1. The document discusses the anatomy and function of the knee joint, including the bones, muscles, meniscus, ligaments, and bursae that make up the knee.
2. Common knee injuries are described such as torn cartilage (meniscus), ligament tears, arthritis, bursitis, and bone tumors.
3. Rehabilitation programs for meniscus tears and ACL reconstruction are outlined, focusing on reducing pain, restoring range of motion and strength through exercises.
The presentation describes a new manual rehabilitative approach to activate the “Integrated Stabilizing System of the Spine, Chest and Pelvis” and achieve exciting levels of improved function of the locomotor system
Gait training Physiotherapy perspective.pptxSusan Jose
do you know what is gait?
lets know more this presentation.
can physiotherapist help you with your walking abilities. click on the above slide to know more.
There are evidence in History of treatment by Passive stretching techniques.
Over past 30-40 years many therapists have worked to identify and learn the techniques which are are more suitable and effective for the patient’s problem.
Joint mobilisations and manipulations techniques are used to safely stretch or snap structures to restore normal joint mechanics with less trauma.
content from
(proprioceptive neuromuscular fascilitation article of Marymount University Fall 2009),
DPT AMIR MEMON (pnf presentation)
DPT AARTI SAREEM (pnf presentation)
The presentation describes a new manual rehabilitative approach to activate the “Integrated Stabilizing System of the Spine, Chest and Pelvis” and achieve exciting levels of improved function of the locomotor system
Gait training Physiotherapy perspective.pptxSusan Jose
do you know what is gait?
lets know more this presentation.
can physiotherapist help you with your walking abilities. click on the above slide to know more.
There are evidence in History of treatment by Passive stretching techniques.
Over past 30-40 years many therapists have worked to identify and learn the techniques which are are more suitable and effective for the patient’s problem.
Joint mobilisations and manipulations techniques are used to safely stretch or snap structures to restore normal joint mechanics with less trauma.
content from
(proprioceptive neuromuscular fascilitation article of Marymount University Fall 2009),
DPT AMIR MEMON (pnf presentation)
DPT AARTI SAREEM (pnf presentation)
A chronicle on muscle strengthening:
MMT is a procedure for the evaluation of strength of individual
muscle or muscles group, based upon the effective performance of a movement in relation to the forces of gravity or manual resistance through the available ROM.
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
Hand rehabilitation following flexor tendon injuriesAbey P Rajan
hand rehabilitation following flexor tendon injuries include introduction, clinical anatomy, tendon nutrition, tendon healing, post op. management, special cases, summary
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Physiotherapy / Physical Therapy is a rehabilitation discipline specializing in assessing and improving movement and function while relieving pain and optimizing healing.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
-Detailed Introduction, Patho-physiology, Evaluation & Physiotherapy Management of Parkinsonism.
-Clinical classification is discussed.
-Various measures of evaluation and physical therapy is discussed in this.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
A chronicle on muscle strengthening:
MMT is a procedure for the evaluation of strength of individual
muscle or muscles group, based upon the effective performance of a movement in relation to the forces of gravity or manual resistance through the available ROM.
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
Hand rehabilitation following flexor tendon injuriesAbey P Rajan
hand rehabilitation following flexor tendon injuries include introduction, clinical anatomy, tendon nutrition, tendon healing, post op. management, special cases, summary
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
This presentation give an upto date insightful information on balance/postural assessment and key domains of Occupational Therapy during assessment of balance using different scales.
Physiotherapy / Physical Therapy is a rehabilitation discipline specializing in assessing and improving movement and function while relieving pain and optimizing healing.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
-Detailed Introduction, Patho-physiology, Evaluation & Physiotherapy Management of Parkinsonism.
-Clinical classification is discussed.
-Various measures of evaluation and physical therapy is discussed in this.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
changes in gait pattern after injury and rehabilitation of the Anterior cruc...lawalsonolatomiwa
description of the anterior cruciate ligament , causes of anterior cruciate ligament, how to rehabilitate and treat anterior cruciate ligament, definition of gait, changes of gait pattern after ACL injury.
ACL Reconstruction Rehabilitation
One of the most common complications following ACL reconstruction is loss of motion, especially loss of extension. Loss of knee extension has been shown to result in a limp, quadriceps muscle weakness, and anterior knee pain. Studies have demonstrated that the timing of ACL surgery has a significant influence on the development of postoperative knee stiffness. The highest incidence of knee stiffness occurs if Acl surgery is performed when the knee is swollen, painful, and has a limited range of motion. The risk of developing a stiff knee after surgery can be significantly reduced if the surgery is delayed until the acute inflammatory phase has passed, the swelling has subsided, a normal or near normal range of motion (especially extension) has been obtained, and a normal gait pattern has been reestablished.
