Daily adjustable progressive resistance exercise technique
D.A.P.R.E.
D.A.P.R.E. To Develop Strength
The athlete must perform some progressive resistive exercises on a regular basis if an increase of strength is desired
The D.A.P.R.E. technique takes advantage of the fact that strength can be redeveloped much more quickly than it was developed initially.
Patients perform maximal repetitions during their third and fourth sets, with the number or repetitions performed used as a basis for adjusting the resistance for the fourth set and next day, respectively.
Each side of the body should be worked independently Prevents the injured limb from depending on the non-injured one It establishes a functional strength-development goal for the
injured side.
D.A.P.R.E.
Set Portion of working weight used
Number of repetitions
1 1/2 10
2 3/4 6
3 Full Maximum*
4 Adjusted Maximum**
*The number of repetitions performed during the third set is used to determine the adjusted working weight for the fourth set, according to the guidelines in the next table
**The number of repetitions performed during the fourth set is used to determine the adjusted working weight for the next day, according to the guidelines in the next table
Adjustment of Working Weight
Number or repetitions performed during set
Fourth set* Next day**
0-2 Decrease 5-10 lb. and perform the set over
Keep the same
3-4 Decrease 0-5 lb. Increase 5-10 lb.
5-7 Keep the same Increase 5-15 lb.
8-12 Increase 5-10 lb. Increase 10-20 lb.
13 to… Increase 10-15 lb.
Set Portion of working weight used
Number of repetitions
1 1/2 10
2 3/4 6
3 Full Maximum*
4 Adjusted Maximum**
Number or repetitions performed during set
Fourth set* Next day**
0-2 Decrease 5-10 lb. and perform the set over
Keep the same
3-4 Decrease 0-5 lb. Increase 5-10 lb.
5-7 Keep the same Increase 5-15 lb.
8-12 Increase 5-10 lb. Increase 10-20 lb.
13 to… Increase 10-15 lb.
Cryokinetics in Rehabilitation of Joint Sprains
Cryokinetics
Effects Cold decreases pain Exercise increases blood flow Exercise reestablishes neuromuscular function
Cryokinetics Advantages
Cryokinetics allows exercise much sooner than normally would be the case.
Cryokinetics retards muscular atrophy and neural inhibitions.
Cryokinetics reduces swelling dramatically through muscular “milking action”
You can progress at the patient’s speed
Cryokinetics
Disadvantages Ice is very painful during the initial ice
immersion.
Cryokinetics
Indications Ankle sprains Finger sprains Shoulder sprains Other joint sprains
Cryokinetics
Contraindications Do not perform any
exercise or activity that causes pain
Do not use ice on a person who is hypersensitive to cold.
Cryokinetics
Precautions Pain must be used as a
guideline With lower extremity injuries,
patients may limp if not frequently reminded to refrain from limping.
There may be an increase in pain 4 to 8 hours after treatment.
Cryokinetics
Equipment Needed Slush bucket or ice
packs Toe cap Towel
Numb the Body Part Use ice immersion, ice massage, or cold-
pack application Numbing generally takes 12-20 min. The patients sensation is more significant
than the time of application Use a toe cap
Application Procedures
Exercise the numbed body part All exercise should be
Active Progressive Pain-free
Exercise should last 2 to 3 minutes, the duration of the numbness Renumbing takes 3 to 5 min.
Begin with simple rang-of-motion activities and progress through full-sport activity.
With some injuries, progression through full-sport activity will take place in a single treatment session, while with others it may take weeks.
Application Procedures
Exercise Progression For an Ankle Strain
Non-weight-bearing range of motion Weight-bearing Weight-bearing range of motion Walking Strengthening the ankle musculature Jogging Hopping and jumping Sprints Hopping and sprinting without ice application Team drills
Relieving Acute Muscle Spasm: Cryostretch
Cryostretch
Combines three techniques for reducing muscle spasm: Cold application Static stretching The hold-relax technique of PNF
Its purpose is to decrease muscle spasm, thereby allowing increased flexibility.
Is similar to cryokinetics in that exercise is performed while the body part is numbed.
Effects Ice diminishes pain and muscle spasm Static stretching overcomes the stretch
reflex, decreasing muscle spasm. Relaxation is often greater after a near-
maximal muscular contraction than it was before the contraction.
Cryostretch
Cryostretch
Advantages The combination of the three components into
one procedure is more effective than any of the parts independently.
Ice is relatively inexpensive; exercise is free.
Disadvantages Ice is painful to some people Melting ice can be messy.
Cryostretch
Cryostretch
Indications Any muscle with residual muscle spasm First-degree muscle strain A muscle that is stiff from prolonged disuse
(immobilized)
Contraindications Do not perform any exercise or activity
that causes pain. Do not use ice on a person who is
hypersensitive to cold.
Cryostretch
Precautions Pain must be used as a guideline. The patient
should not attempt to consciously or willfully overcome pain.
There may be an increase in pain 4 to 8 hours after treatment.
Muscles may tear or pull if the static exercise begins too quickly or suddenly. There must be a gradual build-up to a maximal conatraction.
Cryostretch
Summary Of Cryostretch Technique
ICE - Until numb (20 minutes maximum) Exercise Bout
First Stretch Total of 65 sec. Static stretch 20 sec. Isometric contraction 5 sec. Static stretch 10 sec. Isometric contraction 5 sec. Static stretch 10 sec. Isometric contraction 5 sec. Static stretch 10 sec.
Rest - 20 seconds Second Stretch (Same as first stretch)
Renumb with 3 to 5 minutes ice application Exercise Bout
Two stretches (65 sec.) with a 20 sec. rest between stretches Renumb with 3 to 5 minutes ice application Exercise Bout
Two stretches (65 sec.) with a 20 sec. rest between stretches