Health Care Assignment: Designing A Rehabilitation Session For An Athlete

Question

Task:
Case Scenario
Table 1; Patient Details

The History:
The patient presented with left posterior ankle pain. She competes at a national (level 1) level and in B.U.C.S. competitions. She reported that her symptoms have been gradually getting worse over the past 8 weeks. Initially she had been able to ‘warm it up’, but now feels as though she is unable to do this. The patient reports that she is now unable to train to her full capacity and has noticed a significant decrease in performance. She has big season ahead and is very worried that she will not be able to compete. The patient reported that she had a similar issue six months previously, which settled with rest.

The initial physical assessment revealed:

1. Pain on active heel raises, single and double legged.
2. Reduced muscle length of the calf muscle group (reduced active dorsiflexion/ knee to wall test) bilaterally.
3. A strength deficit in resisted hip extension, knee flexion and ankle plantarflexion.
4. Decreased neuromuscular control of the hip and lumbo-pelvic region.

The athlete was then diagnosed with an Achilles tendon, mid-portion tendinopathy and treated conservatively. After completing the phase 1 and 2 rehabilitation exercise programmes:

1. She has pain free full range heel lifts.
2. Lumbo-pelvic and hip control has improved, in non-functional tasks.
3. Calf strength (work capacity) has improved, although still reduced.

Subsequent assessment revealed:
Table 2; Functional Outcome Measures

• Based on the data provided in tables 1 and 2 you must select appropriate rehabilitation strategies (exercises) and prescribe with appropriate training variables (complete the session plan template) to address the highlighted deficits in the context of the injury.
• Once you have completed the plan you will justify the approaches taken in the plan, e.g. exercise strategy, training variables.

Use the assignment remit and report template to present your work.

Additionally, the psychological assessment of the athlete revealed:

1. Kinesiophobia; Tampa Scale of Kinesiophobia score; 39
2. Developed anxiety and depression as a result of decreased performance

Lastly the athlete’s psychological state needs to be addressed with appropriate optimistic strategies to help her return to full training and competition.

Health Care Assignment Task: You are required to design a rehabilitation session for an athlete with an Achilles tendon injury and to justify return to sport criteria.

Using the provided case scenario; female sprinter with Achilles tendinopathy, you must:

1. Using the Brukner & Khan model of rehabilitation, present an overall specific aim and goals for phase 3 and phase 4. These should be based on the interpretation of the data provided in the case scenario.
2. Select appropriate example exercises and training variables to achieve the goals for each phase.
3. Provide an evidence based justification of the exercise strategies.
4. Identify and justify appropriate return to play criteria, with cut-off values based on normative data.
5. Explain how the design of return to play rehabilitation, addresses the psychological state of the athlete.

Answer

Introduction
The current health care assignment sheds light on the sport and exercise rehabilitation program which is provided to athletes or sports personals who have sustained a major injury or any damage that may have hampered their ability to take part in the sports again. It helps in developing a care plan involving exercise in order to help them restore their ability to take part in sports and exercise (Arvinen-Barrow & Clement, 2017). The following sport and exercise rehabilitation program focuses on the case study of a 20 years old female, who has been found to be suffering from left posterior ankle pain. She is a sprint athlete of 100 m and 200 m and is known to compete on the national level. It has been reported that she has been suffering from deterioration pain and health condition for the last 8 weeks and now is unable even to warm up. The pain in the left ankle has been hampering her ability to train and provide her best performance. Assessing the past medical history of the patient, it was found that she suffered from a similar issue 6 months ago which she treated with complete rest.

After assessing the patient, it was found that she has been suffering from Achilles’ tendon and mid-portion tendinopathy which was the chief reason behind her heath condition. Thus, focusing on the condition of the patient phase 1 and 2 rehabilitation program using exercise were provided which provided her with relief from pain during full range heel lifts, along with improvised hip control and lumbopelvic control as well as improved calf strength. Thus, the phase 3 rehabilitation will focus on replication the sport-specific demands of the patient along with proceeding with the return to sports by initiation from running. It is so because the aim of phase 3 is to help the athletes return back to their sports routine. In the 4th phase, the aim is to manage and maintain a rehabilitation program that will help in avoiding the chances of occurrence of re-injury in the case of the patients, which will thus involve diet as well as exercise for better health (Landry, 2014).

