This was the first set of slides delivered at the Sports Surgery Clinic Workshop on ACL Rehabilitation at the FIFA Isokinetic Return to Play Conference on 9th April 2016 in London, UK

1. return to play or performance
Whos decision is it?
Dr Andy Franklyn-Miller

2. WHAT IS
return to play

3. place holder for video

4. Medical clearance for full
participation in sports
without restriction
or PAIN
Creighton 2010

5. No current lower extremity PPT
has demonstrated reliability,
validity & responsiveness in RTP
Physical Performance
TestsBritishJournalofSportsMedicine.2015:49:642-648
Clinician friendly lower extremity physical performance measures in athletes: A
systematic review of measurement properties and correlation with injury, Part 1 & 2.
HegedusEJ1,McDonoughS2, Bleakly C3,CookCE4,BaxterGD5

6. LACK OF
standardisation leads
to MEDICOLEGAL OR FINANCIAL
IMPLICATION club
vs country

7. But we know a lot
about injury mechanism
and rehabilitation so why
is it not easy?

8. Risk factors for injury
(distant from outcome)
Mechanism of injury
(proximal to outcome)
Intrinsic risk
factors
age
flexibility
previous
injury
phenotype
predisposed
athlete
susceptible
athlete injury
inciting
event
exposure to
extrinsic risk
factors

9. Success
Injury
Reduce the Load Repair Joint /Tissue
Mechanotherapy
“Increase tissue load tolerance”
Address Risk Factors
(biomechanics, training load, environment)
Replicate sport-specific demands
Return to Play
Unstructured Excessive
Loading
Well Structured
Appropriate Loading

10. Traditional Periodization Model
Volume
technique
General (GPP) Special (SPP) Competition Transition
intensity

11. STRENGTH IS NOT SIMPLE
EXPLOSIVE
STRENGTH
ACCUMULATION I RESTITUTION 1 ACCUMULAITON II RESTITUTION II
DT
EXPLOSIVE
STRENGTH
SPEED
EMPHASIS
MAXIMAL
POWER
SPEED
EMPHASIS
DT
MAXIMAL
POWER

12. SET EXPECTATIONS
BASEDON SOLID
EVIDENCE

13. manage
pain

14. normal joint
functionand range
for patient (surgery)

15. restorenormal,
then exceed
absolute strength

16. Ability to generatethat
strength through
a range at rate
appropriate to sport

17. Distributeload using
segmental
coordination and
control

18. Create fatigue
resilience of multiple
segments

19. Tolerate
excess load
and unpredictability

20. return to sport

21. SSC6 Phases of rehabilitation
6 Reproducibility under fatigueBack to Performance
5Back to Sport Multi-directional Running
4Back to Running Linear Running
3Back to School
&Work Power and Reactive Strength
2 Mobility, Control and Optimal Strength
1 Diagnosis and Assessment

22. Who
is in Control
of the RTP
Decision?

23. the patient

24. viaa systemof objective
testing criteria
with a returnto
performance specificity

25. thank you