FUNCTIONAL TESTING GUIDELINES FOR ACL RECONSTRUCTION TESTING INSTRUCTIONS FOR CLINICIANS

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Vivian Maxwell
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FUNCTIONAL TESTING GUIDELINES FOR ACL RECONSTRUCTION TESTING INSTRUCTIONS FOR CLINICIANS A number of criteria should be met before advanced functional testing of ACL reconstruction or ACL deficient

1 FUNCTIONAL TESTING GUIDELINES FOR ACL RECONSTRUCTION TESTING INSTRUCTIONS FOR CLINICIANS A number of criteria should be met before advanced functional testing of ACL reconstruction or ACL deficient knees are tested: - No pain - No reports of instability or giving way - No swelling - Full active range of motion Generally testing be done no earlier than 4 months with the exception of LARS ACL grafts. TESTS: Single Leg Squat Functional Alignment Test Subjects stand on one leg off 20 cm box with arms crossed. 5 consecutive single leg squats are performed in a slow and controlled manner at a rate of 2 seconds per squat. The task is rated as good, fair or poor. ( Crossley et al, 2011). Single Leg Balance Subjects stand on one leg with other leg raised and arms crossed over chest. The assessor uses a stopwatch to time how long stance is maintained on one leg with eyes closed. (Springer et al, 2007). Y Balance Test - Place one foot in the center of the grid (stance leg denotes measure) - While maintaining balance, reach foot forward, medial and lateral as far as possible - Return to the starting position, no lifting stance foot or touching down - Repeat for each of the three directions, alternating legs for direction - 3 attempts each direction, > or equal 4cm difference denotes risk - can express each reach as a percentage of leg length: reach distance divided by leg length (greater trochanter to lateral malleolus) ) x Composite reach distance is sum of 3 reaches divided by 3x leg length multiplied by 100. Less than or equal to 94% composite score is high risk. (Plisky et al, 2006, 2009) 1

2 Single Leg Bridges Subjects lie supine on the floor with one heel on a box or plinth 60 cm high. The knee of the test leg is slightly bent at 20 degrees and the opposite leg is bent to 90 degrees hip and knee flexion with their arms crossed over their chest. Hips are elevated until working leg is straight. Repeat as many times as possible until the subject is unable to bridge to the original height. (Freckleton et al, 2013) Calf Raises Subjects stand on one foot on the edge of a step and perform a calf raise through full range of motion. Calf raises are performed through full range of motion. Calf raises are performed at 1 rep every 2 sec. The test concludes when subjects are unable to move through full range or cannot keep up with cadence Side Bridge Endurance Test Subjects lie on an exercise mat on their side with legs extended. The top foot is placed in front of the lower foot, then subjects lift their hips off the mat to maintain a straight line over their full body length for as long as able. The test ends when they cannot keep straight. (McGill et al, 1999) Single Leg Press Seat position at 90 degrees to the side and the foot should be placed so that the hip is flexed to 90 degrees. A valid repletion is where the weight is lowered to a depth of 90 degrees knee flexion and then extended back to full extension. 1.8 x body weight Males, 1.5x body weight (sled + weight) Females Carioca Quickly side step with lead leg followed by trail leg crossing in front of the lead on the first step and then behind on the second step for a straight distance of 30 feet and immediately reverse the direction to cover the same distance in the shortest possible time. Tuck Jump Feet should be positioned shoulder width apart and the athlete will be asked to repeatedly jump for 10 seconds, pulling their thighs up parallel to the ground, while the clinician scores the quality of the performance for each of the 8 categories by circling a number on a scale from 0 (never) to 10 (always). The scores in each category are summed to provide the total for the assessment (out of 80). Two trials can be performed (one viewing from front and one from side) to attain scores for all 8. A horizontal line of tape can be used as the target for jumping and landing in the same location. Hop Tests x 4 General: Running shoes are to be worn. 1. Perform tests in the order they appear. 2. One practice trial is given for each limb. Two measurements are taken and the average is recorded. 2

