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Unit 18 Assignment 4

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Harry Ferguson

on 22 January 2016

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Transcript of Unit 18 Assignment 4

Rehabilitation Program: Fractured Humerus & ACL Tear Grade 3
Phase 1 (Immediate Post Injury)
Phase one commences immediately after the injury as happened. For example, the player has just made a tackle and they've broken their Humerus. The body will start swelling around the break in order to protect it. The physio/medic will run onto the pitch and assess the injury, avoiding compressing the injury in order to avoid making the break worse. An ambulance will be called and they will be taken to hospital to get an X-ray of the break to assess how bad the damage is to the bone and the surrounding tissue.
Phase 4 (Active Rehabilitation)
Phase 4 is the Active Rehabilitation Stage. This is the point at which the injured player can start doing strengthening movements for their injury and start to re-introduce motor patterns back to the area. Phase 4 officially begins when there are no visible signs of injury such as swelling or bruising, however, the participant may still feel stiff whilst moving the body part. The main body of the rehabilitation will involves strengthening exercises for the muscles around the injury, using resistance bands instead of weights for the majority of this phase. However, as the end of this phase approaches it may be appropriate to add in some weight bearing exercises that will put minimal amounts of stress on the bone in order to strengthen it again.
Unit 18 Assignment 4
Rehabilitation Program
Fractured Humerus
A fractured Humerus is the official term for a broken bone in the upper arm, as it involves a part of the bone fracturing off or in this case, a clean break through the bone. A fractured Humerus has various signs & symptoms which include:
Pain, redness
Limited Range of Motion in the Shoulder/Arm Area
Possible change in length of arm
Obvious deformity of Upper Arm

Phase 2 (Acute)
Phase 2 will be the period in which the doctors take the x-ray and assess the damage, whilst providing the participant with pain killers to ensure that the injury isn't causing pain whilst they decide. The main idea of this phase is to protect the injury from any further damage and keep the bleeding and swelling to a minimum, so ice will be applied to the injury at different points and the doctors will continue to look at it before they do the surgery. The surgery would most likely take place the following day and for a clean break through the humerus it would need fusing together with steel plates to hold the bone together and allow for the best chance of recovery. After the surgery they would continue to ensure that the injury is supported and rested to allow for recovery.
Phase 3 (Sub-acute)
Phase 3 would start to occur 3-4 days after the surgery had taken place on the break. This phase would allow for the scar tissue to start to form on the bone and the surrounding area in an attempt to heal the injury, as well as the blood vessels around the injury being repaired after the damage of the impact that caused the break. The body would also start to remove any dead cells that have been left around the injury, by using enzymes to break them down and then remove them through the blood stream as the body normally would. By doing this, the body is on its way to healing itself and is preparing itself for Phase 4 which is wear it will start being used again.
Phase 1 will be over around 20 minutes after the injury has occurred and Phase 2 will be done 2-3 days after the Phase 1. Phase 3 will last for 3-10 days after Phase 2 whilst Phase 4 & 5 depend on the injury. For this injury, Phase 4 will last between 3-6 weeks depending on how the injury heals and whether or not the participant is doing the correct exercises and doing them enough. Phase 5 therefore, will last another 3-4 weeks as they need to re-strengthen their muscles and re-introduce the motor systems back into the limb.
Phase 5 (Functional Rehabilitation)
This is the phase that will properly re-introduce a full range of movement to the injury and will start to give psychological aid to the injured person to give them support with their progress and rebuild their confidence. As the participant has injured their arm, they are likely to need to improve their co-ordination again to bring it back up to the standard that it was at before. This phase for a broken Humerus will last from anywhere between 3-6 weeks until the injury is back to a reasonable strength level.
Physio Aids Needed for Rehabilitation
The program will need a way of providing compression and ice simultaneously so one of the ice packs that can be strapped around the arm will be extremely beneficial to the patient.
The participant will also require some strengthening aids for Phase 4 & 5, which will come in the form of resistance bands with differing strengths.
Finally, they will need supports for their arm/shoulder to make sure that the injury wont be tweaked by any of the rehabilitation methods being used in the program.
Grade 3 Anterior Cruciate Ligament Tear
Phase 1 will be over around 20 minutes after the injury has occurred and Phase 2 will be done 2-3 days after the Phase 1. Phase 3 will last for 3-10 days after Phase 2 whilst Phase 4 & 5 depend on the injury. For this injury, Phase 4 will last between 5-10 weeks depending on how the injury heals and whether or not the participant is doing the correct exercises and doing them enough. Phase 5 therefore, will last another 6-8 weeks as they need to re-strengthen the muscles around the ligament, the ligament itself and also re-introduce the old motor patterns back into the joint.
Rehabilitation Program
The injured participant will be given exercises to strengthen the fractured arm once it has healed fully during the fifth phase. These exercises will increase the strength of the muscles surrounding the bone which will help protect it and will also increase the bone density when doing weight bearing exercises. These exercises will include the following:
Lateral Raises with a resistance band - this will be conducted by standing on one end of the resistance band and raising the arm laterally until it is horizontal and then lowering it again, this will strengthen the deltoids and will allow the nearest joint to the fracture to start moving again.

