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RE: ACL rehab questions
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RE: ACL rehab questions - January 26, 2008 2:15:27 PM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
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I have to agree with the previous posts. S/P 8 weeks is not a good idea to perform that kind of technique. Initially I was thinking after a long term but not at 8 weeks.
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RE: ACL rehab questions - January 26, 2008 2:21:44 PM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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I guess that's where we have to be careful on this forum....we may post something, and the information is taken and applied at the wrong time. When I read dscouras note he was going to try that technique, I had to say something, and only hope to got he/she did not log off and tries this tomorrow on the poor guy.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: ACL rehab questions - January 27, 2008 3:56:38 AM
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dscouras
Posts: 27
Joined: January 27, 2007
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To be honest and the more I've been reading my approach was going to be one of patience for the next week where easy (light) flexion mobs would be the only aggressive approach taken. I would never do a manip or aggressive traction force on a client unless I had proper documentation or practice/mentorship.
As for the strap technique I was simply replying previously and thanking for the response just after quickly reading the post and was thinking about a few different clients at the same time and had not read the comment over again. I was trying to be nice as someone had taken the time to answer a question. The intention was to do (as I think it is important for everyone) my diligence prior to applying any technique quoted...and that means finding proper research proving effectiveness.
As for the ACL fibrosis and rehab techniques I have been researching like crazy and asking many here of greater experience than I. I have found no one that agreed with the above nor could I reference it anywhere in studies. However if anyone has any better advice than gentle flexion mobs please feel free to advise. I, we, whoever reads these forums should do their own due diligence, before any applications.
I appreciate the help and Mr. Duffy and Henderson I do appreciate the comments above and hope this clears up any misunderstandings. Many use this forum as one of many resources available, not as a bible. I took the responses as 2 Pt's looking out for another and I appreciate that.
< Message edited by dscouras -- January 27, 2008 4:03:20 AM >
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RE: ACL rehab questions - January 27, 2008 1:23:01 PM
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Tom Reeves DPT ATC
Posts: 449
Joined: March 14, 2006
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It depends where the restriction lies when working on regaining extension. If the patient perceives binding in front of the knee, then you have to mobilize to regain anterior tibial glide, tibial external rotation, or both. (usually both) OR their hamstring graft was put in a little tight and will loosen slightly as the tissue remodels.
If they feel it in back, then hamstring/gastroc inhibition, stretching, posterior lunges etc to allow those tissues to allow the extension.
techniques for the loss of accessory motions. Lay the patient prone, put a towel roll beneath the distal femur. proximal hand just inferior and posterior to the knee, distal hand supporting the foot. Grade V mobs allowing the knee to move into greater extension as the sets of mobs continue. the patient should feel less binding as the set goes on. Also, could impart a bit of tibial ER during this as well.
To get functional tibial ER, sort of a Mulligan-esque technique: have the patient do a squat while reaching down and to the side of the involved knee, then straighten the leg (un-squat) while reaching up and away from the involved knee while keeping the involved heel on the ground.
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