According the loss associated with acute injury

According to Physiophedia “Rehabilitation is the restoration of optimal form (anatomy) and function (physiology), a process designed to minimise the loss associated with acute injury or chronic disease, to promote recovery, and to maximise functional capacity, fitness and performance.” It also states that “The ultimate goal of the rehabilitation process is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate altogether the disability.”It is essential to fully understand the processes of tissue healing for effective and safe management of soft tissue injuries and rehabilitation processes. Every musculoskeletal injury goes through 3 stages such as inflammation, repair and remodelling. Each of these stages make an important contribution to healing. There has to be specific rehabilitation and treatment based on the principles of tissue healing. After the inflammatory – acute -phase, in the post acute stage (repair phase) the body begins to repair the damaged tissue with similar tissue, but the resiliency of the new tissue will still be low. New temporary fibrous scar tissues starts to develop, mature and strengthen and permanent scar tissue (collagen) will be laid down. This stage begins around 3-5 days post injury and lasts up to 4 to 6 weeks. The injured area will still be weak and prone to further injury. In the remodelling phase, between 3-4 weeks to three months post-injury, collagen fibres mature and the soft tissues are being remodelled. At the beginning of this stage healing tissue is reasonably mature but stretching or strengthening would stress the newly formed scar tissue. As maturation keeps continue it is important to challenge the muscles to regain full strength. Stretching will help the remodelling of the tissues and enhance mobility and functionality. Once again, it is essential that in every stage of healing the treatment and rehab is specific and safe. As the injury progresses through the stages of healing, the treatment & rehabilitation has to progress accordingly.Active movements are when the athlete is using his own muscles to generate (produce) movement, he is the one who is physically doing the exercises. In the post acute stage of an injury, the athlete will be required to do exercises and activities by himself as part of his rehabilitation program. Keeping the athlete active is crucial part of this stage as without it he will not be able to fully recover from his injury.The benefits of active movements in the post-acute stage of an injury:promotes blood circulation which will provide oxygen and nutrition to the injured site and promote healingprovide proper blood flow and circulation to the injured site which is required for full recovery promote lymph drainage which removes and clears out toxins and waste products which are accumulated in the tissues of the injured site.activate the lymphatic systemenhance healing processhelp regain fitness components of the athletes – flexibility, strength, power, muscle endurance, balance, agility, coordination and skills that were lost as a result of the injuryhelp reorganising scar tissue fibresenhance local circulationprevent recurrence of the injury Without gentle activity (active movements) also the lymphatic system will not be activated and healing processes will be impaired. Therefore an athlete should not wait for full anatomical healing, but instead needs to start his active rehabilitation by re-training his muscle/ligaments/tendons gradually in the post acute phase as soon as the initial stage of swelling and pain has began to settle. Active rehabilitation includes very specific active movements like ROM, stretches, strength and stability exercises which are designed to regain all components of fitness of the damaged structure(s).Example of active movement exercises and their benefits:  ROM exercises – Regain full range of motion is the first priority as it will lays a foundation for more intense and challenging exercises. Without adequate range of motion of joints and its surrounding soft tissue there will always be compensations and inefficiencies within movement. Inefficiencies often lead to overuse of various structures and consequent injury. Therefore the athlete should start to do very gentle, movement base exercises such as first bending then straightening the injured area then, only if its comfortable enough, start to implement rotation exercises such as turning the injured area from side to side, rotate clockwise and anti-clockwise. These exercises aim to improve athletes’ mobility. As rehabilitation progresses ROM exercises can be gradually intensified. This will re-introduce flexibility and strength into to the injured structures. stretching exercises: gentle stretching exercises will further increase the ROM, prepare the injured area for more demanding exercises, reduce muscle tension and muscle tone, enhance proprioception and neuromuscular coordination, reduce the risk of recurrence of injury and supply nutrients to the area. Sample exercises: wrist stretch, palm-out forearm stretch, rotating wrist stretch (for carpal tunnel syndrome) hold each stretch – for 20 sec minimum- count then repeat it 2-3 times.strength: When ROM exercises can be done relatively pain free, then some strength exercise can be added. Starting with light overloading the injured area, then gradually and systematically increasing the load. The use of free-weights, weights machine or own body weights will strengthen the injured area as they provide certain amount of stability of the joints and muscles. Standing dumbbell press, alternate dumbbell curl, press-ups used as rehabilitation for frozen shoulder for example. isometric exercises: muscles contract without creating any movement such as holding plank or holding arms overhead. These exercises will help the athlete maintaining neuromuscular function and improve strength with movements.stability exercises: When flexibility and strength has returned to the injured area balance and proprioceptive exercises can be introduced. These exercises will re-train the damaged nerves around the injured site. They also help to improve proprioception and strengthen the weakened muscles/ligaments. Some example of balancing exercises: Walking along a straight line; balancing on a beam.