Mentally prepare the patient for surgery Before proceeding with surgery the acutely injured knee should be in a quiescent state with little or no swelling, have a full range of motion, and the patient should have a normal or near normal gait pattern
Osteoarthritis of the Knee Joint is a quite common condition found in Indian Population. This presentation is made to understand how this condition affects patients and what are the different Physiotherapy measures to make the patient functionally independent.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
4. What should an Orthopedic surgeon
know about rehabilitation?
When ?
Where? Why?
How?
What?
5. Why The Knee????????
Although the knee joint may look simple ,
it is one of the most complex.
Moreover, the knee is more likely to be injured than
is any other joint in the body.
We tend to ignore our knees until something happens
to them that causes pain.
As the saying goes, however, "an ounce of prevention
is worth a pound of cure."
In addition, if some problems with the knees
develop, an exercise program can be extremely
beneficial.
6. KNEE JOINT - ANATOMY & FUNCTION
Figure 1: Right Knee
7. KNEE JOINT - ANATOMY & FUNCTION ( CONT.)
To function well, a person needs to
have strong and flexible muscles.
In addition, the meniscal cartilage,
articular cartilage and ligaments
must be smooth and strong.
Problems occur when any of these
parts of the knee joint are
damaged or irritated.
I - Bones:
The knee is essentially made up of
four bones:.
femur,tibia,fibula&patella
Figure 2: Right Knee
8. II) Muscles:
When the knee moves, it does not just bend
and straighten, or, as it is medically termed,
flex and extend.
There is also a slight rotational component
in this motion.
The knee muscles which go across the knee
joint are the quadriceps and the
hamstrings.
The quadriceps muscles are on the front of
the knee, and the hamstrings are on the
back of the knee.
KNEE JOINT - ANATOMY & FUNCTION ( Cont.)
9. III) MENISCUS :
The meniscus is a C-shaped
piece of tissue which fits into
the joint between the tibia and
the femur.
The meniscus has several
functions:
A)Stability .
B)Lubrication & nutrition.
C)Shock absorption.
10. IV)Ligaments: (Cruciate Ligaments)
•There are two cruciate ligaments located in the center
of the knee joint
•. The anterior cruciate ligament (ACL) and the
posterior cruciate ligament (PCL) are the major
stabilizing ligaments of the knee.
Figure : Right Knee
12. Types of Knee injury
• Arthritis
• Bursitis
• Meniscus
• Ligaments
• Sprains
• Bone tumours
• Other causes of
knee pain.
13. A)TORN CARTILAGE (MENISCUS)
•The majority of the meniscus has no blood supply.
•The two most common causes of a meniscus tear
are traumatic injury and degenerative
•Meniscus tears can occur in all age groups.
•Traumatic tears are most common in active people
from age 10-45.
• Individuals who experience a meniscus tear
usually experience pain and swelling as their
primary symptoms.
•.
14. DIAGNOSIS AND TREATMENT Of MENISCAL
TEARS
•History
•Physical examination
• x-rays
• MRI
•Arthroscopic
15. Figure 5: Side view of knee.
Circled area contains an area of normal meniscus.
Figure 6
Side view of knee. Circled area contains
an image of a portion of the meniscus.
The light center area represents the tear.
16. • Meniscus tear symptoms are classified as small, moderate or a large tear.
• On the basis of the blood supply, these menisci are grouped as red-red
(within 3mm of meniscosynovial juntion) , red-white(3mm-5mm) and white-
white(>5mm).
• According to site and direction of tear : Longitudinal , transverse ,bucket
handle, complex……
Types of injury
17. DIAGNOSIS AND TREATMENT Of MENISCAL TEARS
(Cont.)
•The recovery from meniscus tear depends on the aspects like
your type of injury & repair, movement intensity, age, and
repairing tendency of your body.
•Guidelines must be individualized and may change during the
recovery phase.
•Arthroscopy is much less traumatic to the muscles, ligaments and
the tissues than the traditional method of opening the knee.
•Occasionally, it is possible to repair a torn meniscus. While this
may be done arthroscopically, because of the slow healing process
of the meniscus, the recovery time is longer then simply removing
the torn piece of meniscus (meniscectomy).
19. Treating a Torn Meniscus Conservatively
RICE—Ultrasound—TENS or D.D.
