Don't Forget the Rehab :: Nationwide Children's Hospital
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Don't Forget the Rehab

Sprains and strains are a common occurrence in athletic activities. And, they do not have to be the end of the season. The most important thing is to catch the injury early and address it with proper care immediately.

Rehabilitation of an injury is the most effective means of reducing an athlete's time on the sideline. An athlete's return to play can be sped up by days - or even weeks - simply by dedication and compliance to a structured rehabilitation program.

STAGES OF REHABILITION

"The length of a rehabilitation program is dependent upon the severity of the injury," explains Terri VanDeCarr, physical therapist for Nationwide Children's Sports Medicine. "Mild sprains may only take a few days to a week to heal, while more severe injuries may require more intense therapy for several months."

In any event, the stages involved when rehabilitating an injury remains the same. The goals for each stage are as follows:

  • Phase 1 - Control Pain and Swelling
  • Phase 2 - Improve Range of Motion and/or Flexibility
  • Phase 3 - Improve Strength & Begin Proprioception/Balance
  • Phase 4 - Proprioception/Balance Training & Sport-Specific Training
  • Phase 5 - Gradual Return to Full Activity

"The length of time an athlete spends in each of the various stages of therapy is dependent upon several factors," says VanDeCarr. "Compliance and dedication to performing the prescribed exercises consistently at home, severity of injury, tolerance to pain, amount of swelling or dysfunction, and level of conditioning prior to injury, are a few factors that can influence the length of rehabilitation."

WHAT DOES THIS MEAN?

Sprains and strains are classified into three categories (discussed in greater detail in the August 2002 SportsPage article "The Sprains and Strains of Sporting Injuries"). As expected, the more severe the injury, the greater the length of time needed to fully recover from that injury and return to full competition. First degree (mild) sprains and strains generally heal within two weeks (at a maximum). The length of rehabilitation for second degree (moderate) injuries is generally between two and six weeks. Third degree injuries (i.e. knee ligament or severe ankle sprains) typically require the athlete to be out of his sport for six weeks or more and involved in a structured rehabilitation program.

GIVE US SOME EXAMPLES

Phase one of the rehabilitative process focuses on controlling pain and swelling (if present). The general rule of Rest, Ice, Compression, and Elevation is used. Other modalities, such as electrical stimulation or ultrasound, may also be used by licensed professionals (athletic trainers or physical therapists) to assist with this process. If necessary, physicians may choose to prescribe medication.

Phase two concentrates on increasing range of motion of a joint or flexibility of a muscle. Athletes are given specific stretching exercises to do on their own or may be manually stretched out by the therapist. It is recommended that all stretches be held for 30 seconds and repeated at least 4 times each.

The goal of the third phase of rehabilitation is to increase strength. Isometrics (pushing against an immovable object) may be used first, followed by the use of elastic bands of varying resistances, free weights, cuff weights, or weight equipment.

Phase four focuses on proprioception/balance and sport-specific training. Proprioception is defined as the body's ability to know its position in space at all times without looking. Simply put, it is balance. When an athlete injures herself, she damages her ability to balance.

VanDeCarr states, "An example of this is the athlete who repeatedly sprains an ankle. Exercises such as balancing on 1 foot with eyes open or eyes closed, balancing on one foot while catching a ball, or balancing on a foam pad, pillow, or mini trampoline are all examples of exercises used to improve proprioception. If not addressed, the injury will likely reoccur in sporting or non-sporting activities, such as the person who sprains an ankle while stepping on a rock on the street."

Sport-specific training implements exercise, skills, or drills that athletes perform during games or practices. At this point, the therapist carefully progresses the injured athlete from basic exercises to those requiring higher skill level as they heal and have the muscle control to tolerate them without risking further injury. This leads to phase five of the rehabilitation process which gradually returns the athlete to full activity, while placing them on a maintenance program to prevent the reoccurrence of injury.

While sprains and sprains may be painful, it will pass. Especially if treatment is started early and followed intently. Just like practice.

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Nationwide Children’s Hospital Sports Medicine is available to diagnose and treat sports-related injuries for youth or adolescent athletes. Services are now available in five locations. To make an appointment, call (614) 355-6000 or request an appointment online.

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000