ACL REHABILITATION -FUNCTIONAL APPROACH
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Transcript of ACL REHABILITATION -FUNCTIONAL APPROACH
ACL REHABILITATION ACL REHABILITATION ACL REHABILITATION ACL REHABILITATION
RECENT ADVANCES RECENT ADVANCES RECENT ADVANCES RECENT ADVANCES
TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL
APPROACHAPPROACHAPPROACHAPPROACH
DR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhD....Senior consultant manipulative sports physiotherapist ,coimbatore
Professor in physiotherapy,RVS college of physiotherapy
WHAT PHYSICAL THERAPY AFTER
ACL RECONSTRUCTION
�AGE
�TYPE OF INJURY
�RECONSTRUCTION- GRAFT,SURGEONS PROFILE,TYPE OF FIXATION
�PRE OP STATUS
�SCOPE FOR SUPERVISED PT
�RECENT BIOMECHANICAL UPDATE
�FUNCTIONAL APPROACH
EXISTING
• Home Versus Supervised Therapy
• Home Exercise Versus Weight Machines
• Aquatic Therapy• Open Versus Closed
Chain Exercise• Progression Based on
Objective Criteria
What's new?
GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING
EXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLS
Based on
Muscle
Strength
Ignored
Proximal
Muscle control
6 months
Too early to
return to sports
BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE
HIP & KNEE STRATEGIESHIP & KNEE STRATEGIESHIP & KNEE STRATEGIESHIP & KNEE STRATEGIES
KNEE STRATEGY
KNEE EXTENSOR MOVEMENT
QUADRICEPS ACTIVATION
HIP EXTENSOR MOVEMENT
HIP ENERGY ABSORPTION
HIP STRATEGY
KNEE EXTENSOR MOVEMENT
QUADRICEPS ACTIVATION
HIP EXTENSOR MOVEMENT
HIP ENERGY ABSORPTION
KNEE STRATEGY
HIP STARTEGY
IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS
MUSCLE PERFORMANCEMUSCLE PERFORMANCEMUSCLE PERFORMANCEMUSCLE PERFORMANCE
Sagittal Plane Frontal/Transverse Plane
THOUGHT PROCESS
• NEED FOR CHANGE DUE TO INCREASING
RESPONSIBILITY
A FUNCTIONAL APPROACHA FUNCTIONAL APPROACHA FUNCTIONAL APPROACHA FUNCTIONAL APPROACH
IN IN IN IN KNEE REHABILITATIONKNEE REHABILITATIONKNEE REHABILITATIONKNEE REHABILITATION
Functional approach
• A functional approach in rehabilitation is the key
concept underpinning the management.
• Functional movement is defined here as the
unique movement repertoire of an individual.
• Functional rehabilitation is defined here as the
process of helping a person to recover their
movement capacity by using their own
movement repertoire(whenever possible).
DEVELOPING A FUNCTIONAL
PROGRAM
1. The focus on functional
movement
2. The principle of
skill/ability level
rehabilitation
3. The code for motor
adaptation
….that ought to
participate in this
particular movement
& accompany the
stabilization of the
body.
MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR
FUNCTIONAL PROGRAMFUNCTIONAL PROGRAMFUNCTIONAL PROGRAMFUNCTIONAL PROGRAM
DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL
PROGRAMPROGRAMPROGRAMPROGRAM
“Simplified complexity” in tensional fields.Shaded circles represent tension created by
muscle groups
ADAPTIVE CODE & PHYSICAL STIMULATION FOR PROPRIOCEPTION
MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE
REHABILITATION SIMILARITY REHABILITATION SIMILARITY REHABILITATION SIMILARITY REHABILITATION SIMILARITY
SPHERESSPHERESSPHERESSPHERES
AMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUT
CHALLENGING CHALLENGING CHALLENGING CHALLENGING
ENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENT
When cognitive becomes autonomous
FUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIES
FUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATION
(RE(RE(RE(RE––––ABILITATIONABILITATIONABILITATIONABILITATION))))
FUNCTIONAL APPROACH REFUNCTIONAL APPROACH REFUNCTIONAL APPROACH REFUNCTIONAL APPROACH RE----ABILITATIONABILITATIONABILITATIONABILITATION
FUNCTIONAL APPROACHFUNCTIONAL APPROACHFUNCTIONAL APPROACHFUNCTIONAL APPROACH
ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS
BALANCE/BALANCE/BALANCE/BALANCE/
POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE.
BALANCE/POSTURAL BALANCE/POSTURAL BALANCE/POSTURAL BALANCE/POSTURAL
STABILITY CHALLENGE. STABILITY CHALLENGE. STABILITY CHALLENGE. STABILITY CHALLENGE.
TAKE HOME TAKE HOME TAKE HOME TAKE HOME
• Rehabilitation with current concept
• Enhance hip strategy
• Functional Re-Abilitation motor complexity
• Differentiate demand & risk in rehab.
• Think movement not muscles
• Team work
DEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGS
INVESTIGATE THE BIG TALK !