•Simple stretches to increase the flexibility of the quadriceps
muscles, the hamstrings, and the calves.
•Simple strengthening exercises
20. Meniscal repair rehabilitation program:
Post-Op. : Day of surgery at home.
1.RICE
2. Do not allow incisions to get wet while bathing.
3. ROM exercises:
a. Ankle range of motion
b. Heel Slides (Do Not Flex Past 90° for 4 weeks)
4. Begin strengthening exercises as tolerated:
a. Quadriceps and hamstring sets,
b. Straight Leg Raises (SLR
c. Seated knee extension, hip flexion, standing
knee flexion.
5. Non-weight bearing with crutches for 4 weeks.
Pre-Op. Instructions
21.
22. Meniscal repair rehabilitation program
(Cont.)
Post-Op: Day 1
1. Continue ice, elevation, and compression
wrap.
2. Continue range of motion exercises 2 - 3
times per day and add:
a. Stationary bike riding with seat height as
low as tolerable with low resistance.
3. Continue strengthening exercises.
4. Ice before and after exercises and 20
minutes every two hours while awake
23.
24. Meniscal repair rehabilitation program
(Cont.)
Post-Op: Day 2 – 7
1. Continue ice and elevation.
2. Continue range of motion exercises.
3. Continue strengthening exercises and add: . Weight
to all SLR’s, Knee Extension, Knee Flexion, Hip
Flexion exercises.
4. Ice before and after exercise and continue use of
compression wrap.
5. Physician examination 6 - 8 days post-op for
evaluation and suture removal.
25. Wall Squats - Stand with back leaning against wall. Walk feet 12 inches in front of body. Keep
abdominal muscles tight while slowly bending both knees 45 degrees. Hold 5 seconds. Slowly
return to upright position. Repeat 10 times.
Heel Raises - Stand with weight even on both
feet. Slowly raise heels up and down. Repeat
10 times.
Straight Leg Raises - Lie on your back with one leg straight and
one knee bent. Tighten abdominal muscles to stabilize low back.
Slowly lift leg straight up about 6 to 12 inches and hold 1 to 5
seconds. Lower leg slowly. Repeat
Heel Slides - Lie on your back. Slowly bend and
straighten knee.
Repeat 10 times
26. Meniscal repair rehabilitation program (Cont.)
Post-Op: Week 1 - 3
1. Continue ice and elevation as needed.
2. Continue range of motion exercises to
90° of flexion limitation.
3. Continue strengthening exercises.
4. Ice before, if indicated, and after
exercise.
27. Meniscal repair rehabilitation program (Cont.)
Post-Op: Week 4 – 8
1.Continue ROM exercises progressing past 90° to
achieve full motion.
2. Continue strengthening exercises, and add:
. Heel raises with balance assistance,.
Progressing to elevated or one-leg heel raises..
Partial squats with balance assistance,
. Progressing to single leg squats. Side Step-Ups,
. Stair Climber exercises .
.Begin Walk-Jog program on smooth, flat surface,
walking curves as tolerated at 6 weeks
28.
29. Meniscal repair rehabilitation program (Cont.)
Return to full activities when:
a. Range of motion and girth measurements are
bilaterally equal,
b. Bilateral strength measurements are 85% or
better, and
c. Clearance by treating physician.
Patients heal at different rates, possess various pre-
operative deficiencies, and require specific attributes
to perform normal function. Due to these factors,
this protocol must be individualized to each patient
to allow for optimal return to desired activities.
30. WE ARE TIRED! WE NEED A BREAK!
LET US DO
SOME
STRETCHING
EXERCISES
32. There is generally some bleeding in the internal
areas surrounding the ACL and is manifested by a
swelling in the knee area.
The pain itself is not so severe and therefore
many patients go for non-surgical ACL physical
therapy options that surgical ones.
33. Diagnosis
• History of the trauma
• Clinically :anterior drawer test.
• MSU
• MRI
• Arthroscope
34. Treatment (ACL)
Non surgical:
ACL physical therapy can be adopted if the cartilage of
the knee is not worn out or damaged.
It is a possibility only if the patient is fine with not
indulging in high risk activities and serious sports.
You may also have to wear a knee brace and some
exercises.
35. • ACL reconstruction surgery uses a graft to
replace the ligament. The most common grafts
are autografts using part of your own body, such
as the tendon of the kneecap (patellar tendon) or
one of the hamstring tendons. Another choice is
allograft tissue, which is taken from a deceased
donor.
