maximal before maximal.
  ~ Give consistent and proper verbal
  and visual cues.
  ~ Document any modifications and
  variations to protocols.
  ~ Compare side to side and time to
  time.

Question 11

LE Functional Profile: Vectors

Answer 11

• Reference Vectors - Indicate the direction of motion.
• Vectors are referenced with respect to the lower extremity being tested.
  ~ Balance Tests - Leg doing the
  balancing.
  ~ Excursion Tests - Stance Leg
  ~ Lunge Tests - Leg doing the lunging.
  ~ Step-Up/Step-Down Tests - Leg on
  the step.
  ~ Hopping Tests - Leg Doing the
  hopping

Question 12

General Points for Functional Rehab

Answer 12

• Always incorporate classic examination techniques to confirm or refute observations of compensation.
• BE SAFE - do not undo healing or surgical repair for the sake of a test or rehab exercise.
• Functional rehabilitation is not “it” - use modalities and manual techniques to enhance performance in functional rehab
• Must keep in mind “functional feeding” relative to test results.
  ~ Ultimately, athlete must perform well
  in all vectors relative to unaffected
  side
  > Use success in alternative
  vectors to enhanced flexibility,
  strength, and NMC in the
  deficient vector
  > Move into deficient vector
  when pain and compensations
  have been minimized