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Sandy Part 2 (MAIN PROBLEMS POST OP (Outcome measures (Tape measure for…

- - - - Stress + parents
- - - - OKC + CKC
      - Quads
      - Hamstrings
      - Hip extensors & abductors
      - Calves
      - Foot & ankle exercises
    - - Knee extension
- - - - Lachman's test +ve = ACL INJURY #
        
        Increased anterior translation
        
        +small tear of lateral meniscus
      - Anterior drawer test
    - - Subluxation on twisting, turning or pivoting
      - Some people cannot feel it
        
        Experience frequent falls
      - Swelling 0-2 hours
  - - - Inferior pole of patella
      - Disrupts immature bone
    - - Can affect girls
    - - Localised pain
      - Tenderness at knee
      - Pain on base of patella
      - Worse with exercise
      - Relieved by rest
  - - - Giving way
      - Swelling between 0-2 hours post injury
  - - - Swelling 6-24 hours post injury
      - Joint line pain on affected side
      - Pain in maximal flexion/deep squatting
      - Pain when twisting and kicking
    - - Can still be damaged but not torn
- - - - Can develop PFJ pain
      - Not used for athletes that require a lot of kneeling
  - - - Many FWBAT
      - With crutches
      - No full extension
        
        Wear a brace
      - No AROM in 0 -40 degrees
      - PROM good
      - Precautions last for around 2 weeks
        
        Graft = tendon not ligament
      - Phase 2 - 2 to 6 weeks
        
        WB w/o crutches
        
        Balance with affected leg
        
        CKC exercises
        
        Stationary bike
        
        some resistance applied
        
        Strengthen quads
        
        Phase 3
        
        Increase resistance
        
        Static balance to dynamic
        
        Phase 4 - post 3 months
        
        Introduce sports specific exercises
        
        Side stepping
        
        Shuttle run
        
        introduce hockey training post 5 months
        
        After 6 months - all okay to introduce exercises
        
        Return to sport/function
        
        Similar strength on both side
        
        No swelling
        
        Running & jumping
        
        Full ROM
        
        Lachlan's test -ve
        
        outcome measures depend on patient
- - - - Anatomical structures
      - NM firing
        
        More quads dominant
        
        More ant shear stress
      - More ligament dominant in absorbing ground reaction force compared to muscle
  - - - Combination with other components
      - Not just : for ACL injury prevention
        
        Improve LL strength
        
        Improve side-to-side imbalance
        
        Good for Sandy - ankle injury hx
        
        Proprioceptive training
        
        Balance board
    - - IMPORTANT
      - Not effective unless with biofeedback component
      - Beyond footwork + agility
      - Landing - increase flexion at knee and hip
        
        More knee flexion decrease anterior shear force, valgus
        
        hamstrings activated
      - muscle control and knee hip and ankle
      - Control of body motion
        
        Deceleration and pivoting!
      - E.g. squat jumps, scissor jumps, tuck jumps
    - - Resistance training can reduce ligaments sprains
      - Must be used with other components
      - use core strength - improved lumbopelvic stability
      - Hip + knee + ankle
    - - Education
      - Mechanisms of injury
      - Video or partner feedback
      - Visualise dangerous positions
  - - - Running exercise at slow speed e.g. jogging
      - Controlled partner contacts - gentle shoulder bumps
      - Warm up muscles
    - - Nordic hamstrings, box jumps, squats
      - Strength, balance + plyometrics
    - - Running exercise at moderate to high speed
      - +planting & cutting movements
- - - - +VE Lachman's
      - +ve McMurray's
      - DIAGNOSIS
        
        Confirmed ACL injury +/- meniscal injury
    - - MRI
        
        Full rupture + lateral meniscus tear
      - X-ray
        
        Clear
    - - Crutches