Surgical options :
• For treatment are recommended when the
knee totally collapses during the injury and
looses functionality.
36. ACL reconstructionRepair rehabilitation program:
THE HIGHEST INCIDENCE OF KNEE STIFFNESS OCCURS IF ACL
SURGERY IS PERFORMED WHEN THE KNEE IS SWOLLEN, PAINFUL,
AND HAS A LIMITED RANGE OF MOTION.
Knee pain
Stiffness
Limping
Quadriceps
wasting
Knee
effusion
Malalignment
37. ACL reconstruction rehabilitation program (Cont.)
Preoperative Rehabilitation Phase
Goals:
•Control pain and swelling
• Restore normal range of motion
• Develop muscle strength sufficient for
normal gait and ADL
38. Reconstruction rehabilitation program (Cont.) Pre-operative ACL
Immobilize the knee
Extended use of the knee immobilizer should be limited to avoid
quadriceps atrophy. You are encouraged to bear as much weight
on the leg as is comfortable.
Control Pain and Swelling
Crushed ice- PT
Restore normal range of motion
ASAP:
Quadriceps isometrics exercises, straight leg raises, and
range of motion exercises should be started immediately.
39. Pre-operative -ACL reconstruction rehabilitation program
(Cont.)
Full extension is obtained by doing the following exercises:
1) Passive knee extension.
• Sit in a chair and place your heel on the edge of a stool or chair.
• Relax the thigh muscles.
• Let the knee sag under it's own weight until maximum extension is
achieved.
2) Heel Props:
• Place the heel on a rolled towel making sure the heel is propped high
enough to lift the thigh off the table.
• Allow the leg to relax into extension.
• 3 - 4 times a day for 10 - 15 minutes at a time.
3) Prone hang exercise.
• Lie face down on a table with the legs hanging off the edge of the
table.
• Allow the legs to sag into full extension.
41. Pre-operativeACL reconstruction rehabilitation program
(Cont.)
Bending (Flexion) is obtained by doing the following
exercises:
1) Passive knee bend
• Sit on the edge of a table and let the knee bend under the influence of
gravity.
2) Wall slides are used to further increase bending.
• Lie on the back with the involved foot on the wall and allow the foot to slide
down
the wall by bending the knee. Use other leg to apply pressure downward.
Wall Slide: Allow the knee to gently slide down
3) Heel slides are used to gain final degrees of flexion.
• Pull the heel toward the buttocks, flexing the knee. Hold for 5 seconds.
• Straighten the leg by sliding the heel downward and hold for 5 seconds.
43. • In later stages of rehabilitation, do heel slides by grasping the leg with
both hands and pulling the heel toward the buttocks.
Heel slides in later stages of rehabilitation
44. Develop muscle strength
1) Stationary Bicycle. Use a stationary bicycle two times a day for 10 - 20
minutes to help increase muscular strength, endurance, and maintain range of
motion.
2) Swimming
3) Low impact exercise machines such as an elliptical cross-trainer, leg press
machine, leg curl machine, and treadmill can also be used.
Till a full range of motion and good muscular control of the leg (you should be able
to walk without a limp).
Pre-operativeACLreconstruction rehabilitation program
(Cont.)
45.
46. ACL reconstruction rehabilitation program
After Surgery
Prior to leaving the operating room a knee immobilizer will
be applied to the knee.
• A Cryocuff or ice packs will provide cold and compression,
reducing pain and swelling.
• The postoperative knee brace helps to maintain extension
and is to be worn at all times while walking and during
sleeping, otherwise it can be removed.
• The drainage tubes will be removed before leaving the
hospital.
47. ACL Reconstruction Rehabilitation Protocol cont.
Early Range of Motion and Extension
1) Passive extension of the knee by using a
rolled towel. Note the towel must be high
enough to raise the calf and thigh off the table.
2) Active-assisted extension is performed by
using the opposite leg and your quadriceps
muscles to straighten the knee from the 90
degree position to 0 degrees.
Hyperextension should be avoided during this
exercise.
Use the non-injured leg to straighten the knee
3) Passive flexion (bending) of the knee to 90
degrees.
• Sit on the edge of a bed or table and letting
gravity gently bend the knee.
48. ACL Reconstruction Rehabilitation.
Postoperative Days 1 - 7
WORK ON EXTENSION IMMEDIATELY.
