Return to play preparation following ACL reconstruction:

Transcription

1 Return to play preparation following ACL reconstruction: Implications for the hockey player Joe Eischen PT, SCS, ATC, CSCS Mayo Clinic Sports Medicine Center 2013 MFMER slide-1

2 Necessary Milestones: Full range of motion. Minimal to absent effusion. Normal gait. Progression of neuromuscular lower extremity control exercises. Progression in core training. Tolerating aerobic progression. Tolerating low level agility drills. Proper loading and unloading mechanics MFMER slide-2

3 Return to play programs following ACL reconstruction: What does the literature say about returning the hockey player following ACL Reconstruction? Not much Tyler, McHugh. Neuromuscular Rehabilitation of a Female Olympic Ice Hockey Player Following Anterior cruciate ligament Reconstruction. JOSPT 2001; 31 (10): Pierce, Laprade, Wahoff, O Brien, Philippon. Ice Hockey Goaltender Rehabilitation, Including On-Ice Progression, After Arthroscopic Hip Surgery for Femoral acetabular impingement. JOSPT March 2013, Vol. 43, Number 3. Many articles on soccer and basketball: Bizzini, Hancock, Impellizzeri. Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer. JOSPT April 2012, Vol. 4, Number MFMER slide-3

4 How do we safely and effectively return a hockey player to the game? Skating treadmill: Safe. Improve mechanics. Build endurance and power. Build player confidence. Build medical staff confidence. Individual skating progression. Partner skating progression. Non-contact team drill progression. Re-introduction to contact MFMER slide-4

5 Dartfish and the skating treadmill Team approach: Interaction of skating coach, PT and patient. Assess fundamentals of skating. Progressive reintroduction of joint to skating. Patient excitement MFMER slide-5

6 See it, feel it, do it.. Through the analysis of the patient s skating with the skating coach and Physical Therapist patient is made aware of potential flaws. Baggage prior to injury. Flaws related to current MSK status. Leads to: Education of patient on rationale of various training exercises MFMER slide-6

7 Skating video 2013 MFMER slide-7

8 Dartfish Analysis: Trunk Tilt: 10 degree difference while on right side. Concerning for: Ligament dominance movement fault with valgus stress to right knee. Trunk dominance movement fault MFMER slide-8

9 Dartfish Analysis Hand rotation: Will this lead to more valgus stress at the knee? 2013 MFMER slide-9

10 Dartfish Analysis Side view 2013 MFMER slide-10

11 Now Let s Train It! Refocus rehab/training based on what we are seeing in our skating analysis. Better patient buy-in MFMER slide-11

12 Bibliography Bizzini, Hancock, Impellizzeri. Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer. JOSPT April 2012, Vol. 4, Number 4. Tyler, McHugh. Neuromuscular Rehabilitation of a Female Olympic Ice Hockey Player Following Anterior cruciate ligament Reconstruction. JOSPT 2001; 31 (10): Pierce, Laprade, Wahoff, O Brien, Philippon. Ice Hockey Goaltender Rehabilitation, Including On-Ice Progression, After Arthroscopic Hip Surgery for Femoral acetabular impingement. JOSPT March 2013, Vol. 43, Number 3. Hewett, Ford, Hoogenboom, Myer. Understanding and Preventing ACL Injuries: Current Biomechanical and Epidemiologic Considerations-Update NASPT Vol. 5, No. 4, December 2010 Adams, Logerstedt, Hunter-Giordano, Ax, Snyder- Mackler. Current Concepts for anterior cruciate ligament Reconstruction: A Criterion-Based Rehabilitation Progression. JOSPT, July 2012, Vol. 42, No. 7. Reid, Birmingham, Stratford, Alcock, Giffen. Hop Testing Provides a Reliable and Valid Outcome Measure During Rehabilitation After Anterior Cruciate Ligament Reconstruction. Physical Therapy. Vol. 87, No. 3, March Crieghton, Shrier, Shultz, Meeuwisse, Matheson. Return-To-Play in Sport: A Decision-based Model. Clin J Sport Med, Vol. 20, No. 5, September MFMER slide-12

13 Thank You 2013 MFMER slide-13