Rehabilitation of joint injuries takes on many forms, with an ever-growing body of exercises and "systems" guiding the clinician. Rehab gurus and daily blogs provide an endless collection of mobility and stability drills to get you back in action and presumably prevent another injury. As a sports physician, I am challenged every day to create rehab plans custom tailored to meet the specific demands of my unique patients, and I wanted to share my approach, and the approach of the Back In Motion Chiropractic & Physical Therapy team in Beaverton, Oregon, to provide a better understanding of why we do what we do.
Initial Injury Rehab (Acute Phase) Much has changed in the last few years regarding how we treat injuries in the first 7-10 days, or the acute injury phase. The traditional paradigm involved immobilizing the area while applying regular ice with elevation. While the debate still rages on the pros/cons of ice for acute injury management, the use immobilization has changed significantly. Fractures notwithstanding, immobilization of a joint for moderate to even severe soft-tissue injury is now in question. The reason this is changing has to do with how tissues remodel after injury and what is necessary to direct that remodeling. We know from research on cell biology that fibroblasts - the cells that produce collagen fibers (muscle, tendon, ligament, etc.) rely on force to direct the orientation of the new fibers. Without specific directional force, a condition that is present with immobilization of a joint, fiber deposition will be sporadic resulting in a weak, haphazard orientation, or what we traditionally refer to as scar tissue. When possible, our approach is to introduce specific directional force immediately following injury to begin to build a new, stronger joint. And for those cases when we miss the acute phase of tissue regeneration, treatment techniques such as the Graston Technique are used to break down the existing scar tissue and trigger a new inflammatory phase of tissue repair, combined with directional exercises to create stronger tissue.
Restoring Joint Range Of Motion Many rehab plans begin with specific strengthening exercises, typically following a generic template depending on the phase of the injury. However, in practice I all to often find that joint loading begins before restoration of optimal joint range of motion, and often these exercises are painful for the patient resulting in either the patient not performing the exercises - BAD - or the development of poor, highly compensated movement patterns - VERY BAD! At Back In Motion Chiropractic & Physical Therapy, we begin the rehab phase by introducing very specific, pain-free, joint mobility drills to not only restore your original range of motion but to add to it. Our goal is to not only increase joint range of motion - flexibility - but to make the joint very strong throughout the full range of motion particularly at end range, which is where most injury occurs - mobility.
Restoring Joint Strength at End-Range As mentioned above, the key to preventing injury is to make the joint strong throughout the entire range of motion, with a specific focus on end range. Most rehab exercises focus on restoring strength in the mid-range of the joint, and in the most biomechanically typical plane of movement. Our approach differs significantly in that we load the joint at the very end range of motion, focusing on strength and motor control, in a variety of planes. This is the very essence of injury prevention! For you typically don't sprain your ankle in a neutral position, you sprain it in a position you are not trained to be in, most usually end-range inversion. So instead of avoiding inversion during ankle rehab, we actually encourage it and load it to the max so that the next time you roll your ankle the joint will be used to being in that position and ready to take on the challenge!
Back In Motion Chiropractic & Physical Therapy - Serving the Beaverton & Portland, Oregon Community For Over 25 Years - "Moving Toward Your Finish Line"