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Reducing PT sessions after ACL Reco
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Reducing PT sessions after ACL Reco - July 30, 2002 3:35:00 PM
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zlat
Posts: 2
Joined: June 2, 2002
Status: offline
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Hi everyone i am 4 weeks post op from an ACL hamstring reco and have been doin PT 3 times a week. Unfortunetly i had to pay for all my expenses for the surgery and the on going cost of PT. The question that i have is will having PT once a week insted of having it 3 times a week dramaticly affect my recovery? Im having a bit of fincancal difficulties at the moment and cannot afford to attend PT more than once a week. Along with having PT once a week i will also be doin my home execerises 3 to 4 times a day and doin gym (stationary bike etc) twice a week. I injured my knee playing soccer and have set a target of getting back to my best within a 1.5 year time frame.
Questions
1)Is it wise to reduce PT session to 1 a week at this stage?
2)Do u beleive that 1.5 years is a sensiable time frame to get back to my best?
Any help would be greatly appreciated thanks in advance everyone.
zlat
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Re: Reducing PT sessions after ACL Reco - July 31, 2002 6:33:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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zlat:
I don't know your case specifically and I cannot comment directly.
I will say that IF a patient is motivated and the recovery seems to be uncomplicated, then PT 1x a week starting one month post op can be adequate. Instructions should be detailed and the progress should be monitored carefully.
As for getting back to top form. That's a tough one. In my experience, it usually takes at least 1 1/2 years. Most of my patients regain full strength and range of motion much earlier. And...they have been taken through the appropriate agilities, plyometrics ect. But....they report to me that it just doesn't feel the same for about 1 1/2 years. We aren't sure why. Perhaps there is some proprioceptive deficit and some motor control issues.
If you look at pro atheletes after their first year after an ACL reconstruction, they usually don't do that well. Two years after is when they return to full form (if they are ever going to get there).
mcap
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Re: Reducing PT sessions after ACL Reco - August 2, 2002 10:13:00 AM
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Tyler29
Posts: 11
Joined: August 1, 2002
Status: offline
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[QUOTE]Originally posted by zlat:
Hi everyone i am 4 weeks post op from an ACL hamstring reco and have been doin PT 3 times a week. Unfortunetly i had to pay for all my expenses for the surgery and the on going cost of PT. The question that i have is will having PT once a week insted of having it 3 times a week dramaticly affect my recovery? Im having a bit of fincancal difficulties at the moment and cannot afford to attend PT more than once a week. Along with having PT once a week i will also be doin my home execerises 3 to 4 times a day and doin gym (stationary bike etc) twice a week. I injured my knee playing soccer and have set a target of getting back to my best within a 1.5 year time frame.
Questions
1)Is it wise to reduce PT session to 1 a week at this stage?
2)Do u beleive that 1.5 years is a sensiable time frame to get back to my best?
Any help would be greatly appreciated thanks in advance everyone.
zlat[/QUOTE]
zlat - I'm curious - have you discussed decreasing your visit frequency w/your physical therapist - if so, what was their response to you?
There was a study published in 1997 that addresses your visit frequency question - I've attached the abstract below. Perhaps you could discuss this w/your physical therapist. In my opinion, it is extremely reasonable to think you can decrease you frequency of visits and not compromise outcome, especially if your range of motion, strength, and function are progrssing as they should be in the early stages following ACL reconstruction (i.e., no complications to adversely influence outcome).
Many patients may return to soccer 1.5 yrs following surgery, altough they may not be back to 100%. Outcome seems to improve with time in the first few years following ACL reconstruction, and it may definitiely take longer for some to return to 100%. Best of luck.
The effects of the number and frequency of physical therapy treatments on selected outcomes of treatment in patients with anterior cruciate ligament reconstruction.
De Carlo MS, Sell KE.
Methodist Sports Medicine Center, Indianapolis, IN 46202, USA.
Health care reform will quite possibly change the delivery of physical therapy by demanding physical therapists to be more accountable for providing appropriate, yet cost-effective treatment. The purpose of this study was to retrospectively compare the results after anterior cruciate ligament (ACL) reconstruction between two groups of patients with different numbers and frequencies of physical therapy visits postoperatively. Two random samples of 100 patients from a total of 1,345 patients identified as undergoing ACL reconstruction from 1990 through 1993 were included. Group A patients attended physical therapy regularly and participated in a home exercise program, while patients in Group B attended limited physical therapy visits and also performed a prescribed home exercise program. Both groups followed the same postoperative rehabilitation program for early range of motion, early weight bearing, and muscle control. The outcome variables measured 1, 6, and 12 months postoperatively included the number of structured visits to physical therapy, range of motion, isokinetic strength testing, and subjective rating. Group A averaged 20 visits in the first 6 months while Group B averaged seven visits. The results revealed no significant difference for flexion, isokinetic strength, or subjective rating. There was a significant difference for hyperextension (Group A, 2 degrees; Group B, 6 degrees). The results of this investigation indicated that by following a structured physical therapy program postoperatively, it is possible for patients to achieve a successful outcome with a limited number of routine physical therapy visits.
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Re: Reducing PT sessions after ACL Reco - August 28, 2002 7:07:00 AM
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Karoliina
Posts: 3
Joined: August 25, 2002
From: Mikkeli, Finland
Status: offline
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Hi!
I totally agree with MCAP.
And I remember reading somewhere that there actually is evidence of patients recovering as well with or without physio post ACL-transplant.
I myself wouldnt go that far on my conclusions since I have worked a lot with them and gained good results. The long term result may be the same but I think the ones who visit physio have faster recovery and they get that extra psychological support as well.
And if you really look at the top athletes, many of them come back after 1 year. Unfortunately they also usually get new injuries soon after. And my opinion is that is more to do with deficits in proprioseptics than strength or ROM
Good luck!
p.s I would concentrate on proprioceptive training with full bodyweight. Do not forget to train your lower back, abdominals and to stretch your hams.
------------------
Karoliina Paukkala
Physiotherapist
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