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Functional Rehabilitation and Progression

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by

Josh True

on 17 July 2015

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Transcript of Functional Rehabilitation and Progression

Forward Sprint (A-C-A)
Retro Sprint (A-C-A)
Side Shuffle Right – Face In (A-B-C-D-A)
Side Shuffle Left – Face In (A-D-C-B-A)
Carioca Right – Face In (A-B-C-D-A)
Carioca Left – Face In (A-D-C-B-A)
Figure 8 Right – (A-B-C-D-A)
Figure 8 Left – (A-D-C-B-A)
45° Cut Right – Plant Outside Foot (A-B-C-D-A)
45° Cut Left – Plant Outside Foot (A-D-C-B-A)
90° Cut Right – Plant Outside Foot (A-B-D-A)
90° Cut Left – Plant Outside Foot (A-D-B-A)
Crossover 90° Cut Right – Plant Inside Foot (A-B-D-A)
Crossover 90° Cut Left – Plant Inside Foot (A-D-B-A)
Forward Sprint (A-C-A)
Retro Sprint (A-C-A)


Benefits of Functional Rehabilitation
Considerations for Functional Rehabilitation
Individuality

Positive activities

Orderly progression

Variability

Phases of Rehabilitation
Stage I - Bench Rehab


Stage II - Progressive Rehabilitation


Stage III - Functional Rehabilitation
Components of Functional Rehabilitation
Communication - Key Component
Functional Rehabilitation
“A succession of activities that simulate actual motor and sport skills, enabling the athlete to acquire or reacquire the skills needed to perform selected athletic endeavors safely and effectively.”

Functional Rehabilitation and Progression
Important part of the rehabilitation process due to the planning of demands on the body

Aids in providing optimal performance when returning to full sport participation

Most of this stage cannot be performed in a traditional clinic setting, but needs to be done in setting of sport training

Psychological Benefits
Re-establish Confidence in Abilities

Decrease Anxiety

Decrease Deprivation

Decrease Apprehension

Physical Benefits
Improved Muscular Strength

Improved Muscular Power

Improved Muscular Endurance/Cardiovascular

Improved Mobility

Improved Motor Skills

Improved Functional Stability

Physical Fitness
Flexibility

Body Composition

Muscular Strength

Muscular Endurance

Cardiorespiratory Endurance

Athletic Fitness
Speed

Power

Agility

Balance

Quickness

Coordination

Drill Progression within Functional Rehabilitation
Discrete Skill



Closed Skill



Blocked Practice

Initial Phase
FINAL PHASE
Serial Task



Open Skill



Random Practice

Drill Prescription for Specific Goals
Plyometric Training and Functional Progression
Functional progression running patterns
Accel Decel Accel Decel
10yds 20yds 30yds
S 8 W
Functional progression running patterns
Run
Shuffle/Carioca
Backpedal
Shuffle/Carioca
Run
Shuffle
Shuffle
Run
Backpedal
Backpedal
Sport Specific Running Progressions
0 - Slant
1 - Flare
2 - Out
3 - Hitch
4 - Curl
5 - Comeback
6 – Square In
7 - Post
8 - Corner
9 - Fade

1
2
3
4
5
6
7
0
8
9
Functional Movement Screen® and Functional Rehabilitation
The FMS is a predictive system that is designed to rank movement patterns that are basic to the normal function of active people.


Bridges the gap between pre-performance physical and performance tests


Assesses MOBILITY and STABILITY
Functional movement pyramid
Functional Movement
Performance
Skill
goals of FMS
Goal #1- to identify movement pattern limitations so medical professionals can prescribe individualized corrective exercise to normalize movement BEFORE increasing physical demands with training
Goal #2- to identify when individuals deserve the benefit of medical diagnosis and treatment (physical medicine and rehabilitation)
Goal #3- to provide medical professionals a way to effectively classify individuals and communicate this classification with other professionals (ATC,MD, PT, OT, CSCS)
Goal #4- to provide medical professionals with a standardized tool to measure, classify and document movement. This standardized classification is used to determine corrective and training programs as well as compare or measure the effectiveness of the chosen program.
FMS Movements
Mobility
Active Straight Leg Raise



