Download - Opening Slides SSC ACL Rehabilitation
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return to play or performance Whos decision is it? Dr Andy Franklyn-Miller
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WHAT IS return to play
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place holder for video
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Medical clearance for full participation in sports
without restriction
or PAIN Creighton 2010
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No current lower extremity PPT has demonstrated reliability,
validity & responsiveness in RTP
Physical Performance Tests
British Journal of Sports Medicine. 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.
Hegedus EJ1, McDonough S2, Bleakly C3, Cook CE4, Baxter GD5
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LACK OF standardisation leads
to MEDICOLEGAL OR FINANCIAL
IMPLICATION club vs country
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But we know a lot about injury mechanism
and rehabilitation so why is it not easy?
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Risk factors for injury (distant from outcome)
Mechanism of injury(proximal to outcome)
Intrinsic riskfactors
age
flexibility
previous injury
phenotype
predisposed athlete
susceptible athlete injury
inciting event
exposure to extrinsic risk
factors
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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
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Traditional Periodization Model
Volumetechnique
General (GPP) Special (SPP) Competition Transition
intensity
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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
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SET EXPECTATIONS BASED ON SOLID EVIDENCE
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manage pain
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normal joint function and range for patient (surgery)
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restore normal, then exceed absolute strength
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Ability to generate that strength through
a range at rate appropriate to sport
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Distribute load using segmental
coordination and control
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Create fatigue resilience of multiple segments
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Tolerate excess load and unpredictability
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return to sport
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SSC 6 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
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Who is in Control of the RTP Decision?
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the patient
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via a system of objective
testing criteria with a return to
performance specificity
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thank you