The document discusses rehabilitation strategies for ACL injuries, including: 1. Early weight bearing and motion are beneficial to decrease pain and avoid stiffness, while closing kinetic chain exercises should be used in the first 6 weeks. 2. Bracing provides no advantages, and neuromuscular electric stimulation should be high intensity. 3. Accelerated rehabilitation programs are safe in the 5-6 month period, and water activities, stair climbing, and slide boards add variety and are also safe.

1. World War Pigeon Found
what was the code found?

2. Closer look

3. Winning power ball number??

4. Actually it was a football score
• Florida 37
• Florida State 26

5. E.J. Manuel injury: FSU QB takes shot
to head vs. Florida
Should he played?

6. Grade ?

7. Physiatrist Prescription
• Pain relief
• Comfort

9. Motion
• Passive
• Passive assist
• ROM re-education
• Active assist
• Active
• Stretch
• ROM limits?

10. Maximum anterior translation of
the tibia occurs at 15-25 deg of
flexion
Limit knee extension

11. Strengthening
• Isometrics
• Multiple angle isometrics
• Short arc isotonics
• Full arc isotonics
• Isokinetrics
• Speed
• ROM

14. Close Kinetic exercises in ACL rehab
1. Enhance functional
performance activities
2. Less strain on the ACL
3. Less harmful on the
patellofemoral joint

16. Q/H Ratio
• exercisers are told that there should be a certain
ratio between the strength of their hamstring and
quadriceps muscles.
• Called the H/Q ratio and reported to be
anywhere from .50 to .75 with a normative value
of .60, the strength ratio of this important
agonist/antagonist pairing is considered essential
to the stability of the knee joint and to prevent
ACL and other injuries.

17. Q/H Ratio
• The balance of quadriceps to hamstring
strength is not 1:1; but closer to 3:2. In
general healthy hamstrings can lift 60 - 80%
of what healthy quads can do.

18. Isokinetic exercises
• are performed at a dynamic preset fixed speed (ranging
from 1 degree per second to approximately 1000 degrees
per second) with resistance that is accommodating
throughout the range of motion (ROM).
• Accommodating resistance means that Isokinetic exercise
is the only way to dynamically load a muscle to its
maximum capability throughout every point in the ROM.
• Therefore, the resistance varies to exactly match the force
applied by the athlete at every point in the ROM.

19. Isokinetic machines have the ability
to objectively measure muscle
strength
• The Isokinetic device is
attached to a computer, that
assesses the torque output of
the muscles being testing.
• The torque output is
converted to a foot-pound
measurement. Isokinetic
testing allows for a variety of
testing protocols ranging from
strength, strength ratios
between two muscle groups,
power, and endurance.

20. Functional Activities

21. Balance/Propriception

22. Quadricep avoidance gait
• quadriceps avoidance gait: - most patients will
alter their gait in order to avoid anterior
displacement of the tibia which occurs with
quadriceps contraction;
• - between 0 to 45 deg of flexion,
contraction of the quadriceps will cause anterior
translation of the quadriceps (which is normally
resisted by the ACL);
• - maximum anterior translation of the
tibia occurs at 15-25 deg of flexion;

23. Quadricep avoidance gait
• that is characterized by increased hip and
knee flexion, reduced knee extensor torque,
power, and loss of the biphasic knee joint
torque pattern
•
• EMG studies support these findings with
increased hamstrings and reduced
quadriceps activity

27. Summary
• Early weight bearing is beneficial and may decrease PF pain
• Early motion is safe and help avoid arthofibrosis
• CPM is not warranted
• CKE should be used in the first 6 weeks
• Bracing has no advantage
• Neuromuscular stimulation electric stimulation high enough
intensity
• Accelerated rehab program safe in the 5 to 6 month period
• Water base activities, stair climber, slide board exercise are safe
and add variety
• Gait proprioception and psychological training may be of some
benefit
• Creatine offers no benefit

28. Physiatric Prescription
Summary