Shoulder Mobility
Motor Control
Trunk Stability Pushup



Rotary Stability
Functional
Deep Squat


Hurdle Step


Inline Lunge
FMS Test and scoring
3 2 1

Deep Squat – Scoring

3 2 1

Hurdle Step – Scoring

3 2 1

Inline Lunge– Scoring

3 2 1

Shoulder Mobility – Scoring

Shoulder Mobility – Clearing Exam

3 2 1

Active Straight Leg Raise – Scoring

3 2 1

Trunk Stability Pushup – Scoring

Trunk Stability Pushup – Clearing Exam

3 2 1

Rotary Stability – Scoring

Rotary Stability – Clearing Exam

scoring Criteria for the FMS
Each test is scored 3 to 0
3 - Pattern performed as directed

2 - Perform pattern with compensation/imperfection

1 - Unable to perform pattern as direted

0 - Pain with movement, regardless of quality (needs further medical evaluation)

Highest score that can be achieved is a 21
When in doubt score low, and do not interpret while testing
5 of the 7 tests are scored bilaterally - if asymmetrical lower score is used overall
Hurdle Step
Inline Lunge
Shoulder Mobility
Active Straight Leg Raise
Rotary Stability
What does the score tell us
Do not get caught up in the overall score

Attack asymmetries prior to anything else - they create a higher risk of injury

Adequate stability cannot be achieved without proper mobility

Eliminate 1's and 0's first - correct dysfunction
Dysfunction
Mobility
Static Motor Control
Dynamic Motor Control
Active Straight Leg Raise
Mobility Order:

Soft Tissue Work (foam rolling)

Hip Mobility Assisted (strap stretch)

Leg Lowering (both 1&2)

ASLR with Core Activation

Hip Flexor Stretch (half kneeling)

Leg Lock Bridge
ASLR Mobility
Static Motor Control:

Half Kneeling Set-Up and Hold

Hip Flexor Stretch from Half Kneeling

Half Kneeling with Rotation

Chop and Lift from Half Kneeling
Strength Patterning

Single Leg Double Arm with Kettlebell


Single Leg Double Arm with Dumbbell


Single Leg Double Arm with Barbell
Dynamic Motor Control:

Deadlift Patterning

Double Leg Deadlift

Suitcase Deadlift

Single Leg Deadlift with RNT

Single Leg Contralateral Deadlift
ASLR Static Motor Control
ASLR Dynamic Motor control
ASLR Strength patterning
Foam Roll
Strap Stretch
Leg Lowering 1 & 2
Core Activation ASLR
Half Kneeling Hip Flexor Stretch
Leg Lock Hip Bridge
Half Kneeling Set Up & Hold
Half Kneeling Hip Flexor Stretch
Half Kneeling Rotation
Half Kneeling Lift and Chop
Hip Hinge
Double Leg Double Arm Deadlift
Suitcase Deadlift
Single Arm Single Leg Deadlift
Single Leg Deadlift w/ RNT
Single Leg Double Arm w/ Kettlebell
Single Leg Double Arm w/ Dumbbell
Sing Leg Double Arm w/ Barbell
Difference Bewtween Loading and RNT (Reactive Neuromuscular Training)

Loading adds volume, intensity, and frequency - if pattern is dysfuncitonal to start, reinforcement of problem will occur

Reactive Neuromuscular Training (RNT) uses the concept of "Feeding the Mistake"
- provide just enough resistance for the body to the proprioceptive systems for the body to self adjust to maintain balance and improve alignment.


- Gray Cook
Shoulder Mobility
Mobility Order:

Soft Tissue Work

Rib Grab T-Spine Rotation

T-Spine Rotation with Reach

Wall Sit with Reach

Quadruped T-Spine Rotation
Static Motor Control:

Trunk Stability Rotation

T-Spine Rotation with Arm Sweep

Shoulder Packing Drills

Deadlift Variations
Dynamic Motor Control:

Arm Bar

Half Turkish Get-Up

Push-Up

Real Row

Overhead Walk

Press Single Arm
Strength:

Bench Press Single Arm with Dumbbell

Bench Press Alternate Arm with Dumbbell

Bench Press Double Arm with Dumbbell

Single Arm Press from Symmetrical Stance
Shoulder Mobility Work
Soft Tissue Work
Rib Grab
T-Spine Rotation and Reach
Wall Sit and Reach
Quadruped T Spine Rotation
Shoulder Static Motor Control
T Spine Rotation
Arm Sweep
Shoulder Packing
Deadlift Variations
Shoulder Dynamic Motor Control
Arm Bar
Half TGU
Pushup Variations
Real Row
Overhead Walk
Press Single Arm
Shoulder Strength
Bench Press Single Arm Dumbbell
Bench Press Alternate Arm Dumbbell
Bench Press Double Arm Dumbbell
Rotary Stability
Mobility Order:

