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Rehabilitation |
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Introduction:Rehabilitation is the key to successful functional recovery after knee injuries and surgery. Early motion and weightbearing are essential for successful rehabilitation outcomes. The Physiotherapist must understand the anatomy and the biomechanics of the knee joint, the pathophysiology of the particular injury, the principles of the particular surgical procedure, and the process of tissue healing. Equally, the surgeon should provide detailed perioperative information, and discuss any special requirements with the physiotherapist. The three-way communication (surgeon-patient-physiotherapist) is very important for the progress and the outcome of postoperative knee rehabilitation. Phases of Knee RehabilitationIndividual rehabilitation programme following knee injury or surgery should be developed on the basis of the knee structures injured, the severity of the injury, the surgical procedure, and the goals of the patient and the physiotherapist. Rehabilitation programs should follow a protocol of ongoing pain and swelling control to aid in establishing and maintaining early range of motion and progressive weightbearing. Each phase of rehabilitation may involve the performance of isometrics, isotonics, isokinetics, balance and proprioception, endurance, power, and functional or sport-specific activities. Phase 1:
involves posttraumatic or postsurgical management of swelling, pain, inflammation and joint dysfunction. This phase may involve joint protection by immobilisation, bracing, and limited weightbearing until the patient can walk without a limp. Inflammation occurs to the knee joint in both injury and after surgery. Managing the inflammatory response after knee injury or surgery includes controlling pain and swelling and regulating motion both in the initial phase and throughout the entire rehabilitation process. Ice, elevation, compression, and other treatment modalities are used to manage pain and swelling. Wound management after injury or surgery should be closely monitored. Any signs of an infection should be reported to the surgeon directly.
Phase 2: re-establishes full ROM and joint mobility. Strengthening progresses
within tissue-healing constraints. Weightbearing advances according
to strength and level of healing. Endurance exercises are used to maintain
or re-establish fitness. Proprioception and balance advance from low-level,
stable surface training to high-level, unstable-surface training. Light
functional activities can begin at this stage.
Phase 3:continues with advanced progressive resistive exercise, functional activities, and implements speed and power training. Plyometrics (exercises that enable muscles to reach maximum strength in as short time as possible - typically jump training), dynamic balance and proprioception, agility and sport-specific training are intensified, protections and limitations gradually decrease during this phase. Phase 4: involves return-to-play criteria. Simulated competition and skill
refinement are important to return to play in a competitive environment.
The ability to return to play should be based on satisfactory performance
on various tests, including an isokinetic evaluation, negative clinical
examination, functional tests and psychological state of readiness.
Proprioceptive Exercises These are exercises that help retrain your position sense, also called
"joint sense". If you close your eyes and bend your knee,
you know what your knee is doing, even though you don't "see"
it. This ability enables us to know where our limbs are in space without
having to look. It is important in all everyday movements but especially
so in complicated sporting movements, where precise coordination is
essential. This coordinated movement is a result of the normal functioning
of the proprioceptive system. We get position sense by way of our vision,
middle ear balance, and from tiny receptors in the ligaments and joints.
When we close our eyes, we rely on middle ear balance and these special
receptors to keep us upright. The proprioceptive system is made up of
receptor nerves that are positioned in the muscles, joints and ligaments
around joints. The receptors can sense tension and stretch and pass
this information to the brain where it is processed. The brain then
responds by signalling to muscles to contract or relax in order to produce
the desired movement. This system is subconscious, and we don't have
to think about the movements or the corrections to movement. Sometimes
the reactions take place so fast they are termed reflexive.
Perioperative ACL RehabilitationFor an update on perioprative ACL rehabilitation please see our separate page on Accelerated ACL Reconstruction Rehabilitation Program which was kindly written and put together by Mark De Carlo and his team at the Methodist Sports Medicine Center, Indianapolis, Indiana, USA. "Footnotes" on Knee Pain:Many of knee problems are created or compounded by the knee being subjected to transverse plane motion generated by internal or external tibial rotation secondary to the foot's excessive pronation or supination. On this basis, stabilisation of the foot will often lead to a reduction in the knee symptoms by reducing both the magnitude and velocity of transverse plane motion within the last 15 degrees of motion that precedes full knee extension. For more information on shoe inserts, see:
Site last updated on: 20 June 2008
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| Mr Vladimir
Bobic, MD, FRCSEd, Consultant Orthopaedic Knee Surgeon, Chester Knee Clinic at The Grosvenor Nuffield Hospital, Wrexham Road, Chester, CH4 7QP, United Kingdom General Enquiries: 0845 6022500 | Appointments: 01925 215087 Spire Cheshire Hospital, Fir Tree Close, Stretton, Warrington, Cheshire WA4 4LU, United Kingdom General Enquiries: 01925 265000 | Appointments: 01925 215050 © Copyright 2002-2002008. Chester Knee Clinic |