most successful knee Re-abilitation concept progressing from the basic biomechanical aspects to the advanced neurophysiological domain

1. Knee Rehab
current Concepts
&
Application
DR.KANNABIRAN
Senior consultant physiotherapist
Professor in physiotherapy

2. CRITICAL THINKING
22YEAR OLD MALE COLLEGE FOOTBALL PLAYER RECEIVED A BLOW
TO POSTERIOR RIGHT KINEE AS HEWAS TACKLED FROM BEHIND.

3. Bad tackle

4. On field
PAIN WAS EXCRUCIATING LOCALISED TO
THE POSTEROLATERAL ASPECT OF KNEE

5. UNABLE TO STAND WITHOUT
SUPPORT
 EVALUATED BY THE PHYSICAL THERAPIST
 ADVISED REST AND NWB WITH CRUTCHES

6. ACLR

7. 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

8. 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?

9. General impression regarding existing ACLR
protocols
Based on
Muscle
Strength
Ignored
Proximal
Muscle control
6 months
Too early to
return to sports

10. Biomechanical update
HIP & 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

11. KNEE STRATEGY

12. HIP STARTEGY

13. IMPAIRED GLUTEUS MAXIMUS MUSCLE
PERFORMANCE
Sagittal Plane Frontal/Transverse Plane

14. THOUGHT PROCESS
• NEED FOR CHANGE DUE TO INCREASING
RESPONSIBILITY

15. A functional approach
in KNEE Rehabilitation

16. 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.

17. MOTOR COMPLEXITY MODEL FOR FUNCTIONAL
PROGRAM

18. Developing a functional program
“Simplified complexity” in tensional fields.
Shaded circles represent tension created by
muscle groups
ADAPTIVE CODE & PHYSICAL
STIMULATION FOR PROPRIOCEPTION

19. merge adaptive code Rehabilitation Similarity
spheres

20. Amazing clinical shortcut

21. Challenging Environment

22. Functional approach composite abilities

23. Functional Approach Rehabilitation
(Re–abilitation)

24. Functional Approach Re-abilitation

25. Functional approach
Advanced composite workouts

26. Balance/
postural stability challenge.

27. Balance/postural stability challenge.

28. 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

29. Depends on how we see things

30. INVESTIGATE THE BIG TALK !