By Andrew Hadrich, PT, DPT
Most athletes today participate in sports year round, and there is an increased emphasis on specialization in a single sport. Both contribute to increased physical demands on athletes’ bodies, resulting in increased incidents of orthopedic injuries. In sports medicine, time is everything. No longer can athletes let their bodies rest and recover for many months between seasons. Once injured, they have to be better and back out on the field as soon as possible.
This presents an ever-growing challenge to physical therapists working in sports medicine. Helping these athletes recover quickly requires correct diagnosis of the current injury, identification of contributing factors, and extensive experience and expertise of the physical therapist to guide therapy progression and return to play. Having access to specific exercise equipment enables physical therapists to help injured athletes heal from injuries faster and maintain their strength and conditioning while injured. This article will describe the benefits of various exercise equipment and utilize a case study to demonstrate each device’s use in a single physical therapy treatment plan.
Keeping Up with Cardio
Stationary exercise bikes and ellipticals in all of their forms can be found in most physical therapy clinics and provide proven utility for getting athletes back on the road toward competition. Both ellipticals and stationary bikes are good options for low-impact cardiovascular conditioning. They are also used for range of motion exercise of the lower extremity following injury or surgery. ProForm, based in Beaumont, Calif, and SciFit, based in Tulsa, Okla, are two manufacturers that offer an extensive line of these types of technologies.
Lower body ergometers, too, can be a helpful technology for athletic rehab, especially as a conditioning tool. For example, the MU100 Upright Lower Body Ergometer from Spirit Medical Systems, Jonesboro, Ark, can be used to warm up a patient, build cardiovascular fitness, or improve range of motion after lower extremity joint surgery by having the patient use the device’s pedal function. Upper body ergometers can be used for cardiovascular conditioning as well as shoulder range of motion and scapulothoracic strengthening. The Inclusive Fitness (IF) PRO1 Upper Body device from SciFit can be used seated or standing, and is built with an adjustable tilt head to accommodate a range of heights and ranges of motion. It has more than 190 levels of resistance, and it offers bi-directional exercise.
Recumbent steppers are excellent devices for working on knee and hip range of motion, lower extremity strengthening, and cardiovascular conditioning. The SciFit StepOne is a recumbent stepper available through Dynatronics, Salt Lake City. The StepOne offers a range of motion from 2 inches to 11.5 inches that can create a 23-inch stride range. Its 1:1 arm-to-leg ratio aims to provide movement that is functional and natural.
The following companies provide a range of equipment for athletic rehab and exercise:
Clarke Health Care Products
Spirit Medical Systems Inc
The Hygienic Corp
Treadmills are used predominately for cardiovascular training but can also be used for dynamic balance training and for lower extremity strengthening by adjusting the incline and by having patients side step, back step, or karaoke step on the treadmill. Sources for treadmills directed at the PT market include Spirit Medical System’s MT200 Gait Trainer Treadmill, which is equipped with separate motors to control speed, incline, and decline. Speed on the MT200 can be adjusted in very small increments and includes speeds as low as 0.1 miles per hour. The AC5000 Medical Treadmill from SciFit also provides a range of speeds and elevations from -3% to 12%.
An additional utility provided by treadmills is that they can be used with unweighting systems such as the LiteGait from Mobility Research, Tempe, Ariz, to take weight off of the lower extremity during walking, jogging, and running. Other treadmills that offer this benefit include the AlterG Anti-Gravity Treadmill from AlterG, Fremont, Calif, and LightSpeed from LightSpeed Running and Rehabilitation, Duluth, Minn.
Total Gym devices are useful for strengthening of the lower extremity and upper body. These devices are great in clinics with limited floor space as a single Total Gym, and can be used for a number of different resistant exercises. A therapist can easily add more resistance to the system by adding plate weights to the device. Or, they can be used to unweight the patient to allow them to complete an exercise with much less than their own body weight.
Cable columns and pulley systems are very versatile devices, as they can be used for a number of different exercises to strengthen the upper and lower body and for balance training.
Rebounders/mini-trampolines are also found in most orthopedic physical therapy clinics. Often these devices are used for balance training, introductory plyometric exercise, and medicine ball tossing/catching.
Big Results, Small Tools
A variety of other smaller exercise devices are often used to maximize the effect of specific exercises. Body Blades are used for stabilization training of the core muscles and the muscles of the upper extremity specifically. Dyna Discs, Wobble Boards, and Airex Pads can be used for balance training and core stabilization. An extensive line of these types of products is available from Minneapolis-based OPTP, which provides OPTP-branded balance pads, rotating discs, as well as the M-Board 1.1 Dynamic Balance Trainer and Airex Balance Pad. Gym Balls can be used for postural stabilization, core strengthening, and can add a level of instability to an endless number of exercises. These products, too, are available from OPTP and the Petaluma, Calif-based Exertools. Free weights, dumbbells, kettlebells, and medicine balls can be used for resistance and strength training. Resistance bands are often used for introductory strength training exercises. Stretchwell Inc, Warminster, Pa, offers its line of Fit-Lastic Therapy Products for use in resistance training, including bands, tubing, loops, straps, balls, and discs, that use a color-coded system of progressive resistance.