Soft Tissue Work - T spine/Lumbar/Glutes/Lats

Rib Grab T-Spine Rotation

Active Straight Leg Raise with Core Activation
Static Motor Control:

Chop and Lift from Half Kneeling

Quadruped Rock with Core Activation

Quadruped Diagonals Resisted (Bird Dog)
Quadruped Rock w/ Core Activation
Quadruped Diagonals Resisted
Dynamic Motor Control:

Assisted Rolling

Lower Body Rolling

Upper Body

Hard Roll

Half Turkish Get-Up

Suitcase Deadlift

Single Leg Single Arm Deadlift
Lower Body Roll
Upper Body Roll
Assisted Roll
Hard Roll
Strength:

Pull Single Arm from Single Leg
Supported

Press Single Arm from Single Leg Supported

Push Single Arm from Single Leg Supported
Pull
Press
Push
Trunk Stability Pushup
Mobility Order:

Soft Tissue Work - T spine/Lumbar/Hamstring/Quad/TFL/Glutes/Lats

Hip Flexor Stretch from Half Kneeling

Half Kneeling with Rotation
Static Motor Control:

Plank Variations

Mountain Climbers

Quadruped Rock with Core Activation
Plank Variations
Mountain Climbers
Dynamic Motor Control:

Elevated Push-Up

Half Push-Up

Push-Up Assisted

Push-Up Walkout

Push-Up

Single Leg Push-Up
Elevated Pushup
Pushup Assisted
Pushup Walkout
Strength:

Push-Up Resisted

Bench Press Single Arm with Dumbbell

Bench Press Alternate Arm with Dumbbell

Bench Press Double Arm with Dumbbell
Don't forget about breathing


Practice crocodile breathing
Current research indicates a trend to a deficit in Ankle Mobility, predominantly dorsiflexion, has led to decreased shoulder mobility scores. (Inter connected)
C



D B



A

A to C = 30’
B to D = 10’

LEF Test

Females Males
Good - 120sec 90sec
Average - 135sec 105sec
Below - 150sec 125sec
Average
Chorba, R, Chorba, D, Bouillon, L, Overmyer, C, Landis, J. (2010). Use of a functional movement screening tool to determine injury risk in female collegiate athletes. North American Journal of Sports Physical Therapy. 5, 47-54.
Cook, G. Movement: Functional Movement Systems: Screening, Assessment, and Corrective Strategies. (2010). On Target Publications.
Hudson, Z. (2009). Rehabilitation and return to play after foot and ankle injuries in athletes. Sports Medicine Arthroscopic Review. 3, 203-207.
Kiesel, K, Plisky, P, Voight, M. (2007). Can serious injury in professional football be predicted by a preseason functional movement screen. North American Journal of Sports Physical Therapy. 2, 147-160.
Logerstedt, D. (2004). Functional neuromuscular rehabilitation of posterior shoulder dislocation in a high school baseball player. Journal of Sports Rehabilitation. 13, 167-182.
Mithoefer, K, Hambly, K, Logerstedt, D, Ricci, M, Silvers, H, Della Villa, S. (2012). Current concepts for rehabilitation to sport after knee articular cartilage repair in the athlete. Journal of Orthopaedic and Sports Physical Therapy. 42, 254-273.
Myers, G, Paterno, M, Ford, K, Quatman, C, Hewett, T. (2006). Rehabilitation after anterior cruciate ligament recontruction: criteria-based progression through the return-to-sport phase. Journal of Orthopaedic and Sports Physical Therapy. 36, 385-402.
Prentice, W. Rehabilitatin Principles in Sports Medicine and Athletic Training, 4th ed. (2004). New York: McGraw Hill
Verstegen, M, Falsone, S, Orr, R, Smith, S. (2012). Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: american football. Journal of Orthopaedic and Sports Physical Therapy. 42, 337-344.
Waters, E. (2012). Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: basketball. Journal of Orthopaedic and Sports Physical Therapy. 42, 326-336.

References
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