Management of injuries after the first 48 hours is a complex procedure that can encompass a variety of different treatment techniques. The type of treatment required depends on the type, severity and stage of injury. If rehabilitation is inadequate the athlete may be:

• Prone to re-injury of the affected area
• Incapable of performing at pre-injury standard
• Predisposed to injuring another part of the body

The following treatment techniques may be used in the management of injuries.

Muscle Strengthening

After injury, there is rapid muscle wasting due to pain, inflammation and immobility. Muscle strength decreases after relatively short periods of immobilization and shows increased fatigability, therefore less endurance.

Muscle weakness is a contributing factor in many acute and chronic soft tissue injuries. It is important to recognize these weak muscles either as a cause, or as a consequence of the injury. For recovery to be successful, rehabilitation must include careful assessment, strengthening and re-education of the affected muscle groups.

Joint Mobilization/Manipulation

These are techniques applied to a spinal or peripheral joint in order to restore full, pain-free range of movement. Mobilization is a passive oscillatory movement that is performed within the control of the patient, who can stop the movement at any time. Manipulation is a sudden movement or thrust of small amplitude, performed at high speed such that the patient is unable to prevent the movement. It can be a very effective form of treatment, however, it is associated with more risk than mobilization.

Massage

Massage involves direct manual manipulation of the soft tissues of the body and has an important role to play in the prevention and treatment of injuries. It can be used to:

• Promote efficient scar formation
• Reduce muscle tension
• Reduce excessive adhesion and scar formation
• Reduce pain
• Reduce muscle spasm
• Promote healing by increasing blood flow
• Help recovery after exercise by promoting lymphatic drainage
• Reduce swelling
• Deactivate trigger points

Neural Stretching

Tension and restricted range of movement can occur in the nervous system just as it can in the muscles. These abnormalities may make a significant contribution to the signs and symptoms in certain injuries and unless they are corrected, full recovery may not occur.

Stretching the nerves (Neural Stretching) is an effective method of treating these abnormalities by restoring normal neural tension and normal mechanics of the nervous system.

Flexibility

Immediately following injury, flexibility of the muscles is reduced due to spasm of the surrounding muscles. Also, if joint range of movement is restricted due to the injury, the muscles very quickly begin to lose their extensibility. This tightness in the muscles causes an abnormal force to act at the surrounding joints, changing the biomechanics of the body. If full flexibility is not regained, injury may occur to the restricted muscles or to the surrounding joints and soft tissues. Normal flexibility is regained by passive or static stretching.

Proprioception

Proprioception is the body’s ability to sense position, motion and pressure in the joints. With injury, proprioception may be altered resulting in impaired balance, decreased co-ordination and a tendency for joints to give way. Impaired proprioception is a common sequel to lower limb injuries. Proprioceptive training should begin as early as possible in the rehabilitation program and may include exercises such as balancing on one leg, using wobble boards, hopping, or running drills.

Cardiovascular Fitness

It is essential that cardiovascular fitness be maintained during rehabilitation in order to minimize the time away from sport. With most injuries it should be possible to design an exercise program to include some form of cardiovascular training.

For instance, a runner with an Achilles tendinopathy may require a period of restricted weight-bearing activity. Cardiovascular fitness may be maintained by performing activities such as cycling, swimming or aqua jogging.

Functional Exercise

Once a reasonable level of strength, power, endurance, flexibility and proprioception has been achieved, functional activities can be introduced. These are movements that form the basis of the sport to be played and prepare the athlete physically and mentally for the demands of that sport.

Functional training begins with basic exercises such as walking, jogging and striding, and progressed to eventually include agility and team drills. The exercises should be progressed slowly and under careful supervision, as too fast a progression will result in re-injury.

Correction of Biomechanical Abnormalities

Biomechanical abnormalities are common predisposing factors to injury, especially overuse injuries. Full biomechanical analysis is essential in the case of recurrent or overuses injuries and, if treatment is to be successful, any abnormalities found must be addressed in the rehabilitation program.

Core Stability

With some sports injuries, poor core stability may be one of the contributing factors. To prevent re-occurrence of the injury, specific core stability training must be included in the rehabilitation program. The most common methods of training your core are with swiss ball exercises or pilates.

Electrotherapy

A large number of different electrotherapeutic modalities are available for the treatment of injuries, and the extent of their use varies widely between therapists. The modalities most often used are Laser, Ultrasound, Interferential, TENS, Neuromuscular Electrical Stimulation (NMES), and Short Wave Diathermy.

The effect of the treatment depends on modality and its parameter settings. Electrotherapy is often used to:

• Reduce pain
• Increase blood flow
• Reduce inflammation
• Promote healing
• Reduce muscle spasm
• Muscle stimulation