Rehabilitation ladder – General muscle ladder

1)      RICE – Rest, Ice, Compression, Elevation

The first- line principle for treating an acute injury:

a)      Rest for 24-48 hours to prevent the clot spreading and an increase of inflammatory exudate. Mobilization too soon produces thicker scar tissue, which is not easily penetrated by fibroblasts and it may provoke continued bleeding.

b)      Ice will cool the periphery and shut down local vessels to decrease bleeding. Ice straight from the fridge may be less than 0 degrees and will produce an ice burn, unless separated from the skin by a cloth. Melting ice(wet ice) will be at 0 degrees and may be used as a bath for 20 minutes, but locally applied ice, for 5-10 minutes can have an effect. Reusable cold packs, which may be stored in the fridge, are available, as are some chemicals that freeze on mixing. Frozen packets of peas, which mould to the shape of the body, may prove most cost – effective. Care must be taken with ice placed around nerves, as they can suffer a cold-induced neuropraxia.

c)      Compression is again designed to reduce inflammatory exudates, and the spread of haemorrhage.

d)     Elevation prevents tracking of inflammatory products to the periphery, thus requiring less effort to return these products centrally.

2)      Stretching 

3)      Isometrics. Short muscle length – see rule 7 

4)      Isometrics. Medium muscle length – see rule 7

5)      Isometrics. Full muscle length – see rule 7

6)      Weights. Use light weights that are light enough to produce no pain and move the joints from one extreme end of the range to the other, repeat for 2-3 minutes

7)      Increase weights. Increase the weight only to the point that produces no pain

8)      Technical skill. Start technical skills slowly, such as running, swimming, throwing, hitting etc. Do not lose rhythm and balance

9)      Increase force. Practice techniques at half maximum effort, do not lose rhythm

10)  Maximum force. Use maximum effort in practice, so as not to lose rhythm. Do plyomethrics. Hopping, bounding and depth jumps

11)  Start play. Begin an easy, low grade matches

12)  Fit again. Play at normal grade

 

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English