2405AHS evidence based practices

ACL preoperative rehab

improve knee flexion and extension, some improvement on quad strength 3/12 post op, decrease time to return, no effect on strength, muscle atrophy, laxity or function

ACL unsupervised vs supervised rehab

no difference in laxity, function, strength and atrophy

ACL duration

no difference between 19/52 or longer

ACL continuous passive motion vs no CPM

beneficial effect on pain, knee flexion, swelling.

ACL continuous passive motion vs active knee motion exercises

no difference on knee ROM, pain and swelling

ACL cryotherapy

is an effect on reducing medication use, pain and patient satisfaction 3/7 post op

no effect on swelling during 2/52 post op

improve knee flexion not extension

compressive cryotherapy more beneficial than just cryotherapy

ACL NMES

improve quad strength, reduction in joint swelling

no significant changes in ROM, laxity, function or time to return to sport

use during functional activities improved quad strength and force symmetry restoration

ACL electromyographic biofeedback

potential benetif on quad strength and knee extension

ACL Low load blood flow restriction training

improve quad and HS strength, prevent atrophy in early phase

improvement in swelling and pain during training

doing it preoperatively improved rec fem muscle volume but no effect on VL or VM

ACL - Kinesio-taping

improved HA strength early phase

no effect in balance or functional activities

ACL Dry Needling

14%risk of adverse event

significant increase pain 1hr after

significant improvement in ROM and subjective function in early phase

ACL whole body vibrations

positive effect on static balance

no effect on quad or HS strength in early stage

conflicting rest ups on quad and HS strength in advance phase

improved quad strength in combination with normal rehab

no effect on ROM, laxity, proprioception, subjective knee function

ACL - local vibration

large improvement on quad and HS strength, postural control, ROM, subjective function, pain

no effect on functional activities

ACL - Exercise initiation

early mobilisation improve knee flex and exten ROM, large patella femoral pain reduction

ACL starting OKC

no different in laxity, strength, pain, ROM, knee function

ACL - Initial exercise prescription

isometric quad exercises first 2/52 post op

leg press from 3/52 to improve knee function and function outcomes (no impact on strength

eccentric cycle ergometer from 3/52 to improve strength, daily activity level and quad hypertrophy

isokinetic HS strengthening from 3/52 to improve HS strength, patient reported knee function, no harmful effects and no effect on quad strength

ACL - Strength and motor control training

no significant different in laxity, knee function, ROM, atrophy or functional activities between open and closed kinetic change

evidence suggests both open and closed to improve functional activities

open induce more anterior knee pain

ACL - Eccentric training

improve functions outcomes and return to sport

did not improve subjective outcomes and balance

combination with concentric to improve quad and HS strength

combination with plyometric to improve balance, functional activity, knee function, psychological readiness

ACL - isokinetic training

mixed with isotonic to improve strength and reduce atrophy

isolation to improve isometric and eccentric strength not concentric strength

no different in atrophy, functional activities or knee function

ACL - motor control training vs usual care

motor control to improve proprioception not balance, strength, subjective function, atrophy, pain, ROM

speedcourt system to improve jump height, reaction time, calf muscle atrophy

improve quad and HS strength

ACL - phyometric an agility training

advance rehab, subjective function, functional outcomes

no difference in strength, balance, proprioception, pain, laxity

combination with eccentric to improve balance and subjective function and functional activities

8/52 of plyometric to improve imprints, psychosocial and knee function

ACL - cross training

little evidence on impact, might improve early phase function

ACL - core stability training

might improve gait, ROM, knee function but not pain

ACL - Aquatic therapy

improve knee function in early phase, no differences in balance, laxity, proprioception, swelling, quad strength

reduced HS strength and thigh circumference

ACL - return to driving

4-6/52 for right 2-3/52 for left

ACL - return to running

no conclusive result (8-16/52 range)

ACL - return to sport

minimum criteria: cleared from clinic/hospital, gradual return to full training

Patellar tendinopathy - advice highly irritable conditions

early bilateral loading

NSAIDS to reduce symptoms and allow progression

Patellar teninopathy - advice in season athletes

address underlying strength deficiencies, load management with isometric exercises (not declined squats)

corticosteroids and tendon polyp may be useful for short term leading up to tournament

Patellar tendinopathy - advice deconditioned athletes

lower limb strength and energy-storage’s 1-2/7

Patellar tendinopathy - advice young jumping athletes

load management and progressive rehabilitation

Knee OA treatment

arthritis education, land-based exercises, possible dietary weight management, NSAIDs, intra-articular corticosteroids

NO = paracetamol, oral and transdermal opiods

Hip and polyarticular OA

arhtritis education, land-based exercises

OA comborbitity recommendations

cardiovascular = no NSAIDs

Lateral Ankle Sprain - RICE

improves pain, swelling and function

only good in combination with other rehab/not primary treatment

Lateral Ankle Sprain - NSAIDs

reduce pain and swelling short term, effective for symptom relief

may delay healing process therefore only used short-term and if needed

Lateral Ankle Sprain - immobilisation

short period (<10days) may be good sever sprains, long term is not recommended

Lateral Ankle Sprain - support

better than immobilisation, braces are most supportive above taping, duration recommended 4-6/52

Lateral Ankle Sprain - Exercise

most important treatment, target proprioception, balance, neuromuscular, strength

improves recovery time, functional instability, recurrent sprains, return to sport outcomes

Lateral Ankle Sprain - manual therapy

improves DF ROM, reduce pain, should be combined with exercise

Lateral Ankle Sprain - surgery

rarely needed, may reduce instability but longer recovery, increased stiffness risk, more complications

Lateral Ankle Sprain - non-recommended treatments

therapeutic ultrasound, laser therapy, TENS, shortwave, acupuncture, passive modalities

Return to sport tool

PAASS framework: requires assessment in Pain, Ankle impairments, athlete perception, sensorimotor control, sport/functional performance

Return to sport - Pain

during sport participation, pain over past 24hrs

why - indicate incomplete tissue recovery and ongoing impairment

Return to sport - Ankle impairments

ROM, strength, endurance, power

why = deficiencies increase re-injury risk and reduce performance

Return to sport - athlete perception

confienced, perceived stability, psychological readiness

why = athletes confidence is central

Return to sport - sensorimotor control

proprioception, dynamic balance/postural control

why = deficits is associated with recurrent ankle sprains

Return to sport - sport/functional performance

hopping, jumping, agility, sport-specific drills, completion of full training session

why = activities reflect real sport demands