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Injury Management of The Anterior Cruciate Injury

Injury Management of The Anterior Cruciate Injury. Sprains Anterior cruciate Posterior cruciate Medial collateral Lateral collateral. Injury Prevention. Knee Taping. Knee Evaluation. CHECK LIFE THREATENING SITUATIONS _____ABC'S (usually not a problem) _____check for traumatic shock

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Injury Management of The Anterior Cruciate Injury

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  1. Injury Management of TheAnterior Cruciate Injury

  2. Sprains • Anterior cruciate • Posterior cruciate • Medial collateral • Lateral collateral

  3. Injury Prevention

  4. Knee Taping

  5. Knee Evaluation

  6. CHECK LIFE THREATENING SITUATIONS _____ABC'S (usually not a problem) _____check for traumatic shock • HISTORY OF THE INJURY _____where doe’s it hurts? point to the spot. _____when did it happened? _____how did it happened? _____what was the position of foot and knee before injury? _____what was the position of foot and knee after injury? _____what activity bothers you most? _____did you hear or feel a pop, snap, crack _____does your knee lock _____were you able to continue your activity after the injury • HISTORY OF THE INDIVIDUAL _____have you had a previous knee injuries? when? _____ -did you see a physician _____ -what was your rehab. _____have you made any training changes

  7. OBSERVATION _____compare opposite sides of the body _____observe for swelling _____observe for deformity _____observe for muscle atrophy (observe the position of the patella) _____-patella alta _____-patella baja (observe for alignment) _____-genu valgum _____-genu varum _____-Q angle • PALPATE _____tell athlete it will hurt and why _____palpate for pain or point tenderness _____palpate for bumps, deformity, and effusion (swelling in joint) _____start away from suspected injury _____palpate the bones (femur, tibia, fibula, patella) _____palpate ligaments (MCL, LCL, ) _____palpate joint lines _____palpate muscles/tendons (hamstring, quads, gastroc, ) _____palpate bursae

  8. TEST STRUCTURAL INTEGRITY_____sensory nerves _____motor nerves _____circulation _____Reflexes _____ -patellar reflex (L3 and L4) _____ -medial hamstring reflex (L5) Active ROM _____ -flex, extend knee Passive ROM _____ -flex, extend knee Resistive ROM _____ sartorius _____quadriceps _____biceps femoris _____semitendinosus/ semimembranosus _____popliteus

  9. Lachman Valgus stress Varus stress • Special Tests _____ -valgus stress test (straight and 20 flex) _____ -varus stress test (straight and 20 flex) _____ -figure 4 test _____ -Lachman's test

  10. TEST FUNCTIONAL ACTIVITY _____**only if you suspect a mild injury** _____walk _____hop 10 times on injured leg (if walking is pain free) _____jog (if hopping is pain free) _____run and cut (if jogging is pain free)8. DECISION AND ACTION _____if it is a mild injury--tape & play _____if it is a moderate injury--ICE & rest _____if it is a severe–refer to a physician9. RE-EVALUATE _____after ICE, if used _____throughout rehabilitation10. RECORD RESULTS _____ enter injury report in records

  11. First Aid Care • Ice, Compression, Elevation • Knee immobilizer • Crutches

  12. TRADITIONAL REHABILITATION

  13. WEEKS 0-2: • Non weightbearing • Brace locked at 30 and 60 degrees • Quadricep and Hamstring isometrics • Electrical muscle stimulation • Ankle ROM and strengthening • Heel slides • Patellar mobilization

  14. WEEK 4: • Non weightbearing • Brace locked at 30 and 90 degrees • Quadricep and Hamstring isometrics • Straight leg raises • Electrical muscle stimulation • Pool exercises (hip and ankle)

  15. WEEK 6: • Non weightbearing • Brace locked at 0 and 90 degrees • Quadricep and Hamstring isometrics • Straight leg raises with weight • Hamstring curls • Hip progressive resistance exercises • Pool ROM • Cycling for ROM

  16. WEEK 8: • Begin weightbearing • Derotational brace without limits • ROM should be 0 and 110 degrees • Cycling • Hamstring curls 

  17. 3 MONTHS: • ROM 0 and 125 degrees • Treadmill walking • SLR with weight increase • Cycling • Quarter squats

  18. 4 - 6 MONTHS: • ROM 0 and l40 degrees • Treadmill walking (taster) • Isotonic knee extensions • Isokinetics when 10% of body weight can be done isotonically (90-240 degrees/second) • Step-ups

  19. 6 MONTHS: • Test isokinetically • Begin terminal knee extension • Running (straight ahead)

  20. ACL Rehabilitation Program Chehalem Physical Therapy, Inc. ,   120 - C N. Everest Rd.,   Newberg, Oregon   97132

  21. Day 1 – 3 • Range of motion with emphasis on knee extension. • Cold therapy (with compression and elevation). • Weight bearing to comfort with crutches using long-leg brace locked at 0 degrees. • Patellar, scar, and soft-tissue mobilization. • Exercises: • Quad/Hamstring setting. • Heel slides. • Knee extension stretch with heel pillow • Ankle pumps. • SLR (in long-leg brace; locked). • Patellar mobilization.

  22. Day 4 – 14 • Weight bearing as tolerated with full weight bearing. • Continue with pain control, range of motion, and mobilization treatment. • Begin balance and position-sense exercises (tandem stance, single stance, mini-tramp balance). • Exercises: • Quarter squats/weight shifts. • Hamstring curls. • Stationary bike for range of motion and early endurance. • Lateral step-ups. • Calf raises.

