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World War Pigeon Found what was the code found?. Closer look. Winning power ball number??. Actually it was a football score. Florida 37 Florida State 26. E.J. Manuel injury: FSU QB takes shot to head vs. Florida Should he played?. Grade ?. Physiatrist P rescription. Pain relief Comfort.
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Actually it was a football score • Florida 37 • Florida State 26
E.J. Manuel injury: FSU QB takes shot to head vs. FloridaShould he played?
Physiatrist Prescription • Pain relief • Comfort
Motion • Passive • Passive assist • ROM re-education • Active assist • Active • Stretch • ROM limits?
Maximum anterior translation of the tibia occurs at 15-25 deg of flexion Limit knee extension
Strengthening • Isometrics • Multiple angle isometrics • Short arc isotonics • Full arc isotonics • Isokinetrics • Speed • ROM
Close Kinetic exercises in ACL rehab • Enhance functional performance activities • Less strain on the ACL • Less harmful on the patellofemoral joint
Q/H Ratio • exercisers are told that there should be a certain ratio between the strength of their hamstring and quadriceps muscles. • Called the H/Q ratio and reported to be anywhere from .50 to .75 with a normative value of .60, the strength ratio of this important agonist/antagonist pairing is considered essential to the stability of the knee joint and to prevent ACL and other injuries.
Q/H Ratio • The balance of quadriceps to hamstring strength is not 1:1; but closer to 3:2. In general healthy hamstrings can lift 60 - 80% of what healthy quads can do.
Isokinetic exercises • are performed at a dynamic preset fixed speed (ranging from 1 degree per second to approximately 1000 degrees per second) with resistance that is accommodating throughout the range of motion (ROM). • Accommodating resistance means that Isokinetic exercise is the only way to dynamically load a muscle to its maximum capability throughout every point in the ROM. • Therefore, the resistance varies to exactly match the force applied by the athlete at every point in the ROM.
Isokinetic machines have the ability to objectively measure muscle strength • The Isokinetic device is attached to a computer, that assesses the torque output of the muscles being testing. • The torque output is converted to a foot-pound measurement. Isokinetic testing allows for a variety of testing protocols ranging from strength, strength ratios between two muscle groups, power, and endurance.
Quadricep avoidance gait • quadriceps avoidance gait: - most patients will alter their gait in order to avoid anterior displacement of the tibia which occurs with quadriceps contraction; • - between 0 to 45 deg of flexion, contraction of the quadriceps will cause anterior translation of the quadriceps (which is normally resisted by the ACL); • - maximum anterior translation of the tibia occurs at 15-25 deg of flexion;
Quadricep avoidance gait • that is characterized by increased hip and knee flexion, reduced knee extensor torque, power, and loss of the biphasic knee joint torque pattern • EMG studies support these findings with increased hamstrings and reduced quadriceps activity
Summary • Early weight bearing is beneficial and may decrease PF pain • Early motion is safe and help avoid arthofibrosis • CPM is not warranted • CKE should be used in the first 6 weeks • Bracing has no advantage • Neuromuscular stimulation electric stimulation high enough intensity • Accelerated rehab program safe in the 5 to 6 month period • Water base activities, stair climber, slide board exercise are safe and add variety • Gait proprioception and psychological training may be of some benefit • Creatine offers no benefit
Physiatric Prescription Summary