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13 yr old Female L Lateral Femoral condyle non-depressed subchondral #…

- - - - Pain at the end of the day, but not too bad otherwise. Feels very stiff in the morning. nil night pain. Agg's stairs and being still for extended periods. Eases having leg extended
        
        (me) feeling much better, able to walk a lot better and managing pain much better
        
        Knee swelled up over weekend after last session. nil complaints today. feeling better every day
        
        was a little sore after heavy session but settled down over the following days
  - - - GOALS: Get to US at the end of the year to snowboard, walking normally again and resuming activities (athletics + swimming), compete at world champs and olympics.
- - - - Treatment session 1. STM quad, HS, calf 2. Quad holds 5 sec 5 x 2 , 3. DL glute bridge 10 x 3, 4. gait training. Plan 13 wk bee knees + graded return to sport
        
        Session 2: not much change > ROM L) ext = -3 flex = 125 1. STM quad, hs and calf 2. DL glue bridge 10x 3, 3. calf raises 3 x10, 4 STS 2 x 8 5. clams 3 x 8 red TB
    - - AROM L) ext = 0 flex = 139 1. STM quad, HS, calf 2. trampoline push down into extension 3. SL balance on foam 30s x 4, 4. BOSU ball circles (mimicking snowboard riding) 5. HS bridges on 20' box 8 x 3 [Check gait and progress strength)
        
        Walking improved again. Squat to full depth bearing weight mostly through R leg. SLS no pain L side, however valgus motion by L leg (loss of glue control?) Rx Box Squats 2 x 25 @ BW + 1 x 25 holding 5 kg plate, hip thruster with 12.5kg bar x 10 kg, 2 x 10 20kg, DL calf raise 20 kg bar 1 x10, + 10kg 2 x10, GHD back extension 3 x 10, Bosu balance work in DL stance (squatting, coming onto toes, rolling around, forwards/backwards, catching + throwing and doing maths problems) 4 x ~2mins,reformer calf raises. SLS and DL squat slight improvements in depth and control post exercise nil pain. Next begin jumping on reformer
        
        AKE: 160 Thomas: 1 L. Rx STM HS// 170 AKE, HS PNF 10 sec x 3 // AKE 175, clams green TB 3 x 8, HS slide outs 8 x 3, leg press DL 50 kg, Deadlifts 20, 30, 30kg 8 x 3 // SLS and DL squat quality improved and pain free
        
        AKE 165. Rx HS PNF 10s x 3 // AKE 175 clams + HS slide outs + leg press DL 50kg + Deadlifts 30kg + walking lunges + GHD + seated calf raises // squat quality getting more balanced and greater depth
        
        Next addition of jumping (reformer, tramp, DL, landing practice, hopping ++ plyometrics for return to sport) also consider cutting high velocity shearing forces involved in snowboarding. consider training with equipment. board on bosu etc, jumps, spins, lands, moving around up and down + pressure forwards and backwards.
  - - - Wks 16-20 Agility/cutting/twisting • Sport specific
        • Symptom free sports specific training
      - Wks 20+ • Return to full competitive sport
        • Fully fit for demands of specific sport
      - Wks 12-16 Progress strength training + commence jogging/running + plyometrics (Ensure no pain, no activity related swelling, normal running pattern
      - Wks 6-12 Squats/lunges + treadmill walking + ex bike low resistance + ham/quads strengthening Ensure no pain or effusion and normal gait pattern