Pain Management for Athletic Rehab
Modalities and physical agents are used in conjunction with traditional rehabilitation approaches to reduce pain, decrease inflammation, and improve motor control.
Combination electrical stimulation and ultrasound machines are often used in the initial acute stages of sports-related injury. Chattanooga (DJO Global), Vista, Calif, and Richmar, Chattanooga, Tenn, have product lines that are intuitive to use and can be adapted for the specific needs of the patient. Both systems offer ultrasound soundheads in 2cm, 5cm, and 10cm.
When it comes to managing swelling, vasopneumatic systems with integrated cryotherapy are the gold standard. Biocompression Systems, Moonachie, NJ, and Game Ready Systems, Concord, Calif, have a variety of garments for every joint in the body, and are both easy to use by the patient and therapist alike.
Neuromuscular electrical stimulation units can be used to improve motor control and muscle facilitation. Clinically, the Chattanooga Vectra Genisys allows the clinician to use surface electromyography to assist the patient to activate the correct muscle, and then the unit’s NMES activates to help the patient maintain a contraction. This increases the speed of strengthening and the development of proper motor patterns. The NeuroTech Kneehab unit is a home NMES unit that has special garments to ensure proper electrode placement. The electrodes can also be sequenced to activate specific muscles in a specific order.
A high school senior suffered a severe ankle fracture while playing football last year. He required open reduction internal fixation of his tibia, fibula, and talus, and he was casted for 6 weeks. When the cast was removed, he had significant range of motion limitation of his foot and ankle and some swelling.
The first goal of physical therapy was to improve the range of motion of the ankle and reduce swelling. Our clinical staff utilized ultrasound to improve the extensibility of the calf muscle then manual therapy and stretching. The patient had partial weight-bearing restrictions; thus, we elected to use a SportsArt C530r exercise bike, offered by SportsArt, Mukilteo, Wash, after hands-on treatment to help his body relearn to use the newly acquired range of motion. Vasopneumatic compression and cryotherapy using a Biocompression Systems BioCryo System was utilized to reduce swelling.
When the patient was 8 weeks postoperative, his surgeon approved him to progress to weight-bearing as tolerated. His range of motion had improved but was still limited by about 25%, and he was very apprehensive to put weight on his foot. To continue to work on range of motion and improve his comfort with weight-bearing, we elected to use our SciFit StepOne recumbent stepper. The patient found that the SciFit StepOne gave him complete control over how much pressure he put through his foot, which made him less apprehensive to begin weight-bearing. As his comfort grew, we progressively increased the resistance of the stepper. During this time, we continued working on stretching and range of motion exercises. To begin working on his cardiovascular conditioning, that patient used an upright stationary bike as part of his home exercise program.
By postoperative week 10 the patient had regained full ankle ROM, had no ankle swelling, and had no pain. He did continue to have a limp of which clinical testing indicated was caused by weakness and balance impairment. Thus, our treatment plan was modified to emphasize these areas.
We began to utilize an Airex pad and Wobbleboard to improve his static balance. Thera-Band was added to his range of motion program to increase the strength of his foot and ankle muscle. He lacked strength in his calf to perform a heel off. Thus, we utilized our Total Gym to take some of his body weight off of the leg, and he was able to perform a single-leg heel-off effectively. As his strength improved, we increased the angle of the Total Gym to put higher levels of weight onto the leg until he eventually could perform the exercise standing. To prepare his body for normal gait, we began to use our SportsArt E825 elliptical, which helped him begin a normal gait sequence with added stability. The adjustable stride length feature on the E825 enabled us to best match the patient’s normal gait cycle. The elliptical also allowed him to build the endurance of the muscles of the ankle and continue to improve his cardiovascular conditioning in a more functional manner.
At postoperative week 12, his surgeon cleared him to begin walk to run progression. To complete this, we elected to use our SportsArt T630 treadmill as we could easily control the speed on 0.1mph increments and ensure he was working on a level surface. We also had the patient side step and walk backward with various incline on the treadmill to develop dynamic stability. At this point, we also began to use our mini-trampoline to begin bouncing exercises as an introduction to jumping. We added use of a medicine ball, kettlebells, cable column, and the Body Blade to his balance training.
By postoperative week 14, the patient was cleared to begin sport-specific exercise. He was ecstatic about this, as he was previously told that he wouldn’t be able to return to sports for approximately 6 months.
This case study demonstrates how having access to specific exercise equipment and devices can provide a significant benefit to the rehabilitation of orthopedic and sports injuries. PTP
Andrew Hadrich, PT, DPT, is director of operations and a lead physical therapist at Select Therapy Inc. Hadrich received his Doctor of Physical Therapy from The College of St. Scholastica in Duluth, Minn, and has completed advanced postgraduate training in Osteopathic Manual Medicine at Michigan State University. Clinically, he specializes in treating chronic back and neck pain as well as orthopedic and sports injuries. For more information, contact PTPEditor@medqor.com.