The next exercise will be a normal body weight press up, as this will provide the weight bearing exercise needed to strengthen the actual bone, whilst also improving the strength of the triceps which are a surrounding muscle to the injury.

The final exercise will be a resistance band bicep curl, as this will also strengthen the surrounding muscle to the injury as well as allowing movement at the other joint near the injury and will restore the movement patterns.

The participant should try and use the exercises once or twice a day where possible and continue to use them until they are told that they can move onto more strenuous exercises by their physio or doctor. All of the exercises should be completed using a 4 sets of 8 repetitions approach, as this will provide the most work for the injury without hurting it. The resistance of the bands will increase over time, starting with the least resistance and working up to a higher resistance once they feel or have been advised to move up a resistance.
The Anterior Cruciate Ligament is one of the two ligaments inside a persons knee, which is used to connect the tibia and the femur and helps allow movement at the joint. A grade 3 tear to this ligament or the Posterior Cruciate Ligament would be detrimental to a persons ability to move and would also be excruciatingly painful for them. The signs & symptoms of the injury involve pain being experienced at the knee, instability of the joint, swelling, redness and inflammation. A grade 3 tear could be caused by a twisting the knee at the joint, over-pronation or impact injuries.
Phase 1
Phase one commences immediately after the injury as happened. For the first 24-48 Hours, RICE will be used. For example, the player has just been tackled around the knee and it has twisted unnaturally, causing the ACL to tear completely. The body will start swelling around the tear in order to protect it. The physio/medic will run onto the pitch and assess the injury and start conducting their SALTAPS and PRICED treatment. An ambulance will be called and they will be taken to hospital to get an scan of the tear to assess how bad the damage is to the ligament and decide what the best option is, which will most likely result in surgery and then rehabilitational exercises and treatments provided afterward.
Phase 2
The second phase will last for around 24-48 hours after the injury has occurred. For a ACL Tear, this is the phase that will involve the reconstructive surgery that will re-attach the ligament and before and after the surgery will mainly involve the RICE treatment. This will also be the time when the doctors will administer pain relief and limit the movement of the joint to stop any further damage being done to the ligament or joint.
Phase 3
The third phase of rehabilitation for this injury will mainly involve resting the injury, allowing the swelling to decrease and removing the debris (if there is any) from when the injury occurred. At this point they will have had surgery and this will limit what they can do, so the movement allowed will be restricted for 3-10 days after the surgery depending on what the doctors decide.
Phase 4
Phase 4 of rehabilitation for an ACL tear will be the longest phase as the idea is to re-strengthen the ligament and not the muscles, which will take longer than normal as it needs to have healed properly before it can begin to get stronger. Exercises and stretches needed for the strengthening of the ligaments will have been provided by physiotherapists, these exercise's and stretches will include moving the joint through is range of motion without pain and loosening the muscles below and above the injury to ensure the ligament will move freely. Once weight bearing exercises can be administered then all the major muscles of the leg/lower body will be strengthened (gluteus maximus, quadriceps, hamstrings, gastrocnemius and the transverus abdominis).
Phase 5
Phase 5 is used to re-strengthen the ligament that was damaged and and the muscles around it. This is because by this phase the ligament will be able to move through a pain free range of motion and will be able to take the weight of the injured person. Therefore, they will able to do weight bearing exercises that will rebuild the strength of the muscle's and ligament and this will increase the strength of the entire joint which will decrease the chances of the injury re-occurring. This stage will also allow the participant to improve their balance and co-ordination with their leg. Finally, they will also be provided with a psychological reassurance that they can and will be able to do the activities that they were taking part in before the injury, it will just take time to get back to near the level that they were at before. However, it is essential that they are given this re-assurance as it will allow them to believe that they can do it and continue trying to get back as this will give them the best chance of recovery.
Physio Aids Needed for Rehabilitation
The main physio aids that the injured participant will need are resistance bands of differing resistances and a balance board. These two bits of equipment will allow the participant the best forms of resistance whilst allowing them to perform the exercises without providing too much pressure on the injury.
Rehabilitation Program
The injured participant would be provided with exercises that would be used to strengthen the surrounding muscles and the stability of the joint/ligament.

