Active rehabilitation programmes of the lower limbs are designed with the intent of restoring physical strength and mobility in an individual, most often following a passive care programme if injury or surgery was involved.
Such programmes are tailored specifically for a patient’s condition, and involve a combination of muscle stretching, strengthening and core exercises to increase flexibility and enhance functionality in the lower extremity.
Recommended as a noninvasive method of pain management and recovery, active rehabilitation strategies are widely used in the treatment of a number of musculoskeletal problems associated with biomechanical abnormalities.
A study conducted by Michael Skovdal Rathleff for the Scandinavian Journal of Medicine & Science in Sports focused on investigating the effectiveness of short inserts and plantar fascia-specific strengthening exercises, in comparison to shoe inserts and high-load strength training in patients with plantar fasciitis.
The traditional plantar fascia-specific exercises were found to be less effective in reducing pain after three months, when compared to the superior functional outcomes achieved with high-load strength training consisting of unilateral heel raises.
This established the fact that the use of simple progressive exercise protocol can help in achieving stabilisation of ligaments and tendons, providing long-term relief from pain and discomfort in addition to improving functionality.
Another elaborate study by Matthew T. Crill for the Foot & Ankle Specialist investigated changes to muscle architecture that occurred with eccentric training in patients with Achilles tendinosis.
For this purpose, twenty-five patients diagnosed with the condition participated in six weeks of rehabilitation, which included specific exercises for the ankle plantar flexors.
The medial gastrocnemius muscle fascicle length was reported to have increased by 12 per cent, correlating with improvement in a validated patient outcome scoring system; this signifies a rightward shift in the length tension curve which could be responsible for preventing future injuries related to the muscles.
Most injury-prevention programmes include core stability training because of its crucial role in facilitating the transfer of momentum and torque between the upper and lower extremities for the performance of daily activities.
Kellie C. Huxel Bliven, of the Department of Interdisciplinary Health Sciences at AT Still University, explored this further by reviewing several epidemiological, biomechanical and clinical studies, which focused on core stabilisation exercises for injury prevention.
At the end of the review, the author suggests a multifaceted approach to designing training programmes, which would address core muscle strength and endurance such as muscle activation, neuromuscular control, static stabilisation and dynamic stability for the effective reduction of lower extremity injury rates.
William Ben Kibler, of the Lexington Clinic Sports Medicine Center, describes core stability as a “highly integrated activation of multiple segments that provides force generation, proximal stability for distal mobility, and generates interactive moments”.
In a study published in Sports Medicine, he recommends an evaluation of the three-planar motions used by the core to accomplish functionality; this would help develop a better understanding of the complex biomechanics which can be used for designing specific rehabilitation protocols.
An active rehabilitation programme augments the use of customised orthotics in treating and managing pathologies of the lower extremity. By adding strength to affected muscle groups whilst providing adequate support to the musculoskeletal system, the patient has a better chance of recovery and is able to make a gradual return to activity.
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