3 3. No restrictions are given on arm movement. 4. Begin with non-operated leg. 5. Two alternating trials on both limbs are measured and means for each are recorded 6. Start with lead toe behind marked line. 7. Measurement is taken to either the nearest 10 th of a second (stopwatch) or nearest 10 th of a centimetre (measuring tape). 8. A failed jump consists of loss of balance, touching the floor with arms or opposite leg, or an additional short hop on landing. 9. To calculate "Limb Symmetry Index" values, average the two-recorded trials on each limb; divide the operative limb average by the non-operative limb average, and multiply by 100 (percentage). Once "Limb Symmetry Index" values are calculated for each of the 4 hop tests, the average of these is taken for the "Overall Combination" score. < 85 % considered abnormal. 1. Single leg hop for distance Stand on one limb and hop as far forward as possible, landing on the same limb. Maintain the landing for a minimum of 2 seconds while the toe measurement is recorded. (measured to the nearest cm) 2. Single leg 6 m timed hop Perform large one-legged hops in series over 6 metres. (timed to nearest 10 th of a second) 3. Triple hop for distance Perform 3 successive hops as far as possible and land on the same leg. Maintain the final landing for a minimum of 2 seconds while the toe measurement is recorded. (measured to nearest 10 th of a cm) 4. Crossover hop for distance Perform 3 hops as far as possible crossing over a 15cm wide strip marking on each hop and maintain landing after the 3 rd hop for 2 seconds. The first of the 3 hops is lateral with respect to the direction of the crossover. (measured to the nearest 10 th of a cm) 3

4 Single Leg 8-inch Jump Landing Stand on one leg and perform a jump landing off a 8-inch box. The landing must be held for 5 seconds with balance maintained. The entire sequence is to be completed with good mechanics, including proper landing stance, knees flexed and in line with foot, level pelvis, and vertical alignment of trunk. Single Leg Vertical Jump for Height Stand sideways on one leg, unsupported, next to a wall. Bend your knees and jump as high as possible, tap your hand on the wall at the maximum vertical height. One practice trial is given for each limb. Perform two alternating trials on the unaffected and affected sides. The vertical height is measured and the averages recorded for the L and R legs. Single Leg Hop onto Bosu Stand facing bosu on one leg, unsupported. Hop onto round side of bosu and hold for 5 seconds x 5 repetitions. Assess for form and technique for both L and R legs. 4

5 Modified Vail Sports Test (strength, muscular endurance and power) 4 components ( Garrison et al, 2012) General: - each component tested once - total of 20 points, where 17/20 or 85% is a pass - no point after 3 verbal feedbacks on incorrect patterns minute break after each component 1.) Single Leg Squat (3 mins) Perform each rep at a cadence of 1 sec up and 1 sec down between degrees knee flexion. Score 1 point per 30 seconds, comment on test ending due to form, pain or endurance. Thick tubing on thigh perpendicular to motion. 2.) Lateral Hopping (90 sec) Perform lateral hops, jumping from one leg to the other, leg length distance apart (measured from greater trochanter to ground). Score 1 point per 15 seconds. Tubing around waist. 3.) Forward and Backward Jogging (2 mins) Perform both forward and backward jogging on the spot. Score 1 point per 30 seconds. Tubing around waist. 5

6 Stroke Test (effusion) (Sturgill et al, 2009) Zero Trace (small wave medial side with down stroke) (Circle one) 1+ (large bulge medial side with down stroke) 2+ (effusion spontaneously returns to medial side) 3+ (so much fluid not possible to move effusion) Hold/progress Leg Circumference 3 and 6 PFJ Non Operative (R / L) Operative (R /L) Hold/progress Knee range Non Operative (R / L) Operative (R / L) Hold/progress Flexion Extension Flexion Extension Lag (yes / No) SLS Squat Non Operative ( R / L) Operative ( R / L) Hold/Progress Good Fair Poor Good Fair Poor 1.) Maintain balance, while squatting to at least 60 degrees 2.) No trunk movement (lateral deviation, rotation, LF or excess forward flexion) 3.) No hip adduction or internal rotation 4.) No knee valgus and knee remains over centre of foot 5.) Smooth and controlled through whole movement (Crossley et al, 2011) SLS Balance Eyes closed (sec) Left Right LSI Hold/progress Time ends when: 6

