The majority of patients in the study by Cohen et al (2007) examining rotator cuff contusions showed quick responses to treatment with modalities such as, pulse ultrasound and cuff/scapula strenthening. It was noted that the athletes who had significant subentheseal bone bruises and what the researchers called “chronic tendinopathy” had more prolonged recovery. In the patients who did not demonstrate significant improvement by the third day after injury (23%) a subacromial corticosteroid injection was utilized; this step was described to be of benefit, because only one of the six athletes who received a cortisone injection later needed surgery. Minimal morbidity was noted overall as a result of the contusions but 11% of the patients required later surgical intervention.

In the overhead throwing athlete, shoulder rehabilitation should be directed at the underlying deficits, most commonly loss of shoulder internal rotation and poor control of the scapula. A four-phase approach is described by Wilk & Macrina (2014) in the nonoperative treatment of throwing shoulder injuries. In phase 1, the “acute phase,” the primary goals are to diminish pain/inflammation, improve motion, activate the appropriate muscles, create dynamic stability and muscle balance, and restore proprioception. The athlete’s level of activity is adjusted according to symptoms, which usually require the athlete to abstain from activity. Internal rotation motion is addressed; the preferred stretches are the modified sleeper’s stretch and supine horizontal adduction with internal rotation stretch (Fig. 6A.2). A horizontal adduction stretch with manual patient assistance into internal rotation is performed. Assessment of scapula positioning is also recommended, with strengthening of the scapula retractors and the lower trapezius and additional stretching of the pectoralis minor. The primary goals of phase 2, the “intermediate phase,” are to progress the strengthening program, improve the range of motion, and facilitate neuromuscular control. Core strengthening is also initiated during this phase. Kibler et al (2013) have emphasized the need to evaluate and treat the entire system to restore the athlete’s kinetic chain. Phase 3, the “advanced strengthening phase,” involves aggressive strengthening drills to promote power and endurance as well as functional drills, and throwing is gradually introduced. “Return to throwing phase,” phase 4, incorporates the progression of an interval-throwing program. This program controls for distance, intensity, and surface, in that for pitchers, throwing from the mound is the last advancement. It is important to be aware that when athletes are told to throw with 50% effort, they actually throw at 83% of their maximal speed, and when asked to throw at 75% they are actually throwing at 90% of their maximal effort (Fleisig et al, 1996).
Evaluation formative : L'évaluation formative a lieu dans le cours d'une progression (suite de séances d'apprentissage). Elle a en réalité trois objectifs. Le premier est de donner une première indication à l'enseignant sur l'efficacité des premières séances de la progression. Le deuxième est de participer à l'apprentissage en permettent à l'élève de faire le point sur ce qu'il est en train d'apprendre. Le troisième est l'adaptation par l'enseignant de la fin de la progression aux besoins qui demeurent ou aux nouveaux besoins qui sont apparus.
Pédagogie de maîtrise : La pédagogie de maîtrise est une pédagogie par objectif. L'objectif d'apprentissage est fixé par l'enseignant et les élèves ont le droit pour l'atteindre de passer par des "chemins personnels" différents. Elle est basée paradoxalement sur la reconnaissance que l'enseignant ne peut pas tout maîtriser de ce qui se passe dans la tête de l'élève et de sa manière personnelle d'apprendre. On la rencontre sur internet sous le sigle de PMEV (Pédagogie de maîtrise à effet vicariant).
Pour les fiches PEMF, peut-être que le mieux c'est de mettre tout le monde en même temps du plan de travail et quand ils ont terminé une fiche, ils s'inscrivent à la correction et tu les appelles un par un à ton bureau? Et quand ils attendent la correction, ils font autre chose (autre fiche pemf ou remise au propre de texte libre, création mathématique ou autre?)
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