Injury Prevention & Rehabilitation

The technical advancements in the rehabilitation of sports injuries has increased significantly in the past decade, including revolutionary surgical techniques, material science innovations, and aggressive protocols. BMT researches and effectively utilizes these technical advances to provide a comprehensive rehabilitation program. Our team has insight into optimal athletic function and we serve a vital role during the final stages of an advanced rehabilitation program by preparing the athlete for a return to unrestricted competition. We have unmatched expertise in the physiological events that follow a musculoskeletal injury and therefore we achieve the best injury outcomes. We understand that although both the team and player are anxious for the return to the playing field, each athlete responds differently to injury and progresses at a unique rate during rehabilitation. That is why our programs are team structured and tailor made. We confer with each member of the BMT team to make the final determination of an athlete's readiness for return to competition. Our team approach allows each member, who is an expert in a specific discipline, to know which exercises the injured athlete is performing, how the athlete is responding to these exercises, and what changes have been made.

BMT employs the latest advances in acute injury management and rehabilitation, utilizing new prophylactic treatments and therapeutic modalities such as preventive exercise and equipment (new types of braces made from state-of-the-art materials by bioengineers, and machines that control stress and minimize impact). We have developed our own criteria for indications and contraindications for the rehabilitating athlete, and have developed specific criteria to progress from one phase to another during the rehabilitative process, considering variables such as range of motion, strength, and balance. Our extensive knowledge of sport biomechanics allows us to design rehabilitation programs that prepare an athlete for return to specific stresses of his sport- we perform functional activities that are specific to the athlete's sport and position. Our expertise in biochemistry allows us to understand the body's metabolic response to the healing process, as well as appropriate nutrition regimens that accelerate the healing process. We also understand that rehabilitation and regaining confidence is a psychological process, so we emphasize the mental aspect of returning from a serious injury. We carefully monitor and keep data on all our athletes’ injuries, no matter how minor, so that they do not progress.

The tissue healing process

We are careful to maintain the balance of not overstressing healing tissues yet continually progressing the athlete’s rehabilitation. Though therapeutic stress is appropriate during tissue healing too much stress can damage new structures and bring the athlete back to the beginning. This balance is accomplished by our extensive research into ligamentous and musculotendinous trauma and the inflammation, repair, and remodeling phases of tissue healing. During the inflammatory phase, we use state of the art technology to maximize the body's natural mechanisms that contribute to tissue healing (new blood vessel and collagen production using ultrasound, electrical, and laser stimulation), while minimizing those that results in a decrease in function (swelling and pain). We realize that a quick return to function relies on the health of other body tissues. Therefore, the power, strength, speed, and endurance of the musculoskeletal tissues and the function of the cardiorespiratory system is maintained, which involves resistance and aerobic training of the uninjured extremities. This is in an effort to speed the rehabilitation process into the next phase, the repair phase. We improve tissue integrity by speeding up the process by which damaged, unviable tissue is replaced by new, functional tissue. It is important during the repair phase to prevent excessive muscle atrophy and joint deterioration of the injured area. A balance must once again be maintained in which disruption of the newly formed collagen fibers is avoided but low-load stresses are gradually introduced to allow increased collagen synthesis and prevent loss of joint motion. To protect the new, relatively weak collagen fibers, we avoid active, resistive exercise to the damaged tissue. However, too little activity, can also have a deleterious effect, as newly formed fibers will not optimally align and may form adhesions, thereby preventing full-motion. Early, protected motion hastens the optimal alignment of collagen fiber and promotes improve tissue mobility. The use of therapeutic modalities during the repair phase is to promote collagen synthesis. Exercises that can be used include isometric exercise at a low enough intensity (and at multiple joint angles) so that newly formed collagen fibers are not disrupted. Performing isokinetic exercises will allow a resistance at a given speed, and gains can be quantitatively recorded. Isotonic exercises or movements with constant external resistance are useful because the amount of force required to move the resistance varies depending primarily on joint angle and the length of each agonist muscle. The speed at which the movement occurs is controlled by the athlete. Therefore movement speed can be a program design variable, with more acute injuries using slower movement and later phases of healing using faster, more sport-specific movement.

After an injury, proprioception, or the sense of joint position in movement is impaired. We use lower-extremity balance exercises that improve the neuromuscular sense. Upper-extremity exercises include strength maneuvers with the hands on uneven surfaces. This process also can be accelerated into the final phase, the remodeling phase, where this new tissue, still lacking structural organization and integrity, is strengthened and becomes functional. During the remodeling phase we focus on optimizing tissue function by adding more advanced, sport-specific exercises that allow progressive stresses to be applied to the injured tissue. Progressive tissue loading allows improved collagen fiber alignment and fiber hypertrophy. These sport-specific exercises are designed to replicate movements common in the athlete's sport. In addition, the exercises must replicate the movement speed in the athlete's sport, and rapid speeds may be required during the later phases of rehabilitation. Exercises will include combinations of closed kinetic chain and open kinetic chain movements, since both occur simulataneously in sports. Closed kinetic chain exercises simulate most sports because the feet are fixed to the surface and provide the basis upon which movement occurs. In addition, these exercises are sport-specific because they involve joints working in concert with the adjacent joints and surrounding musculature. Open kinetic chain exercises allow for greater concentration on an isolated joint or muscle. Our resistance training protocols have been carefully designed and allow flexibility for manipulating the intensity and volume, so they can be tailored to the demands of specific sports. The orderly and timely progression through these phases determines how that body part will function for the rest of the athlete's career.

Preventive Physical Theraphy

This program is aimed at preventing injury, impairment, and functional limitation. Our team completes a thorough evaluation of the athlete and a comprehensive individual program is implemented for each patient, with an emphasis on preventing the statistically most common injuries in that athlete’s sport. In addition, we research and utilize all compounds which have been demonstrated to play a role in reducing joint and muscle inflammation in order to promote recovery and prevent injury.

Rehabilitational Physical Therapy

Our team of physical therapists, working closely with our physicians and scientists, is specially trained to examine and treat musculoskeletal and neuromuscular deficits that limit an athlete’s optimal performance. We are experts at this analysis of sport induced impairment and functional limitation, and determine a diagnosis and prognosis. Our accurate prognosis will indicate the degree of improvement that might be attained. We then design and implement the appropriate therapeutic intervention, which is a comprehensive individualized program for each patient. Our purpose is to not only decrease pain, but to normalize function, provide a quick return to high performance athletics, and finally to establish an ongoing prevention program.

Pain Reduction

The challenge of managing painful conditions has produced a variety of techniques. The human body responds to pain in unique and unexpected ways. The body's own corrective processes are generally sufficient to produce enough mechanical force to reduce pain and normalize function. Since this process is unconsciously motivated, appropriate intervention must support and encourage the patient's ongoing activity.

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