* Control pain and swelling
* Care for the knee and dressing
* Early range of motion exercises
* Achieve and maintain full passive extension
* Prevent shutdown of the quadriceps muscles
•Gait training
•DO NOT SIT FOR LONG PERIODS OF TIME WITH FOOT IN A
DEPENDENT POSITION (LOWER THAN THE REST OF YOUR BODY),
AS THIS WILL CAUSE INCREASED SWELLING IN the KNEE AND LEG.
WHEN SITTING FOR ANY SIGNIFICANT PERIOD OF TIME, ELEVATE
LEG AND FOOT.
IT IS IMPORTANT TO KEEP THE INCISIONS DRY FOR THE FIRST 7-10 DAYS.
49. ACL Reconstruction Rehabilitation
Exercising Quadriceps
1)You should start quadriceps isometric contractions with the
knee in the fully extended position as soon as possible.
2) Begin straight leg raises (SLR) with the knee immobilizer
on 8 sets of 10 repetitions 3 times a day. Start by doing
these exercises while lying down.
REMEMBER TO RELAX THE MUSCLES EACH TIME THE LEG TOUCHES
DOWN
Straight leg raises – lying (left) and seated (right)
50. ACL Reconstruction Rehabilitation
Exercising Hamstrings
1) For patients who have had ACL reconstruction using
the hamstring tendons it is important to avoid
excessive stretching of the hamstring muscles
during the first 6 weeks after surgery.
2) The hamstring muscles are exercised by pulling
your heel back producing a hamstring contraction.
• If a hamstring tendon graft from your knee was
used to reconstruct the ACL, this exercise should
be avoided for the first 4 - 6 weeks.
51. ACL Reconstruction Rehabilitation
Postoperative Days 8 – 10
Goals: Physical therapy
Maintain full extension
REMEMBER THAT IT IS EXTREMELY
IMPORTANT TO CONTINUE TO REMOVE the
LEG FROM THE KNEE IMMOBILIZER 4 TO 6
TIMES A DAY FOR 10 - 15 MINUTES AT A TIME
TO MAINTAIN FULL EXTENSION.
52. ACL Reconstruction Rehabilitation
PostoperativeWeek 3
Goals: * Maintain full extension
* Achieve 100 – 120 degrees of flexion
* Develop enough muscular control to wean off knee
immobilizer
* Control swelling in the knee
MAINTAINING FULL EXTENSION AND DEVELOPING
MUSCULAR CONTROLARE IMPORTANT
Maintain Full Extension
1) Continue with full passive extension (straightening), gravity
assisted and active flexion, active-assisted extension, quadriceps
isometrics, and straight leg raises.
2) Work toward 90-100 degrees of flexion (bending)
54. ACL Reconstruction Rehabilitation cont.
3) Continue to use the knee brace for walking even if
you have good muscle control of the leg.
4) Wean from crutches when you can put full weight
on the leg and walk with a normal heal-toe gait and
no limp.
5) You can continue using a stationary bike. Cycling
is an excellent conditioning and building exercise for
the quadriceps.
THE BIKE IS ONE OF THE SAFEST MACHINES YOU CAN USE TO
REHABILITATE YOUR KNEE, AND THERE IS NO LIMITATION ON
HOW MUCH YOU USE IT.
55. ACL Reconstruction Rehabilitation cont.
Postoperative Weeks 3 - 4
Goals: * Full range of motion
•Strength through exercise
1) Expected range of motion is from full extension to 100 – 120 degrees of flexion.
(Add wall slides) and hand assisted heel drags to increase your range of motion.
2) Continue quadriceps isometrics and straight leg raises
3) Continue partial squats and toe raises
4) If you belong to a health club or gym you may start to work on the following
machines:
• Stationary bike.
• Elliptical cross-trainer 15 - 20 minutes a day.
• Inclined leg-press machine for the quadriceps muscles. 70 - 0 degree range.
• Seated leg curls machine
• Upper body exercise machines.
• Swimming: pool walking, flutter kick (from the hip), water bicycle, water jogging.
No diving, or whip kicks.
57. ACL Reconstruction Rehabilitation cont.
Postoperative Weeks 4 - 6
Goals:
* 125 degrees of flexion pushing toward full flexion
* Continued strength building
1) Expected ROM should be full extension to 125
degrees. Start to push for full flexion. Walls slides added
if your flexion range of motion is less than desired.
2) Continue quad sets, straight leg raises, partial squats,
toe raises, stationary bike, elliptical machine, leg presses,
and leg curls.
3) Tilt board or balance board exercises. This helps with
your balance and proprioception.
59. ACL Reconstruction Rehabilitation cot.
Postoperative Weeks 6 – 12
Now ROM should be full extension to at least 135 degrees of
flexion.
