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| Rehabilitation Exercises |
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REHABILITATION EXERCISES Rehabilitation is the term used to bring the patient back from injury, or post operative situations to full use of the damaged area. The aims of rehabilitation, in order, are:-
Mobility exercises will move the involved joint through its available range of movement. The amount of movement available will depend on the type of joint affected, the shape of the joint surfaces, the muscles and ligaments surrounding the joint and the degree of freedom allowed at the joint for that particular person. Exercises at this level will be quite simple and often Open Chain. Open Chain exercises mean that an end segment of the chain (arms or legs) are not fixed and does not support the weight of the body. A seated leg extension is an Open Chain exercise. Mobility exercises are the first type of exercise to be attempted and are often performed with the weight of the body supported, by sitting or lying down. This means that the injured joint can be moved with minimal weight bearing. At this stage the range of free range of movement will be limited. Take a knee injury for example. The patient may only be able to bend the knee a few degrees before pain sets in. This then is the range of free range of movement. Mobility exercises will work on increasing that range until the full range of movement has been achieved. Flexibility exercises will involve different stretch techniques to encourage a greater range of movement and improved flexibility. The most useful form of flexibility stretch at this stage of recuperation is Reciprocal Inhibition. This is a far easier stretch to achieve than it is to say! Let’s go back to the lower leg and that damaged knee again. With the patient sitting on a stable surface the object of the exercise is to bend the knee as far as possible without pain, then with the therapist holding the lower leg to stop the leg extending the patient then tries to bend the knee just a little bit further. With time, the patient will be able to flex, (bend) the knee to the same degree as before the accident or operation. Strengthening exercises can either be isometric, concentric or eccentric. Isometric exercises do not involve joint movement, for example holding a weight (like a bag full of groceries) involves an isometric contraction. On the other hand (maybe literally!) a concentric contraction involves movement of the joint – lifting the shopping up. An eccentric contraction involves the muscle lengthening under weight and is the strongest contraction of the three. Back to the shopping, putting the shopping down on the floor involves lengthening the biceps muscles and controlling the weight of the shopping bag. Isometric exercises are used when there is limited joint movement or when the muscles are still too weak to initiate a dynamic (concentric or eccentric) contraction. Dynamic contraction exercises are initiated without weight and as the muscles strengthen body weight and finally free weights are introduced. The progression will involve slowing down the tempo, it’s harder to lift a weight slowly than quickly. Just sit down and kick your leg out in front of you. Easy? Now do the same movement but really slowly. Much harder! Proprioception Training (awareness of motion or position as it pertains to one’s limbs), (Plowman & Smith 1997) is next on the list and the best way to retrain that is to work with your eyes closed. Standing on one leg is good balance training and closing the eyes is more of a challenge than it sounds. This is an excellent way to improve your self awareness of where your limbs are in space. The better you know yourself physically, the more aware you become of posture. This in turn will help you to be more in tune with your posture in relation to your horse. Sport’s specific training and confidence. By the time the patient has reached this level, they will have returned to their sport and it is now a question of re-building confidence in ability and making the injured joint or joints work through the range of movement required. A little and often here is the key, using the foregoing exercises to assist in correct positioning. For example, holding a squat will challenge the hip, knee and ankle joints. Any pain felt will show that the patient is not yet ready to sit back on a horse as the movement patterns are similar. Let’s look at progressive exercises for knee and shoulder. Both of which are often damaged in riding accidents. Knee: Mobility: Sit on a chair and the therapist will straighten the leg as far as possible without pain. Lie on the floor and the therapist will bend the knee as far as possible without pain. These exercises can then be performed standing, firstly holding onto a chair for support and then free-standing. Shoulders: Mobility and flexibility exercises are often performed simultaneously. Strength and proprioceptive exercises are often brought in at the same time, when flexibility has reached an acceptable level. Sports’ specific/confidence will be introduced alongside strength and proprioceptive exercises, if appropriate. Some injuries will incur a greater degree of confidence building than others. A good rapport between the therapist and the patient will ensure that the right exercise is introduced at the right time. Flexibility stretching should be performed after every exercise discipline.
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