Discussion:
Section 1:
Focusing on the case study of the athletes as well as the principles of sports and exercise rehabilitation, it has been found that it is necessary to focus on providing the patent with a phase 3 and phase 4 rehabilitation program. The principle focusing on the rehabilitation of the patient focuses on ensuring mobility and stability in order to assist her return back to her sports. It is necessary to assist her with the ability to return to practice and sustain a normal routine (Jiang, 2020). In order to attain success in a rehabilitation process, it is necessary to maintain mobility while the injury is stabilizing. The key factor is to avoid any kind of rigid or harmful situation for the athlete. It is only necessary to avoid the total rest of the muscles in order to make them incompatible to function again. It is because, it has been found that in order to recover from the injury or damage, the tendon needs to witnesses a certain level of pressure or load as it helps them increase their strength and recovery in an increased manner. It has been found that mobility whole stabilization of the injury requires muscular rigidity which tends to promote co-contraction which often takes place against pain or a condition of kinesiophobia (Maestroni et al., 2020). It is evident that a significant amount of co-contraction tends to permit mobility of muscles which takes when as soon as the stress within the injured location is minimized. Focusing on the principles and information on sport and exercise rehabilitation, it has been found that the athlete requires to be provided with exercises such as seated heel raises, Side-lying leg lift or abduction, and Leg extension in standing, as well as initiating with running in phase 3 along with Perform Plyometric Drills and Protein-rich healthy diet along with strengthening exercises in phase 4. The exercises in phase 3 have been provided as it is known to be playing a significant role in promoting better tendon recovery in athletes with the condition of Achilles tendinopathy. Running within short distance will help in initiating the sport without exerting extra pressures over the injured area and will also avoid the condition of early initiation of sport without total recovery (Kirkby Shaw et al., 2020). While in phase 4, the Perform Plyometric Drills along with dietary activity will help in avoiding any chances of injury or damage of the tendons as complete rest often minimizes the pain but increases the risk of future injury. As it was found in the case study that the athlete in past sustain a similar issue but relied on complete rest in order to withstand recovery while it entirely hampers her condition and leads her to attain the injury again.

Section 2:
Triple hop test for the athlete:
In order to assess the return to play criteria of the athletes, it will be necessary to assess the outcome measures of the patient to the triple hop test. In the case of the triple hop test, the power and strength of the leg are measured which is carried out with the help of performing three consecutive jumps in horizontal directions. In these jumps, one has to take off both legs at once to conduct each jump (Peebles et al., 2019). It is known to be one of the significant four tests distributed under the category of Quadrathlon Test. It is used in order to assess and measure the strength of the legs in conduction horizontal as well as vertical jumps with consideration of coordination of both kegs and maintenance of balance. In the earlier report of the patient, it was found that triple hop in the right direction showed 450 cm while on the left direction, it was 300 cm which explains the injury of the ankle of the athlete. Thus, using the test will help in evaluating the change in the measurement where triple hop on both the direction left as well as right will indicate similar measurement along with increased ranges (Gokeler et al., 2017). It has been found that the normative range of the triple hop is often above 600 cm in athletes, thus as soon as the patient indicates a range nearby the normative range it will be considered as an improvement in the condition. It will help in assessing the condition of the patient’s ankle and strength of the legs to continue with the practice and return to sports.

Drop jump test:
Drop jump is also known as box jump or depth jump which is actively used in a fitness test for athletes as it measures the strength and power of the legs. Thus, focusing on the injury of the patients and provided recovery options, it will be necessary to assess the drop jump test of the athlete to understand the strength and power restored in the leg after providing the rehabilitation (Baena-Raya et al., 2020). In the case of the athlete, it was found that the drop jump test result indicated 1.5 of the reactive strength indexes which were measured to be fair according to the chart. The reactive strength index or the RSI is known to be established for the measurement of the explosive strength and capability of the polymetric activities performance by any athletes. It involves the ratio of the height form where the thump is conducted while the seed of the jump. It has been found that the normal range of the RSI in drop jumps is stated to be above 2.0 to 2.5 as it indicates very good as well as excellent strength and power of the legs to return back to sports without any risk of fear (Bishop et al., 2020). Thus providing the test to the athlete will help in understanding the idea of the strength restored in her leg and her capability to initiate with her practice and return back to her normal sports routines.

Section 3:
Kinesiophobia:
Kinesiophobia is often found in the case of athletes who sustain major impairment and disability after injury or any damage. Return back to sports often becomes complicated and difficult as treating the condition of kinesiophobia is quite complex (Kaço?lu, Atalay & Turhan, 2018). It is known to be diagnosed during any rehabilitation or physical theory provided to the athletes. It is known to develop a fear of pain and injury in the case of patients with the condition. Thus, in order to support the athlete from the case study to return back to sports, it will be necessary to provide her cognitive therapy to help her fight against her pain and proceed with her sports routine. Cognitive therapy will help in providing the athlete with the strength and ability to fight against the pain and the fear that has developed after injury (Luque-Suarez, Martinez-Calderon & Falla, 2019). It will help in gaining cognitive strength to understand that the injury is recovered and no serve pain will be witnessed while proceeding with the practice. It is necessary to remind the athlete about the happiness as well as joyful feeling they felt while they were in the field or ground with the sports. Thus, it will help them gets their mental strength and take step towards proceeding to the normal routine without any fear of pain or injury.

