Therapeutic Intervention and Rehabilitation
What this domain tests
Exercise-based rehabilitation design, loading progression, modality selection and criteria-based return to sport rather than time-based clearance.
Core rules and concepts
- PEACE & LOVE (2019) replaced RICE-style advice: Protect, Elevate, Avoid anti-inflammatories, Compress, Educate acutely; then Load, Optimism, Vascularisation, Exercise. Early controlled loading is preferred to prolonged rest.
- Tendinopathy responds to progressive mechanical loading. Eccentric and heavy-slow-resistance programs for Achilles and patellar tendons typically run 12 weeks with 3–4 sessions weekly, progressed by pain response (acceptable pain up to about 3–4/10 that settles within 24 hours).
- Return-to-sport criteria after ACL reconstruction include quadriceps limb symmetry index above ~90%, hop-test symmetry, and psychological readiness (ACL-RSI). Time since surgery alone is insufficient.
- Pain-monitoring model: modify load when symptoms exceed the agreed threshold or fail to settle; do not simply rest.
- Modalities: ultrasound and passive electrotherapy have weak evidence; exercise and load remain the active ingredients.
Worked example
A volleyball player with 6 months of anterior knee pain has focal patellar tendon tenderness and pain on loading. Reasoning: this is patellar tendinopathy, so prescribe a 12-week decline-squat eccentric or heavy-slow-resistance program, three sessions weekly, adding load when pain settles within 24 hours; concurrently address landing mechanics and jumping volume. Isolated ultrasound or corticosteroid injection would give short-term relief without restoring tendon capacity.
Traps that cost marks
- Clearing an athlete for sport on elapsed time rather than tested criteria.
- Advising complete rest for tendinopathy, which reduces load tolerance.
- Missing psychological readiness as a reinjury risk factor.