7 mean - Arms are used (uncrossed) sec sec % - Use of raised foot (touches ground or other leg) - Movement of stance foot - 45 sec has elapsed - Eyes open Abnormal if less than 85%, normative data for year olds 43 sec EO, 9 sec EC (Springer et al, 2007) Y Balance Left Right LSI Hold/progress Anterior posteriormedial posteriorlateral Total: - Best of 3 trials each - 4cm L-R diff, 94% significant injury risk. Left Right LSI Single Leg Reps: Reps: Bridges (Freckleton et al, 2013) Calf Raises Reps: Reps: Single Leg Press (pt. may need to test in gym) Weight: Weight: Bodyweight = 1.8x Male for 1RM 1.5x Female for 1RM Calculate 1 RM from 5 RM: (5 reps x.033) + 1 x (weight in lbs lifted) = approx 1RM Carioca (Agility Drill) Hold/progress Compensatory movements? (hip hike, knee F in air, altered weight bearing) NO YES Adequate speed/patterning? NO YES Apprehension? NO YES Complaints of pain? NO YES 7

8 Comments: 10 Second Tuck Jump (plyometric drill) (Myer, 2006) Hold/Progress Knee and Thigh Motion SCORE 1. knees neutrally aligned at landing thighs reach parallel (observed at highest point of jump) 3. Thighs equal side-side (throughout sequence) Foot Position 4. Foot placement shoulder width apart Foot placement not staggered (side view) Toe to mid foot rocker utilized (no heel strike) Plyometric Technique 7. Rapid rebound between jumps (no visible delay) 8. Lands same footprint (from point of take off) Total For Assessment /80 Hop Testing (Reid, 2007) Hold/progress Single Hop For Distance Non Operative limb (cm) Operative (cm) LSI

9 6 m Timed Hop Non Operative limb (cm) Operative (cm) LSI Triple Hop For Distance Non Operative limb (cm) Operative (cm) LSI Cross Over Hop For Distance Non Operative limb (cm) Operative (cm) LSI Single Leg 8 inch Jump Landing Able to land with 5 sec hold Yes No Good body mechanics? (ball-midfoot landing, knees flexed, pelvic level, trunk midline Yes No Complaints of pain? Yes No Vertical Jump For height (cm) Trial 1 / 2 Trial 1 / 2 Average height Non-operative limb (R / L) / / Operative Limb (R / L) / / Single Leg Bosu Hop Progress/Hold Yes No 9

10 Able to land with 5 sec hold Good Body Mechanics/Position No complaints of pain? Comments: Modified Vail Sports Test If patient repeats error on 3 consecutive repetitions after correction, they do not receive a point for that particular segment/time frame. Test ends when patient cannot continue or form is incorrect. 1 point for every 30s for SL squat, 1 point every 15 s for lateral bound. 1 point every 30 s for running tests. Single Leg Endurance Squats (goal: 3 min) 1.) Knee Flexion angle between 30 and 60 Yes No 2.) Patient performs without dynamic knee valgus Yes No 3.) Patient avoids locking knee during extension Yes No 4.) Patient avoids patella extending past the toe during knee flexion Yes No 5.) Patient maintains upright trunk during knee flexion Yes No 30 s 30s-60s Total Points /6 Lateral Bounding (goal: 90 sec) - Length of bound is half of body height 1.) Knee flexion angle is 30 or greater when landing Yes No 2.) Patient performs without dynamic knee valgus Yes No 3.) patient performs within landing boundaries Yes No 4.) Landing phase does not exceed 1 second in duration Yes No 10

11 5.) Patient maintains upright trunk during knee flexion Yes No Total Score /6 Forward Jogging (goal: 2 mins) 1.) Knee flexion angle between 30 and 60 Yes No 2.) patient performs within landing boundaries Yes No 3.) Patient performs without dynamic knee valgus Yes No 4.) Patient avoids locking knee during extension Yes No 5.) Landing phase does not exceed 1 second in duration Yes No 6.) Patient maintains upright trunk during knee flexion Yes No Total points /4 Backward Jogging (goal: 2 min) 1.) Knee flexion angle between 30 and 60 Yes No 2.) patient performs within landing boundaries Yes No 3.) Patient performs without dynamic knee valgus Yes No 4.) Patient avoids locking knee during extension Yes No 5.) Landing phase does not exceed 1 second in duration Yes No 6.) Patient maintains upright trunk during knee flexion Yes No Total points /4 TOTAL OVERALL /20 (17/20 is 85%) Physiotherapist/Assessor Comments: 11

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Lower Body Plyometric Exercises

Lower Body Plyometric Exercises These animated lower body plyometric exercises can be used to develop power in any sport that involves sprinting, jumping, quick changes of direction and kicking etc. They