Anxiety and depression:
It was found that the athlete after sustaining injury and disability to conduct her practice, depression, and anxiety was found to impact her cognitive health. Thus, it is necessary to address the issue of mental health with the help of cognitive-behavioral therapy (Liu, Nie & Wang, 2017). It is known to be a technique used in the case of athletes who have been witnessed to be suffering from anxiety and depression. It helps them overcome their issues and stress that they sustain from inside as well as outside due to pain, injury as well as failure. It will be necessary for the athletes t change their behavior in order to address the factors that might have been impacting their cognitive health (Pluhar et al., 2019). Thus, the athlete needs to change her behavior and get actively indulged in practice and exercise along with counseling in order to fight against anxiety and depression in order to sustain better recovery.

Conclusion:
In order to conclude, it can be stated that the case study assessment of the sport and exercise rehabilitation of the athlete has provided a wide range of understanding and data about the need of having a proper exercise routine. It was found that rehabilitation phases 3 and 4 have a significant role in providing effective treatment to the condition of disability and provide better recovery from the condition in order to help them return to the normal routine of sports. In phase 4 the patient sustains the ability as well as supportive exercise routine in order to manage any risk of injury in the future and sustain better involvement and strength to proceed with respective sports and exercise. It also explains the need of having significant mental health therapies in order to support the athlete with the fear of injury and pain they sustained which often hampers them in taking active participation in the practice and sports.

References:
Arvinen-Barrow, M., & Clement, D. (2017). Preliminary investigation into sport and exercise psychology consultants’ views and experiences of an interprofessional care team approach to sport injury rehabilitation. Journal of Interprofessional Care, 31(1), 66-74. https://doi.org/10.1080/13561820.2016.1235019

Baena-Raya, A., Sánchez-López, S., Rodríguez-Pérez, M. A., García-Ramos, A., & Jiménez-Reyes, P. (2020). Effects of two drop-jump protocols with different volumes on vertical jump performance and its association with the force–velocity profile. European journal of applied physiology, 120(2), 317-324. https://doi.org/10.1007/s00421-019-04276-6

Bishop, C., Pereira, L. A., Reis, V. P., Read, P., Turner, A. N., & Loturco, I. (2020). Comparing the magnitude and direction of asymmetry during the squat, countermovement and drop jump tests in elite youth female soccer players. Journal of sports sciences, 38(11-12), 1296-1303. https://doi.org/10.1080/02640414.2019.1649525

Gokeler, A., Welling, W., Benjaminse, A., Lemmink, K., Seil, R., & Zaffagnini, S. (2017). A critical analysis of limb symmetry indices of hop tests in athletes after anterior cruciate ligament reconstruction: a case control study. Orthopaedics & traumatology: surgery & research, 103(6), 947-951. https://doi.org/10.1016/j.otsr.2017.02.015

Jiang, Y. (2020). Combination of wearable sensors and internet of things and its application in sports rehabilitation. Computer Communications, 150, 167-176. https://doi.org/10.1016/j.comcom.2019.11.021

Kaço?lu, C., Atalay, E., & Turhan, B. (2018). Assessingthe Kinesiophobia and Depression Status at Return to Sport Following Sport Related Injuries in Contact and Non-Contact Sports. Spor Hekimli?i Dergisi, 53(2), 67-75. https://doi.org/10.5152/tjsm.2018.092

Kirkby Shaw, K., Alvarez, L., Foster, S. A., Tomlinson, J. E., Shaw, A. J., & Pozzi, A. (2020). Fundamental principles of rehabilitation and musculoskeletal tissue healing. Veterinary Surgery, 49(1), 22-32. https://doi.org/10.1111/vsu.13270

Landry, M. (2014). Brukner & Khan's Clinical Sports Medicine. Physiotherapy Canada, 66(1), 109. doi: 10.3138/ptc.66.1.rev2

Liu, J., Nie, J., & Wang, Y. (2017). Effects of group counseling programs, cognitive behavioral therapy, and sports intervention on internet addiction in East Asia: a systematic review and meta-analysis. International journal of environmental research and public health, 14(12), 1470. https://doi.org/10.3390/ijerph14121470

Luque-Suarez, A., Martinez-Calderon, J., & Falla, D. (2019). Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. British journal of sports medicine, 53(9), 554-559. http://dx.doi.org/10.1136/bjsports-2017-098673

Maestroni, L., Read, P., Bishop, C., & Turner, A. (2020). Strength and power training in rehabilitation: underpinning principles and practical strategies to return athletes to high performance. Sports Medicine, 50(2), 239-252. https://doi.org/10.1007/s40279-019-01195-6

Peebles, A. T., Renner, K. E., Miller, T. K., Moskal, J. T., & Queen, R. M. (2019). Associations between Distance and Loading Symmetry during Return to Sport Hop Testing. Medicine and science in sports and exercise, 51(4), 624-629. 10.1249/mss.0000000000001830

Pluhar, E., McCracken, C., Griffith, K. L., Christino, M. A., Sugimoto, D., & Meehan III, W. P. (2019). Team sport athletes may be less likely to suffer anxiety or depression than individual sport athletes. Journal of sports science & medicine, 18(3), 490. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683619/pdf/jssm-18-490.pdf

Appendix A: Exercise Rehabilitation program
EXERCISE REHABILITATION; EXAMPLE EXERCISE PRESCRIPTION