isfahan university of medical siences physiotherapy department faculty of rehabilitation
TRANSCRIPT
ISOMETRIC از استاتیک شکل یک ایزومتریک های انقباض
که هستند عضله تغییر forceانقباض بدون رامفصلی حرکت بدون و عضله طول در محسوس
. لحاظ از گرچه کنند می فراهم مشاهده قابلمقداری ولی نمیگردد انجام کار و forceمکانیکی
tension . كار انقباض این در شود می تولیدبود . خواهد صفر با مساوی عضالنی
ISOKINETIC: از داینامیک شکل یک ایزوکینتیک انقباضاتی
شدن طویل و کوتاه سرعت که است انقباضاتو شده تعیین قبل از اندام ای زاویه سرعت و عضلهبه که سرعت کننده محدود ی وسیله یک ی بوسیله
است معروف داینامومتر شود holdایزوکینتیک میبا. که دارد حرکتی به اشاره ایزوکینتیک اصطالح
. مفیدترین انقباض این افتد می اتفاق ثابت سرعتعضله . آسیب میزان است ورزش در انقباض نوع
. است حداقل
ISOTONIC کنترل یا ایجاد منظور به عضله در تنش تولید شامل
. عضله در تنش تغییرات باشد می مفصل در حرکتمی رخ مفصل زاویه در تغییر واسطه به
انقباض. شامل ایزوتونیک انقباض دهد . انقباض این در باشد می واکسنتریک کانسنتریک
ثابت كمیتی ، شود می وارد عضله بار با كه نیروییكند . نمی تغییر انقباض عمل طول در و داشته
The injury mechanism is a valgus/external rotation trauma with a slightly bend knee
Because the ACL is a primary stabilizer of the knee, a rupture can lead to functional instability
In the long term, an ACL rupture can cause further intraarticular damage like meniscal tears cartilage defects and osteoarthritis
The younger and more active the patient, the earlier surgical reconstruction is chosen
medication, exercises, postsurgical compression
wraps and elevation, cryotherapy is advised as it
significantlyreduces postsurgical pain
ONE POINT
The results clearly indicated that an accelerated protocol without postoperative bracing, in which reduction of pain, swelling and inflammation, regaining range of motion, strength and neuromuscular control are the most important aims, has no important advantages and does not lead to stability problems.
POSTSURGERY, PHASE 1 (WEEK 1)
controlling pain,swelling and inflamation recovery of ROM and neuromuscular control There are no long-term advantages of bracing
Aggressive control of pain, swelling and inflammation prevents
quadriceps inhibition maintains full knee extension and makes immediate weight bearing possible
Immediate recovery of passive and active ROM (emphasis on full extension) reduces pain stimulates the homeostasis of cartilage prevents patellofemoral problems alterations in gait pattern quadriceps atrophy and arthrofibrosis
Multidirectionalmobilizations of the patella
patellar immobility leads to decreased ROM and quadriceps inhibition
Initioted Muscul control:
by isometric exs closed chain (CC, safe range 0_–60_)
open chain (OC)safe range (90_–40_)
without additional weight.
muscle setting exercises straight leg-raising (SLR) heel slides
mini squads (0_30 flexion)
OC extension (90_40)
shifting body weight
OC flexion (isolated hamstring) exercises Full weight-bearing without crutches within
10 days
PHASE 2 (WEEK 2 TO WEEK 9)
Cryotherapy should be continued
Flexion can be increased gradually
while full extension and patellar mobility will be maintained
THE STRENGTH OF THE GRAFT IS NOT OPTIMAL
Quadriceps and hamstring strength by isometric isotonic and isokinetic exs
Isotonic strength training in a safe range (CC: 0–60, OC: 90–40),
Increasing endurance and strength of quadriceps significantly has no negative
effect on anterior knee pain and knee laxity
safe range (CC: 0–90, OC: 90–0) neuromuscular training for loss of
proprioception
prevention (re-rupture)
Quadriceps atrophy persistent quadr lag with SLR
incomplete extension and gait impairmentsin
week 5 are predisposing factors for quadrice weekness after 6 month
NEUROMUSCULAR TRAINING SHOULDSTART AS SOON AS WALKING WITHOUT
CRUTCHES IS POSSIBLE
gentle non-complex exercises using minimal weight
developing from static to dynamic balance training
plyometric exercises into agility training
sport specific exercises
Gait training on a treadmill or flat surface without
crutches is still necessary
SPECIFIC EXERCISES FOR PHASE 2
walking on a treadmill
cycling on an ergometer
swimming from week 3
stair-stepping machine from week4
jogging in a straight line
outdoor cycling from week8
PHASE 3 (WEEK 9 TO WEEK 16)
o obtaining and maintaining full ROM
o increased further with CC and OC
o Neuromuscular control:o slowly increasing functional dynamic
balance training
o plyometric exs
TRAINING OF FUNCTIONAL MOVEMENTPATTERNS (TRUNK, HIP, KNEE AND ANKLE)
Plyometric exs
agility training
variation in visible input surface stability speed of exercise performance complexity of the task Resistance One or two-legged performanc etc
SPECIFICEXERCISES FOR PHASE 3 normalization of runing
(gradually increasing duration and speed to
decrease neuromuscular adaptation and recovery time)
from week 9, jogging outdoors starts in week13
PHASE 4 (WEEK 16 TO WEEK 22)
Maximizing endurance and strength of the knee stabilizers
optimizing neuromuscular control with plyometric exercises
agility training and sport-specific exs: with variations in running, turning and
cutting maneuvers
acceleration and deceleration, improves arthrokinetic reflexes
TO EVALUATE PERIODICAL RECOVERY AND TO CORRECTLY TIME RETURN TO SPORTS,
(VAS): for pain Goniometer:active and passive ROM Measurements (IKDC): a knee-specific questionnaire Hop tests: measures total leg function. Isokinetic tests:objective measurement
of strength and endurance of the knee stabilizers
IF GOALS OF THE PREVIOUS PHASE ARE MET,THE NEXT PHASE CAN BE STARTED
if full ROM is achieved, the hop tests and strength of the hamstrings and quadriceps are at least 85%
compared to the contralateral side hamstring/quadriceps<15% compared to the contralateral side patient tolerates sport-specific activities (no increase in pain and swelling).