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DON’T JUST RECOVER. CONQUER. Charlene Challenger-Smith, MPT, SCS, ATC.

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Presentation on theme: "DON’T JUST RECOVER. CONQUER. Charlene Challenger-Smith, MPT, SCS, ATC."— Presentation transcript:

1 DON’T JUST RECOVER. CONQUER. Charlene Challenger-Smith, MPT, SCS, ATC

2 DON’T JUST RECOVER. CONQUER.  Pre-operative Rehab  Basic Healing Concepts  Post-operative Rehab  Goals and Criteria to Progress During Rehab Phases Outline

3 DON’T JUST RECOVER. CONQUER. Purpose Pt education on entirety of rehab plan pre/post operatively Goals Eliminate effusion, normalize ROM, normalize strength, and improve proprioception to maximize post-operative outcomes  HEP  Gait/Crutch Training  ADL education  Clear expectations for rehab plan post-operatively Pre-Hab

4 DON’T JUST RECOVER. CONQUER. Key Rehab Consideration  ROM Precautions  Weight bearing restrictions  Timeline in Regards to Healing Process

5 DON’T JUST RECOVER. CONQUER. Healing Phases

6 DON’T JUST RECOVER. CONQUER. MFx vs. Ligament Reconstruction Healing Considerations  Microfracture: “Super Clot” provides enriched environment for tissue regeneration Emphasize healing by protection from Wbing, Gentle A/PROM and joint mobilization to nourish the clot with synovial fluid  Brostrum: Reconstruction of ATF and/or CF ligament to provide return of passive stabilizers to the ankle

7 DON’T JUST RECOVER. CONQUER. Rehabilitation: Phase I Maximum Protection Phase Weeks 0-4 Emphasis  Protection and acute healing Goals  Control pain and swelling Arthrogenic muscle inhibition is a reflex inhibition of joint musculature after distention or damage to a joint and can become a consequence of increased swelling  Splint x 2 weeks, cast x 2 wks  NWBing x 6 weeks-Crutch Training  Hip and Core Ex-Prevent Associated Disuse Atrophy  Cryotherapy and Elevation

8 DON’T JUST RECOVER. CONQUER.  DF insufficiency persists through the acute and subacute healing phases – Yang et al., J of Sci and Med in Sport 2002  Reduction in posterior glide of the talus in the ankle mortise up to 6 months post-injury – Denegar et al., J Orthop Sports Phys Ther 2002 Rehabilitation: Range of Motion

9 DON’T JUST RECOVER. CONQUER. Rehabilitation: Range of Motion Joint Mobilizations  (n = 41) acute ankle sprains (<72 hrs)  Anterior-posterior force 3 sets of 60 sec with 10 sec. rest between sets  Greater improvements in DF ROM than RICE application alone – Green et al., Physical Therapy, 2001

10 DON’T JUST RECOVER. CONQUER. Rehabilitation: Range of Motion Vincinzo et al., JOSPT 2006  (N =16) Hx of ankle sprain (<6 mo)  3 groups weight-bearing MWM non–weight-bearing MWM no-treatment control group  Both MWM groups showed sig. increases in weight bearing DF and posterior talar glide when compared to control group

11 DON’T JUST RECOVER. CONQUER. Weeks 2-6 Emphasis:  Repair and regeneration Goals  A/P Dorsiflexion, Plantarflexion-to resting posture cycles/day  Gentle Eversion allowed  NWB  Ankle Isometrics  OKC LE ex and Core Ex Rehabilitation: Phase II Early ROM and Joint Protection

12 DON’T JUST RECOVER. CONQUER. Weeks 6-10 Emphasis:  Remodeling Goals  Normalize Gait-progressive WBing  Progress to full ROM  Progressive strengthening  Advance NRE/Proprioceptive activities Rehabilitation: Phase III Strengthening

13 DON’T JUST RECOVER. CONQUER. Basic Science Healing Concepts  6 weeks to 12 months  Tissue changes from cellular to almost collagenous by the end  Tissue becomes contracted and demonstrates greater tensile strength  Activity level within physiological limits for best healing

14 DON’T JUST RECOVER. CONQUER. Rehabilitation: External Support  Lace-up ankle support effective in reducing swelling in the short-term compared with semi-rigid ankle support, elastic bandage and tape – Kerkhoffs et al. 2009; Cochrane Review

15 DON’T JUST RECOVER. CONQUER. Phase III Strength/Endurance Continued Weeks Emphasis:  Proprioceptive control Goals  Develop strength and stability in all planes of motion and under various conditions Stable vs. unstable Predictable vs. unpredictable  Strength & endurance Fatigue-mediated alteration in proprioception possible contributor to injury – Hiemstra, J Orthop Sports Phys Ther. 2001

16 DON’T JUST RECOVER. CONQUER. Rehabilitation: Balance/Proprioception  Postural control impairments present in patients with acute and chronic lateral ankle sprains – Wikstrom et al., Med. Sci. Sports Exerc, 2009  Significantly delayed onset times for ankle, hip, and hamstring muscles in CAI – Van Deun 2007

17 DON’T JUST RECOVER. CONQUER.  8 subjects w/ lateral ankle sprains (6-16 mos)  8 wks, 15 min/day of ankle disk training  Significant decrease in onset latency of anterior tibialis – Osborne et al., Am. J Sports Med., 2001 Rehabilitation: Balance/Proprioception

18 DON’T JUST RECOVER. CONQUER. Rehabilitation: Balance/Proprioception  6 weeks of balance training program improves postural sway in patients w/ unstable ankles  Balance training on trampoline just as effective as ankle disc – Kidgell et al., J Strength & Cond., 2007

19 DON’T JUST RECOVER. CONQUER. Phase IV Advanced Strengthening Weeks Emphasis:  Prep for return to sport Goals  Progressive jogging program  Sport cord test  Dynamic Balance/Proprioceptive activity

20 DON’T JUST RECOVER. CONQUER. Phase V Return to Sport Weeks Emphasis:  Return to sport Goals  Unilateral Agility  Multidirectional Agility  Side hop test (Docherty 2005, Journal of Athletic Training)  Figure 8 test

21 DON’T JUST RECOVER. CONQUER.  Clinical Bottom Line: Rest, Ice, Compression, Elevation still important Protection during healing phase: NWB Early Gentle Active/Passive ROM and Joint mobilization Early isometric activity for peroneal activation and proprioceptive Re-ed Lace-up ankle support for swelling and support while initiating WBing Progressive Proprioceptive program SEBT, Y-balance, Side-hop, Figure 8, observation of functional movement for return to sport Rehabilitation Wrap Up


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