  23. Week 2 - 6 • Push for full extension range of motion. • Exercises: • Leg press • Sport cord drills • Swimming, cycling, functional exercises (squats, lunges) • Fit for custom sports brace (per MD).

  24. Week 7 – 11 • Exercise progression (intensity, resistance, and aerobic work). • Begin lateral resistance drills (sport cord, carioca). • Straight-line jogging.

  25. Week 12 – 16 • Advanced closed kinetic chain functional exercises. • Sport-specific exercises. • Isokinetic knee evaluation 90 - 40 degrees.

  26. Week 16 + • Progressive cutting/pivoting. • Progressive running. • Progressive plyometrics.

  27. Criteria for return to competition: • Full range of motion. • Normal balance and proprioception. • 90% or better functional strength.

  28. University of Oregon Athletic MedicineAnterior Cruciate Ligament Rehabilitation Protocol • Purpose: The purpose of having a written protocol for the rehabilitation of knees after ACL reconstructive surgery is not to create a "cook book" formula, but to have an outline that can be followed as a consistent guideline for progression of the athlete. The time frames may change depending on the goals of each athlete and the philosophy of the surgeon. Ideally, surgery would be delayed until knee motion and quadriceps control are restored and effusion is minimal.

  29. Weeks 1-4 • Goals: • Decrease pain and swelling • Increase ROM • Progress from partial to full weight bearing with proper gait • Increase quadriceps and • hamstring strength • Promote proper patellofemoral function • Initiate restoration of proprioception • Promote crossover effect by exercising uninvolved knee • Specific Rehabilitation Techniques: • Ice/electrical modalities • Quadriceps/hamstring sets (single & co-contraction) • Biodex PROM (Pain-Free) • Patellar mobilization • Prone hangs (Progress to ankle weights) • Supine passive terminal extension stretch • VMO training (starting w/QS & Russian EMS) • Lateral complex stretching & McConnell taping (If necessary) • Ankle pumps & PNF • AROM leg extension (No resistance) • MRE for hip (Ext., ab., ad., flex. (bent knee) • Note: Adduction is contraindicated during this time for athletes who also injured their MCL • Non-weight bearing to weight bearing step-up progression • Bike for ROM • ¼ Squats • Carpet Drags • Step-ups w/Russian EMS • Shuttle w/Russian EMS • Sport cord 1/3 squats (double & single leg) • Shuttle leg presses (double and single leg) • Leg curls (single) • Bridging with and without a physioball (Can be initiated after athlete has 45 degrees of flexion) • Single leg balance (Begin on floor, progress to foam and then to trampoline) • UBE • Calf exercises (Seated machine, leg press, shuttle, standing)

  30. Weeks 5-12 • Goals: • Continue to strengthen the quadriceps muscles with closed chain exercises ONLY • Continue to strengthen the hamstring muscles • Facilitate proper gait patterns and joint mechanics • Continue to facilitate proprioception • Initiate restoration of cardiorespiratory function • Specific Rehabilitation Techniques: • WWP (AROM) • Leg curls (single) • Hip & thigh machine • Step-downs w/Russian EMS • Backward walking on treadmill (Progress to 2.0 MPH at 12x % grade for 5 minutes) • Shuttle leg presses (Double & single leg) • Leg press • Tubing squats • Biodex (Hamstrings only) • Eccentric hamstrings on Biodex • Squats (Back & overhead) • Pool • Bike • Form walking routine • Balance squats • Single leg balance (Progress to trampoline: eyes open/closed w/wo body blade) • Stairmaster • Slideboard • Treadmill walking • Treadmill walk/jog • Treadmill jogging • Treadmill walking/running • Seated calf raises • Ball toss • Chair scoots • Calf exercises (seated machine, leg press, shuttle, standing)

  31. Weeks 13-24 • Goals: • Continue increasing strength, power, muscular endurance • Restoration of cardiorespiratory function • Further development of normal gait patterns • Progress from general sport movements to sport and position specific drills • Specific Rehabilitation Techniques: • Stairmaster • Bike • Treadmill Jogging • Leg curls (Single) • Biodex (Hamstrings only) • Eccentric hamstrings on • Biodex • Ball toss (Foam & trampoline) • Strides • Figure 8’s • Zig-zags • Stadiums • Form walking/running routine • Slideboard • Sport cord jogging • Leg press • Shuttle leg presses (Double & single leg) • Shuttle jumps (Double & single leg) • Fitter • Calf exercises (Seated machine, leg press, shuttle, standing)

  32. 6-9 Months • Goals: • Increase strength, power, muscular endurance to 90%+ of uninvolved leg • Increase running and cutting to meet demands of individual sport • Increase cardiorespiratory function to levels needed for particular sport participation • Progress to partial of full sport activities • Specific Rehabilitation Techniques: • Biodex testing (180 degrees – 10 reps, 300 degrees – 15 reps) • Return to activity drills Agilities • Plyometric program • Calf exercises • Squats • Shuttle jumps (Double & single leg) • Leg curls (Double) • Sprint Progression • Integrate into normal lifting and conditioning activities with appropriate limitations

  33. 9-12 Months • Goals: • Continue rehabilitation of any deficient areas of involved extremity (i.e. strength, power, muscular endurance, or cardiorespiratory function) • Maintenance program for non-deficient areas • Specific Rehabilitation Techniques: • Appropriate exercises from previous techniques • Biodex Testing (If necessary)

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