Orthopedic Rehabilitation: Principles & NEET PG Pearls
1. Foundational Phases of Rehabilitation
| Phase | Primary Goals |
|---|---|
| Acute (Protection) | Pain control, edema reduction, and maintenance of ROM in adjacent joints. |
| Sub-acute (Motion) | Safe mobilization, restoration of normal joint mechanics, and initiation of isometric strength. |
| Strengthening | Progressive resistance training (isotonic), eccentric control, neuromuscular re-education. |
| Return to Sport | Functional/sport-specific drills, agility training, and psychological readiness. |
2. Critical Modalities & Concepts
- Isometrics: Used early to prevent atrophy without joint movement.
- Isotonics: Concentric/eccentric muscle contractions; eccentric is vital for tendon rehabilitation.
- CKC vs. OKC:
- Closed Kinetic Chain (CKC): Distal segment is fixed (e.g., squat); generally safer, increases joint compression, and enhances co-contraction of muscles.
- Open Kinetic Chain (OKC): Distal segment is free (e.g., leg extension); creates higher shear forces on joints.
- PNF (Proprioceptive Neuromuscular Facilitation): Techniques like “hold-relax” are used to improve ROM and strength.
3. Examination Pearls
- Delorme’s Protocol: A classic method for progressive resistance (e.g., 10 reps at 50%, 10 at 75%, 10 at 100% of 10-RM).
- ACL Reconstruction Rehab: Crucial to avoid early OKC knee extensions (0°–45°) to protect the graft; emphasize CKC early.
- Hydrotherapy: Excellent for early weight-bearing rehabilitation due to buoyancy, which reduces joint load.
- Wolff’s Law: Bone adapts to the loads under which it is placed—the principle behind controlled weight-bearing in fracture healing.