Goals:
•135 degree of flexion-* Continued strength-* Introduce
treadmill
1) Continue quad sets, straight leg raises, partial squats, toe
raises, stationary bike, elliptical machine, leg presses, and leg
curls.
2) Hamstring reconstruction patients can start leg curls in a
sitting position. If you develop hamstring pain then decrease
the amount of weight that you are lifting, otherwise you can
increase the weight as tolerated.
.
60. IT IS IMPORTANT TO AVOID USE OF A LEG
CURL MACHINE THAT REQUIRES YOU TO LIE
ON YOUR STOMACH. THIS MACHINE PUTS TOO
MUCH STRAIN ON THE HEALING HAMSTRING
MUSCLES, AND CAN RESULT IN YOU
"PULLING" THE HAMSTRING MUSCLE
61. ACL Reconstruction Rehabilitation cont.
NO MOUNTAIN BIKING OR HILL CLIMBING!
3) Continue tilt board and balance board for balance
training.
4) Continue swimming program.
5) Start treadmill (flat only).
6) You may begin outdoor bike riding on flat roads.
62. ACL Reconstruction Rehabilitationcont.
Postoperative Weeks 12 – 20
Goals:
* Continued strength
* Introduce jogging and light running
* Introduce agility drills
* Determine need for ACL functional brace
1) Continue all previous strengthening exercises.
2) Start straight, forward and backward jogging
and light running program.
3) Start functional running
program after jogging program
is completed.
63. Cross over drills
Agility drills
4) Optional fitting for ACL functional brace.
5) Start agility drills & zig-zags
Definition: Agility is the ability to move and
change direction and position of the body
quickly and effectively while under control.
64. ACL Reconstruction Rehabilitationcont.
24 Weeks Postoperative (6 months)
This is the earliest you should plan on returning to full
sports.
Goals:* Return to sports
To return to sports you should have:
• Quadriceps strength at least 80% of the normal
leg
• Hamstring strength at least 80% of the normal leg
• Full motion
• No swelling
• Good stability
• Ability to complete a running program
65. WE ARE TIRED! WE NEED A BREAK!
LET US DO
SOME
STRETCHING
EXERCISES
66. ACL reconstruction with simple meniscal repair
•General Considerations:
-PROM as tolerated. Early emphasis on achieving full
extension.
-Patients will be in a knee immobilizer for weight
bearing for 3 weeks post-op.
-Touchdown weight bearing for 3-5 days, progressing to
full weight bearing in extension until 3 weeks post-op.
-Important to watch for lower leg rotation or heel whip
with ambulation.
-Closed chain activities initiate at 2-3 weeks post-op and
beginning between 20°-70° OR in full extension to avoid
stress onto the repair.
67. -Active hamstring exercises can be initiated at 4 weeks
and resistive at 6 weeks.
-No lateral exercises for 6-8 weeks and nor ballistic
activities for at least 4 months post-op.
-No resisted leg extension machines (isotonic or isokinetic)
at any point in the rehab process.
-Patients are given a functional assessment test at 14
weeks, 6 months and 1 year post-op.
ACL reconstruction with simple meniscal repair
cont.
68. Week 1:
-Straight leg raise exercises (lying, seated, and standing),
quadricep/adduction/gluteal sets, gait training.
-Well-leg stationary cycling, abdominal exercises and upper body
conditioning.
• Weeks 2-4:
-Continue with pain control, gait training, and soft tissue treatments. -
Aerobic exercises.
• Weeks 4-6:
-Discontinue use of knee immobilizer if able to demonstrate adequate quad
control.
-Incorporate closed-chain exercises (i.e. mini-squats, modified lunges,
short step-ups) .
-Add hamstring curls without resistance*.
-Patients should have full extension and 110 degrees of flexion by the end
of this period.
• Weeks 6-8:
-Leg weight machines
-Stationary cycling initially for ROM, increasing as tolerated. -Increase the
intensity of functional exercises (i.e. add a stretch cord for resistance, add
weight, increasing resistance of aerobic machines).
69. • Weeks 8 - 12:
-Introduce resistive hamstring curls*.
-Add lateral training exercises (i.e. lateral stepping, lateral step-ups,
step overs).
• Weeks 12-16:
-Progress to running as able to demonstrate good mechanics and
appropriate strength.
-Begin to incorporate sport-specific training (i.e. volleyball
bumping, light soccer kicks and ball skills on contralateral side).
-Patients should be weaned into a home program with emphasis on
their particular activity.
