Our Fantastic S&C course covers basic principles, application to rehab and an amazing athlete case study from a leading S&C coach
Here is a great slide to refresh your knowledge of ACL structural anatomy.
Its important to remember that alongside the structural support it provides, the ACL also has an important sensory function. High concentrations of mechanoreceptors at the insertion of the ACL provide the CNS with vital input on knee position and movement (proprioception)
Efferent feedback has an important role in regulating muscle activity and more recent research has highlighted the neurosensory element of feeling of instability when traditionally we just thing along mechanical lines.
The media recently speculated about the discovery of a new ligament which could be the answer to curing knee injury and pain. The 'new' Anterolateral Ligament (ALL) was actually described as early as 1879 by French Surgeon Segond and prior to the advent of arthroscopic procedures, surgeons would use lateral extra articular tenodesis techniques to address rotatory knee instability.
Check out more recent research by Alan Getgood and his team on the reduction of hamstring graft failure in young high risk patients with the addition of a lateral tenodesis here https://journals.sagepub.com/doi/10.1177/0363546519896333
Its essential to get rehab ticking along as early as possible after any surgery but post ACL reconstruction keeping the knee quiet whilst regaining extension range and early quads activation is imperative to good long term outcomes.
Here are some great exercises to get you started
Check out this taster video from our strength and conditioning course. A fantastic case study insight from Alan Murdoch S&C coach for Bath Rugby
Unfortunately when rehabilitating patients we often lose them to budget/session/insurance limitations before we can get to end stage rehab. If you are lucky enough to work at a sports club or can see patients right the way through their rehab these are some great drills for getting their speed back up to peak levels.
Patients can sometimes be fearful that their wound may open post surgery so its nice to be aware of the skilled work that goes in stitching multiple layers prior to gluing the superficial layer. Patients find it very reassuring to hear and it can give them the confidence they need to push their range post op.
Research points to general lower limb strength and conditioning to reduce injury risk and improve performance. Here are some nice progressions starting with double leg squats them progressing through split and single leg variations with load.
Dynamic valgus is often cited as a risk factor for ACL injury and this appears to be true for some groups but not all.....
There is no general consensus on which exercises we should use for rotator cuff pain. Here is a nice loading progression which can be used pre and post operatively to increase load tolerance through the cuff
This fantastic prevention programme not only reduces ACL injury risk but also all lower limb injuries and also improves performance. We have speeded it up so one of our tutors doesn't feel embarrassed by his lack of speed
Here is a simple MET you can use as a treatment techniques to increase neck mobility and you can also teach a patient to carry out themselves.
With Gyms reopening and some relatively quiet here are some great mid to late stage equipment based exercises to try with your patients
Some great research is going on in the field of tendinopathies at the moment with graded loading being hailed as the an essential part of management process. This can be done with minimal equipment as demonstrated in the video below. You can substitute the barbell with a weighted rucksack to ensure adequate late stage loading.
Post ACL injury/reconstruction research has shown alterations in muscle activation and knee mechanics. Early post op we find patients bias weight bearing through the contralateral limb and as time passes weight bearing becomes more symmetrical but hip musculature is relied upon over the quads. Check out this video outlining these movement patterns and strategies to improve quads recruitment.
Unloader or Offloader braces can be used to relieve the pain of Unicompartmental knee OA.
This trial of 149 patients found improved outcomes with use of the brace comparative to a placebo brace.
So these braces can be very effective and non invasive assistance for those struggling despite rehab. They are however expensive and some patients find them difficult to tolerate due to discomfort.
More info on our extensive Knee OA Course with full narrated surgery for no copers, patient case studies and rehab videos.
Here we are flicking through sections from a shoulder arthrogram. Can you spot the injury? MRI arthrograms are often utilised by clinicians to attempt to get a clearer picture of the integrity of the glenoid labrum.
Full case study and the resulting surgical repair and rehabilitation are depicted in detail in our Rotator Cuff Injury Course.
One of many prevention programmes but one of our favourites as it can be performed in just 15-30 minutes with minimal equipment. Research has shown that the Fifa 11+ programme can not only reduce ACL injury up to 50% but also improves speed, jump height and reduces risk of other lower limb injuries. Set up your cones at 5 metre intervals and away you go! This video shows the warm up. Parts 2 and 3 and a whole lot more resources on ACL prevention can be found in our ACL course