b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEREHAB UpdateBridging the Gap Between ANJC Scholarships Rehab and Return to PlayBy Dr. Donald C. DeFabioChiropractic physical rehabilitation is an integral part of todaysand be attentive to balancing agonist/antagonist muscle CHIRO Assist training in this stage.practice paradigm.Flexibility, cardiovascular and strength/ groups.Remember SPEED KILLS.Slowly introduce speed stability exercises allow the patient to return to ADLs faster and enable them to hold their adjustments better.In sport, LEGAL Q&A the same components are utilized for return to play (RTP) andBridge the Corrective Care Gap: Remember the Zone of Vulnerability - take charge of the activities that are allowed Executive Directors Update performance enhancement. and be clear on the patientsshort and long term goals.For Lets be honest, most patients present to our offices with painthe non-athlete, their current stability, flexibility and cardio 2020 ANJC AWARDS exercises will most likely be enough.Counsel them on or the inability to perform an activity.Whether it is awakening in the morning without back pain or being able to bench presswellness and consistency of doing the exercises to prevent without pain, they want to feel better.Therefore, the first goalregression.For athletes, RTP instructions are at a prescribed towards recovery is pain relief. level of intensity.Okay to do incline bench and pullovers at Active care for pain relief involves at a minimum maintaining50% max, or You can return to practice, walk through plays Legislative Update ROM and if possible restoring motion.In the acute stage,and do drills, but no scrimmaging, would be examples.INSURANCE Update INSURANCE Update progressive loss of motion will prolong the recovery process. Performance enhancement is the final frontier of physical Sports doctors frequently use protective devices such asrehab. Power, speed, balance and agility all need to be TECHNIQUE Update addressed.Multiplanar movements, functional specific braces, splints, taping, and appliances to limit motion to allow healing and provide protection of injured tissues. movement patterns and exercises with unstable surfaces are However, these protective devices that limit motion are not aincorporated.Relapses in this stage are generally due to stand-alone treatment, they are one part of a comprehensiveprogressing the patient too fast or failure to restore mechanics rehabilitative program that includes flexibility, stability andand stability in the corrective stage.Remember it takes time cardio.to build muscle, remodel injured soft tissue and correct faulty Bridge the Acute Care Gap: If protective devices are usedmovement patterns.Steadily increase activities and safely MedicareQ&AMedicare Update in your non-athlete population, follow the training roomchallenge your athletes.OUR HEALTHconcept of incorporating flexibility, stability, and cardioReturn to play is a clinical skill.However, when it comes to exercisesexercises that will assist in promoting full ROM,rehab, symmetry is essential.Balance in muscular strength, flexible scar tissue formation and functional mechanics.Forflexibility and endurance is imperative before an athlete can your athletes, be explicit on the activities they can and cannotreturn to the field.Here are your baseline ratios for RTP:perform. Knee & lower extremity injuries:Each leg must be within As patients begin to feel better and enter the sub-acute phase1. of care, our rehabilitative goal is to restore and balance motion10% for the non-elite athlete and 100% symmetry is of the affected joints as well as protect the area from additionalrequired for the elite athleteinjury.In sports rehab, once a patient becomes pain free, we2. Low back and Pelvis: 1:1.3 anterior chain to the posterior call it the Zone of Vulnerability.We have all seen it.As soonchain and 1:1 in the lateral chain for strength and endur-as the patient is feeling better, they overdo it and ZAP, they areanceback to the acute stage.In the sub-acute phase, restoring joint3. Cervical spine: 1:1.7 anterior to the posterior chain andmechanics, ROM and steadily increasing stability exercises are the key. 1:1 in the lateral chain, for both strength and enduranceBridge the Sub-Acute Care Gap: Movement patterns needEvery patient wants to Get back in the game of their life to be assessed and corrective exercise incorporated as theand chiropractic physical rehabilitation has the tools to treat patient becomes pain free.Teach them how to move betterathletes and non-athletes.Bridge the gap in your treatment so as they continue to strengthen, they will groove appro- plans by treating your athletes with attention to stability and priate movement patterns.For example, the low back painmovement patterns while treating your non-athletes with the patient mentioned above needs good hip hinge mechanics,attention and thoroughness your athletes receive.and the bench press athlete needs to isolate the scapularREFERENCES:retractors and depressors while benching. AndersonMJ et al, A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament, Orthop J Sports Med. 2016 MarchThe third phase of chiropractic rehabilitation is the corrective,Assessment and Treatment of Muscle Imbalance: The Janda Approach, Page P, Frank C, return to function, phase when you hear, When can I goHuman Kinetics, Champaign IL, 2010back to the gym? or Can play in the game tomorrow?TheFunctional Training Handbook, Liebenson C, Wolters Kluwer Health,China, 2014 rehabilitative goals are to maintain the motion that has been restored and increase stability and strength.This is a goodDonald DeFabio, DC, DACBSP, DACRB, DABCO, is in private time to introduce balance, agility, and proprioception activities.practice in Berkeley Heights where he hosts relevant rehab study For strength, resistance and repetitions need to be increasedgroups for doctors looking to workshop together. 14 I Summer 2021 www.anjc.info'