• Weeks 16-24:
-Incorporate bilateral jumping and bounding exercises, making
sure to watch for compensatory patterns and any signs of increased
load onto the knee with take-offs or landings.
-cautiously introduce hamstring resisted exercises, watching for
signs of joint line/meniscus irritation
71. ACL reconstruction with complex meniscal repair-
rehabilitation program
General Considerations:
-PROM as tolerated. Early emphasis on achieving full
extension.
-Patients will be in a knee immobilizer for 4 weeks post-op.
-Non weightbearing for 3-4 weeks.
-Closed chain activities initiate at 3-5 weeks post-op and
beginning between 20°-70° OR in full extension to avoid
stress onto the repair.
72. Active hamstring exercises can be initiated at 6 weeks
and resistive at 8 weeks
-No lateral exercises for 10 weeks and no pivoting or
ballistic activities for at least 4 months postop.
-No resisted leg extension machines (isotonic or
isokinetic) at any point in the rehab process.
-Patients are given a functional assessment test at 14
weeks, 6 months and 1 year postop.
73. • Week 1
-Straight leg raise exercises quadricep/adduction/gluteal sets, gait training.
Well-leg stationary cycling, abdominal exercises and upper body conditioning.
-Soft tissue treatments to posterior musculature, retropatella and surgical
incisions.
• Weeks 2-4:
-Continue with pain control, gait training, and soft tissue treatments.
mini-squjits, modified lunges,
^Avoiding going into the last 15°-20° of extension avoids stress onto the repair.
Aerobic exercises consisting of well-leg stationary cycling, and upper body
weight training.
Weeks 4 - 6:
-Discontinue use of knee immobilizer if able to demonstrate adequate quad
control.
-Add hamstring curls without resistance.
-Stationary cycling initially for ROM, increasing as tolerated.
-Patients should have full extension and 110 degrees of flexion by the end
of this period.
74. • Weeks 6 - 8:
-Leg weight machines
-Stationary cycling initially for ROM, increasing as tolerated. -Increase
the intensity of functional exercises (i.e. add a stretch cord for resistance,
add weight, increasing resistance of aerobic machines).
• Weeks 8 - 12:
-Introduce resistive hamstring curls*.
-Add lateral training exercises (i.e. lateral stepping, lateral step-ups,
step overs).
• Weeks 12-16:
-Progress to running as able to demonstrate good mechanics and
appropriate strength.
-Begin to incorporate sport-specific training (i.e. volleyball bumping,
light soccer kicks and ball skills on contralateral side).
-Patients should be weaned into a home program with emphasis on their
particular activity.
75.
76. C) Total knee replacement
Considerations
· Knee replacement surgery is considered a last
resort in many cases, as it involves various risks.
However, knee replacement is commonly
suggested for people who have constant pain in
the knee joint that is severe enough to affect their
daily life. Anyone experiencing significant
stiffness, instability or deformity of the knee
joint is also considered a candidate for knee
replacement surgery.
77. Causes
.
Osteoarthritis-Rheumatoid Arthritis-Post-traumatic
Arthritis
·
Technique
•During a total knee replacement, the end of the femur bone is removed and
replaced with a metal shell. The end of the lower leg bone (tibia) is also
removed and replaced with a channeled plastic piece with a metal stem.
Depending on the condition of the kneecap portion of the knee joint, a plastic
"button" may also be added under the kneecap surface
78. Proposed Rehab Protocol for Total Knee
Replacement.
.
Extension:
o Place a rolled towel under your ankle to help with extension.
.
o Getting the knee fully straight (fully extended) is one of the most
important things for a successful total knee replacement.
o Put nothing under the knee.
--------------------------------------------------------------------------------
Ice the knee as needed for 20 minute intervals on/off as needed.
Be sure to ice it after your physical therapy sessions.
N.B. The knee is going to be warm and swollen for a long time (9 months
to 1 year).
80. (Proposed Rehab Protocol for Total Knee Replacement cont).
Phase I
Immediate Postoperative Phase (Day 0 – 10)
Goals:
Active quad contraction
Safe independent ambulation with walker or crutches
as needed
Passive knee extension to 0 degrees
Knee flexion to 90 degrees or greater
Control of swelling, inflammation, bleeding
81. (Proposed Rehab Protocol for Total Knee Replacement
cont).
