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ACL Rehab
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ACL Rehab - May 9, 2005 3:15:00 AM
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tf8560
Posts: 47
Joined: October 21, 2004
From: miami
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I have an 18 year old female college basketball player (power forward) S/P R ACL surgery (Patellar tendon graft)End of January. At this time she is home for summer I have her through July. My question is How do you decide on how much training volume ie weight/sets/reps in designing her program. Her primary problem is still a lack of strength, balance and coordination. She really has not begun running or jumping yet. I am designing her rehab program.
PS I have my own ideas on rehab but am just looking to get your input.
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Re: ACL Rehab - May 9, 2005 6:19:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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The answer to your question depends entirely on her appearance in clinic.
For those this far out, you need to have a way to decide where in your rehab progression to place her.
I use functional movements such as squatting, stepping, and bending to help determine this.
Try that...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: ACL Rehab - May 9, 2005 7:34:00 AM
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karmzack
Posts: 181
Joined: March 20, 2005
From: Hawaii
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For a typical patient that had ACL surgery 13 weeks ago I would have them doing leg press 3 x 15, HS curl 3 x 15, and calf raises 3 x 15. Jogging 50-75% pace on level surfaces, progressing gradually. Sports specific balance/proprioception exercises and plyometric progression.
The big change in their program at 12 weeks is the return to running.
Again this is a typical program for my typical patient - 18-30 yo, male, active
_____________________________
Zack Solomon MPT, OCS, CSCS
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Re: ACL Rehab - May 9, 2005 2:25:00 PM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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I agree with everyone and still say see what her dysfunctions are and put her through some functional tasks. I would not advocate missing a normal progression (i.e. no running beofre you can crawl) what I mean is not crazy mogul hop cutting activities day one until you know she is stable in a sagital plane and then a frontal plane, before returning to transvere plane activities. I'd typicall take this patient and have them do some stair climbing, some isolated mini squats with focus on good biomechanics and kicking in that VMO, some closed chain proprio activities, standing on dynadisk and throwing swiss or med ball,or using rebounder, step ups on 8 inch block increase the height and speed, step ups and push up and out with med ball, lots of mini squat eccentrci closed chain. Progress into lateral gallop, high march, jogging, progress to high skip, running with gradual turns, mogul hops in controlled directions, quadrant hop and stabilize, plyo jumps, and then you should have her long enough to have her doing sport specific activities at the end of the summer which will be like 7 months out. Just keep an eye on swelling, etc. I usually progress as quickly as the patient can take it for the most part. I mean she is sufficiently out enough to hope she is past isolated strenghtening of the hip quad hs and calf, etc. Start function activities, PNF patterns stabilizing on uneven surafaces, etc, take it from there...have fun, this is the fun phases of rehab, rarely get to see those when insurance is involved...wow am i rambling, i need dinner-
Ben
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Re: ACL Rehab - May 9, 2005 2:25:00 PM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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tf8560, i lost your email, private email me and let me know where this patient lives and what you needed for treatment, etc, for that one patient referral you have-
Ben Galin, MPT, OCS
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Re: ACL Rehab - May 9, 2005 3:58:00 PM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Consider, at this point in the program, progressing the PRE's to 3 sets to fatigue, upping the weight if they are able to do more than 12 in the set.
Also, even with BPTB graft, studies have shown loss of tibial IR strength (not to the extent of the hamstring/gracilis grafts, however)
Address hamstrings with foot in ER and IR during the hamcurls, especially ER to emphasize the lateral group. Backward treadmill during full incline, isokinetics, stair master (or the "Death Machine", the VersaClimber)
And, of course, all the obvious patellar mobility, extension ROM etc.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: ACL Rehab - May 10, 2005 7:47:00 AM
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tf8560
Posts: 47
Joined: October 21, 2004
From: miami
Status: offline
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Thanks for the input.
A typical session at this time usually includes the following
1) Aerobic exerciseon bike or stairmaster using Tabata protocol
2) Dynamic warm up
3)5-10 minutes of core activation
4)Leg press 80% 1RM 3X12-15
5)Single leg deadlifts w/ dumbells 3x15
or swiss ball bridge with rollout
6)Calf raises
7)Agility ladder
8)Split squats BW or Step -up with 6lb med ball held in an overhead rebound position
9)Retrowalking using pulley resistance @ 10% BW
10) Jump rope 3x 100 skips
11) Balance exercise either using airex or upside down BOSU with basketball toss
12) Light Multi plane mini lunges w/ Kettleball reaches to knee level.
My main concern is to methodically strengthen her while avoiding any PFJ set backs. I was just wondering how to tweak/periodize her quad work to develop 1st more strength, then explosive power all while trying not to give her tendinitis or set her up for further joint problems as an adult.
Thanks for the help
Tom Fletcher
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