Functional Progressions and

Functional Testing in Rehabilitation

Rehabilitation Techniques for Sports Medicine and Athletic

Training
William E. Prentice
 Introduction
 To reduce lasting effects of injury, athletic trainer should
direct rehabilitation toward improving neuromuscular
coordination and agility as well as strength and
endurance
 Return athlete to pre-injury activity levels
 Function refers to patterns of motion that use multiple
joints acting with various axes and multiple planes

 Focus on functional rehabilitation will ready patient for

activity and competition
 Role of Functional Progressions in
Rehabilitation
 A.T. must adapt rehabilitation to the sports specific
demands of each individual sport and position
 Functional Progression
 Succession of activities that simulate actual motor and
sport skills
 Enable patient to acquire or reacquire skills needed to
perform athletic endeavors safely and effectively
 Places stresses and forces on each body system in a
well-planned positive and progression fashion
 Improves patients overall ability to meet the demands of daily
activities as well as sport competition
 Role of Functional Role of Functional
Progressions in Rehabilitation
 A.T. breaks down activities involved in a given sport
into individual components
 Patient concentrates on components in a controlled
environment before combining them together in an
uncontrolled environment

 Essential in the rehabilitation process

 Tissues not placed under performance level stresses do
not adapt to the sudden return of such stresses when full
activity is resumed
 Benefits of using Functional Progressions
 Assist patient and A.T. in reaching the goals of the
entire program
 Restoration of joint ROM
 Strength
 Proprioception
 Agility
 Confidence
 Allow patient to reach desired level of activity safely and
effectively
 Physical Benefits
 Improving functional stability
 Maintained by neuromuscular control mechanisms involved in
proprioception and kinesthesia
 Performance during functional task can be evaluated and corrected
 Functional testing can be used to provide objective measure of ability

 Muscle strength
 Muscles involved will be strengthened dynamically under stresses similar
to those encountered in competition
 Using SAID and Overload Principles

 Endurance
 Muscular and cardiorespirtaory endurance can be enhanced with
functional progressions
 Through repetition of of individual activities and their combination into one
general activity
 Physical Benefits
 Flexibility
 Injured area stressed within a controlled range during functional
progression
 Improved mobility and flexibility crucial to patient return to
activity
 Strength and endurance do not mean much if injured area
cannot move through normal ROM

 Muscle relaxation
 Functional progression can teach an individual to recognize
muscle tension and eventually control or remove it by relaxing
muscles after exercise
 Relieve muscle guarding that may inhibit normal ROM
 Physical Benefits

 Motor Skills
 Coordination, agility and motor skills are complex aspects
of normal function
 Needed to transform strength, flexibility and endurance
into full-speed performance
 Repetition and practice are are important to learning
motor skills
 Rehabilitation exercises must stress neuromuscular
coordination and agility to increase performance and
decrease chance of reinjury
 Develop automatic reactions needed during activity
 Psychological Benefits
 Functional progression can help reduce common
emotions found after injury
 Anxiety
 Athlete gradually placed into more demanding situations.
 Experience success and not be as concerned with failure
 Deprivation
 Athlete can engage in activity during practice to remain close
in proximity and socially feel little loss in team cohesion
 Apprehension
 Enable patient to adapt to imposed demands of their sport in
a controlled environment
 Restore confidence
 Components of a functional
progression
 Four principles
 Individuality of the patient, sport and the injury
 Activities should be positive not negative; no increase in
signs or symptoms
 Orderly progressive program
 Program should be varied to avoid monotony
 Vary exercise techniques
 Alter the program at regular intervals
 Maintain fitness base
 Set achievable goals , reevaluate, and modify regularly
 Use clinical, home and on field programs
 Use sport specific activities to enhance patients return to activity
 Designing a Functional
Progression
 No cookbook, be creative and specific to athletes goals
and injury status
 Progressions should start early in rehab
 Start with low impact and progress to high impact
 Assess athlete periodically to determine ability to
progress to next exercise
 Achieving a certain skill level occurs when a the skill
can be completed at functional speed with high
repetition without increase in pain, swelling or a
decrease in ROM
 Functional Testing
 Patient performs certain tasks appropriate to their stage in
rehab
 Isolate specific deficits

 A.T. able to determine current functional level and set functional

goals

 Indirect measure of muscular strength and power

 Uses maximal performance of an activity

 Provide A.T. with objective data

 Functional Testing
 Three purposes

 Determine risk of injury due to limb asymmetry

 Provide objective measure of progress during rehab plan

 Measure the ability of the individual to tolerate forces

 Functional Testing
 A.T. must evaluate what test will be used
 Validity : test should measure what it intends to measure

 Reliability: Test should consistently provide similar results

regardless of evaluator

 Observe unilateral and bilateral function to determine

compensation patterns

 A.T. should also consider stage of healing, strength,

patients ability and physician approval
 Functional Testing
 Preseason baseline measurements are preferred so
A.T. has data to compare post injury activity levels

 Not always obtained by A.T., however individual sports

may do baseline testing

 With or without baseline measurements a score of 85% or

better compared to noninjured side is recognized as
standard for limb symmetry scores
 Functional Testing
 Uses functional progression drills for the purpose of
assessing the athlete’s ability to perform a specific
activity
 Entails a single maximal effort to gauge how close the
athlete is to full return
 Pre-season baseline testing for comparison post injury
 Variety of tests
 Shuttle runs -Vertical jumps
 Agility runs -Balance
 Figure 8’s -Hopping for distance
 Carioca tests -Co-contraction test
 Lower Extremity Functional
Progression
 Walking: Normal Gait
 Walking: Heels walks
 Walking: Toe walks
 Side step/Shuffle
 Lunge 90° to Lunge 180°
 Step ups forward to lateral step ups
 Increase speeds
 Jogging
 Begin straight ahead, gradually increase intensity 50%-
100%
 Introduce curves: Oval,“S” course, figure “8” course, “Z”
course

 Sprint
 Straight ahead varying intensities
 Add acceleration/deceleration drills
 Box Runs
 Carioca
 Hopping:
 Double Leg to Single Leg to Alternate
 Jumping:
 Plyometrics
 Progress intensities
 Sport specific

 Speed and Agility drills:

 Sport specific
 Ladder drills
 Cutting, jumping on command
 Position specific activities
 Upper Extremity Functional
Progression
 Assisted PNF techniques
 T-band exercises simulating specific sport/position
motions
 Strength and endurance
 Closed chain exercises: Push up progression
 Upper Body Plyometrics
 Interval throwing program
 Focus on mechanics and biomechanical dysfunctions
 Begin with general warm up
 Step 1: 45 ft. phase
 Warm up throwing
 25 throws
 Rest 10 minutes
 Warm up throwing
 25 throws
 Step 2: 45 ft. phase
 Warm up throwing’
 25 throws
 15 minute rest
 Warm up throwing
 25 throws
 Rest 10 minutes
 Warm up throwing
 25 throws
 Repeat steps 1 & 2 for 60, 90, 120, 150, 180 ft.
 Only progress if pain free and no signs or symptoms
develop
 When program completed move to position specific
throwing
 For example: pitcher throw off mound
 Designing a Functional
Progression
 Full Return to Play
 Physicians release
 Pain free
 No Swelling
 Normal ROM
 Normal strength (in reference to contralateral limb)
 Appropriate functional testing completed with no adverse
reactions