The exercises would include doing squats on a balance board, which would allow the participant to strengthen their muscles in their leg, whilst improving their balance and training both legs at the same time.

Another exercise would be the resistance band leg extensions which would strengthen the ligament in the knee and also allow them to move the leg through a full range of motion.

A final exercise would be resistance band hamstring curls, as these allow the same range of motion at the joint and therefore strengthen the ligament and the hamstring at the same time.

For the exercises, they should all be completed by using 4 sets of 8 repetitions as this will allow the blood to flow to the area and will provide just enough resistance that the exercises will help the injury. If the intensity was higher, then a lower repetitions parameter would be used. The exercises will be completed twice a day and will be used until the doctors have approved them for moving onto more strenuous activity. The resistance bands will increase in resistance each one to two weeks to make sure that the muscles are strengthening and recovering.
Justification
The exercises selected were probably the best exercises to use for the program as they all allow a full range of motion at the joint and therefore they were providing the most exercise for the ligament and will allow them to strengthen it the quickest. However, there were other exercises they could have done such as normal body weight squats, resistance band calf raises, seated leg extensions (no resistance) and standing hamstring curls (no resistance). However, these exercises will not provide the same resistance and the differing resistance levels for the exercises I chose could not be used in these ones as well. The same problem was experienced again with this one not providing much guidance for the participants as to when to use the exercises, however, depending on their schedule they could fit it in in the morning and afternoon, as long as they completed the exercises twice a day. The set and repetition parameters for the exercises are suitable for the injury as they shouldn't tire the injured performer out but they will allow for growth of the muscles and strengthening of the ligament.
Justification
The exercises chosen for this injury may not all be the best option. The lateral raises for the arm are good because they provide a good amount of resistance on the arm when at the horizontal point, and the press ups will help increase the bone density which will improve their strength, however, the bicep curls may not be the best option as they aren't specifically targeting the bone. A better option may be body weight chin ups, as these target similar muscles whilst also testing the strength of the bones. These exercises were chosen for the program as a result of them being cheap to perform and they are also easy to complete no matter where you are. The other options for them to do would involve a higher cost as they would have to invest in a gym membership or some free weights if they wanted a different kind of resistance.
Evidence for P6
Evidence for P6
Evidence for P6
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3 D2
Not sure about this bit - we need a chat!
There are 4 knee ligaments!
Evidence for P6
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for P6 M3
Evidence for D2
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