Day 0-2:
Weight bearing as tolerated with walker/2 crutches as needed
starting on Day 0-1
Cryotherapy immediately and continuously unless ambulating
ROM of knee to begin immediately post op
Exercises
• Ankle pumps
• Passive knee extension to 0 degrees
• SLR
• Quad sets
• Knee flexion to 90 degrees
• Knee extension to 0 degrees
• Instruct in gait training - safe transfers
82. (Proposed Rehab Protocol for Total Knee Replacement
cont).
Day 3-10:
Weight bearing as tolerated with walker/2 crutches as
needed
Cryotherapy
Exercises
Ankle pumps
Passive knee extension to 0 degrees
SLR
Quad sets
AAROM - Knee flexion to at least 90 degrees
Hip adduction/abduction
Instruct in gait training – safe transfers
Start stationary bike, low resistance
83. (Proposed Rehab Protocol for Total Knee Replacement
cont).
Phase II: Motion Phase (Week 2-6)
Goals:
Improve ROM
Enhance muscular strength, endurance
Dynamic joint stability
Diminish swelling/inflammation
Establish return to functional activities
Criteria to enter Phase II:
Leg control, able to perform SLR
AROM 0-90 degrees
Minimal pain/swelling
Independent ambulation/transfers
84. (Proposed Rehab Protocol for Total Knee Replacement cont).
Weeks 2 -4:
WBAT with assistive device as needed. Wean from walker to cane or from 2
crutches to 1 by 2 weeks. Wean off all assistive devices by no later than 4 weeks.
Exercises:
Quad sets
SLR
Knee extension 90-0 degrees
Terminal knee extension 45-0 degrees
Hip abduction/adduction
Hamstring curls
Knee flexion to at least 115 degrees
Stretching:
Hamstrings- Gastroc/soleus- Q-uads
Passive knee extension stretch
Continue stationary bike and advance resistance as tolerated
Continue cryotherapy
Patellofemoral mobilization
Incision mobilization
Patients may begin to drive if they are no longer using assistive devices
for ambulation (about 2 weeks post op)
85. (Proposed Rehab Protocol for Total Knee
Replacement cont).
Weeks 4-6:
Exercises:
Continue previous exercises +
o Initiate front and lateral step ups
o Advance resistance on stationary bike
Initiate progressive walking program
Initiate endurance pool program, swimming with flutter kick
Return to functional activities
Continue compression, ice, elevation as needed for swelling
Patients should be walking and driving independently
at this point
86. (Proposed Rehab Protocol for Total Knee Replacement cont).
Phase III: Intermediate Phase (Weeks 7-12)
Goals: Progression of ROM to greater than 115 degrees
Enhancement of strength and endurance
Eccentric/concentric control of limb
Cardiovascular fitness
Functional activity performance
Criteria to enter Phase III:
ROM 0-115 degrees
Voluntary quad control
Independent ambulation
Minimal pain
87. (Proposed Rehab Protocol for Total Knee Replacement cont).
Weeks 7-12:
Exercises: Continue previous exercises
Continue pool activities
Continue walking
Continue stationary bike
Aggressive AROM 0-115 degrees
Strengthen quad/hamstrings
88. (Proposed Rehab Protocol for Total Knee Replacement cont).
Phase IV: Advanced Activity Phase (Weeks 12 and beyond)
Goals:
Allow patients to return to advanced level of function such
as recreational sports
Maintain/improve strength and endurance of lower
extremity
Return to normal life and routine
Criteria to enter Phase IV:
Full non painful ROM 0-115
Strength 90% of contralateral limb (if contralateral limb is
normal)
Minimal pain and swelling
Satisfactory clinical examination
89. Exercises:
o Quad sets
o SLR
o Hip abduction/adduction
o Step ups
o Knee extension
o Stationary bike
Swimming
Walking
Stretching 0-115 degrees
Return to pre op activities and develop HEP to maintain
function of leg.
NO SQUATS OR LUNGES AT ANY TIME!
90. Remember:
Don’t permit the session if:
o The wound site is red
o There is excessive drainage or pus
o Tense ,swollen ,tender leg
o The patient has a fever over 37.5°C
o The patient is experiencing severe
pain
91. D)Muscles tears
Quad & Hamstring Injuries
. Types of traumas:
Pulls and Strains
Partial tears
Complete tears
Contusions and bruises
92. Management:
• Rest
• Ice + splinting
• Stretching .
•Physical modalities for pain
•Surgeries could be indicated in full thickness
complete tears
98. Remember
1)Each patient has his own circumstances.
2)Modalities of physical Rehabilitation are not constant
for all patients having same disorders.
3)Revise every detail with the physician & therapist in
charge.
4)Working in a team is the best way for cure