Opening Slides SSC ACL Rehabilitation
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Transcript of Opening Slides SSC ACL Rehabilitation
return to play or performance Whos decision is it? Dr Andy Franklyn-Miller
WHAT IS return to play
place holder for video
Medical clearance for full participation in sports
without restriction
or PAIN Creighton 2010
No current lower extremity PPT has demonstrated reliability,
validity & responsiveness in RTP
Physical Performance Tests
British Journal of Sports Medicine. 2015: 49: 642-648
Clinician friendly lower extremity physical performance measures in athletes: A systematic review of measurement properties and correlation with injury, Part 1 & 2.
Hegedus EJ1, McDonough S2, Bleakly C3, Cook CE4, Baxter GD5
LACK OF standardisation leads
to MEDICOLEGAL OR FINANCIAL
IMPLICATION club vs country
But we know a lot about injury mechanism
and rehabilitation so why is it not easy?
Risk factors for injury (distant from outcome)
Mechanism of injury(proximal to outcome)
Intrinsic riskfactors
age
flexibility
previous injury
phenotype
predisposed athlete
susceptible athlete injury
inciting event
exposure to extrinsic risk
factors
Success
Injury
Reduce the Load Repair Joint / Tissue
Mechanotherapy “Increase tissue load tolerance”
Address Risk Factors (biomechanics, training load, environment)
Replicate sport-specific demands
Return to Play
Unstructured Excessive Loading
Well Structured Appropriate Loading
Traditional Periodization Model
Volumetechnique
General (GPP) Special (SPP) Competition Transition
intensity
STRENGTH IS NOT SIMPLE
EXPLOSIVE STRENGTH
ACCUMULATION I RESTITUTION 1 ACCUMULAITON II RESTITUTION II
DT
EXPLOSIVE STRENGTH
SPEED EMPHASIS
MAXIMAL POWER
SPEED EMPHASIS
DT
MAXIMAL POWER
SET EXPECTATIONS BASED ON SOLID EVIDENCE
manage pain
normal joint function and range for patient (surgery)
restore normal, then exceed absolute strength
Ability to generate that strength through
a range at rate appropriate to sport
Distribute load using segmental
coordination and control
Create fatigue resilience of multiple segments
Tolerate excess load and unpredictability
return to sport
SSC 6 Phases of rehabilitation
6 Reproducibility under fatigueBack to Performance
5Back to Sport Multi-directional Running
4Back to Running Linear Running
3Back to School & Work Power and Reactive Strength
2 Mobility, Control and Optimal Strength
1 Diagnosis and Assessment
Who is in Control of the RTP Decision?
the patient
via a system of objective
testing criteria with a return to
performance specificity
thank you