ACL REHABILITATION ACL REHABILITATION ACL REHABILITATION ACL REHABILITATION

RECENT ADVANCES RECENT ADVANCES RECENT ADVANCES RECENT ADVANCES

TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL

APPROACHAPPROACHAPPROACHAPPROACH

DR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhD....Senior consultant manipulative sports physiotherapist ,coimbatore

Professor in physiotherapy,RVS college of physiotherapy

WHAT PHYSICAL THERAPY AFTER

ACL RECONSTRUCTION

�AGE

�TYPE OF INJURY

�RECONSTRUCTION- GRAFT,SURGEONS PROFILE,TYPE OF FIXATION

�PRE OP STATUS

�SCOPE FOR SUPERVISED PT

�RECENT BIOMECHANICAL UPDATE

�FUNCTIONAL APPROACH

EXISTING

• Home Versus Supervised Therapy

• Home Exercise Versus Weight Machines

• Aquatic Therapy• Open Versus Closed

Chain Exercise• Progression Based on

Objective Criteria

What's new?

GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING

EXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLS

Based on

Muscle

Strength

Ignored

Proximal

Muscle control

6 months

Too early to

return to sports

BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE

HIP & KNEE STRATEGIESHIP & KNEE STRATEGIESHIP & KNEE STRATEGIESHIP & KNEE STRATEGIES

KNEE STRATEGY

KNEE EXTENSOR MOVEMENT

QUADRICEPS ACTIVATION

HIP EXTENSOR MOVEMENT

HIP ENERGY ABSORPTION

HIP STRATEGY

KNEE EXTENSOR MOVEMENT

QUADRICEPS ACTIVATION

HIP EXTENSOR MOVEMENT

HIP ENERGY ABSORPTION

KNEE STRATEGY

HIP STARTEGY

IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS

MUSCLE PERFORMANCEMUSCLE PERFORMANCEMUSCLE PERFORMANCEMUSCLE PERFORMANCE

Sagittal Plane Frontal/Transverse Plane

THOUGHT PROCESS

• NEED FOR CHANGE DUE TO INCREASING

RESPONSIBILITY

A FUNCTIONAL APPROACHA FUNCTIONAL APPROACHA FUNCTIONAL APPROACHA FUNCTIONAL APPROACH

IN IN IN IN KNEE REHABILITATIONKNEE REHABILITATIONKNEE REHABILITATIONKNEE REHABILITATION

Functional approach

• A functional approach in rehabilitation is the key

concept underpinning the management.

• Functional movement is defined here as the

unique movement repertoire of an individual.

• Functional rehabilitation is defined here as the

process of helping a person to recover their

movement capacity by using their own

movement repertoire(whenever possible).

DEVELOPING A FUNCTIONAL

PROGRAM

1. The focus on functional

movement

2. The principle of

skill/ability level

rehabilitation

3. The code for motor

adaptation

….that ought to

participate in this

particular movement

& accompany the

stabilization of the

body.

MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR

FUNCTIONAL PROGRAMFUNCTIONAL PROGRAMFUNCTIONAL PROGRAMFUNCTIONAL PROGRAM

DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL

PROGRAMPROGRAMPROGRAMPROGRAM

“Simplified complexity” in tensional fields.Shaded circles represent tension created by

muscle groups

ADAPTIVE CODE & PHYSICAL STIMULATION FOR PROPRIOCEPTION

MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE

REHABILITATION SIMILARITY REHABILITATION SIMILARITY REHABILITATION SIMILARITY REHABILITATION SIMILARITY

SPHERESSPHERESSPHERESSPHERES

AMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUT

CHALLENGING CHALLENGING CHALLENGING CHALLENGING

ENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENT

When cognitive becomes autonomous

FUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIES

FUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATION

(RE(RE(RE(RE––––ABILITATIONABILITATIONABILITATIONABILITATION))))

FUNCTIONAL APPROACH REFUNCTIONAL APPROACH REFUNCTIONAL APPROACH REFUNCTIONAL APPROACH RE----ABILITATIONABILITATIONABILITATIONABILITATION

FUNCTIONAL APPROACHFUNCTIONAL APPROACHFUNCTIONAL APPROACHFUNCTIONAL APPROACH

ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS

BALANCE/BALANCE/BALANCE/BALANCE/

POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE.

BALANCE/POSTURAL BALANCE/POSTURAL BALANCE/POSTURAL BALANCE/POSTURAL

STABILITY CHALLENGE. STABILITY CHALLENGE. STABILITY CHALLENGE. STABILITY CHALLENGE.

TAKE HOME TAKE HOME TAKE HOME TAKE HOME

• Rehabilitation with current concept

• Enhance hip strategy

• Functional Re-Abilitation motor complexity

• Differentiate demand & risk in rehab.

• Think movement not muscles

• Team work

DEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGS

INVESTIGATE THE BIG TALK !