RJAH Femral Cndyle Micrfracture Rehab Guide Patient Details: C-mrbidtity: Nte t Therapist: *This is a guide t prgressin, nt an exhaustive list f rehabilitatin and des nt replace clinical reasning. *Treat any sft tissue symptms n their merit. *Objective Tests can be used as an indicatin fr prgressin. *Special Instructin(s) includes specific pst-perative advice fr the individual patient based n their surgen s recmmendatin (as applicable). This will be cmpleted n discharge r fllw-up clinic appintments. *Please nte prgressin will be based in the individual s starting pint and gals. Fr example, if they have nt attempted t run fr mre 12 mnths prir t the surgery, they might nt be able t prgress t running by Week 8. PHASE OF PHASE 1 Successful perative Crycuff/ Ice. 1. Reduce inflammatin. Frm Day 1 utcme. Adequate pain relief. Understands pst-p instructins. CPM if available. Active-assisted and active F and E exercises. EOR E mbilisatins. H and calf stretches. Ankle Exercises (e.g. heel raises). 2. Gain terminal E. 3. Prmte distal circulatin. 4. Gradually regain ROM. 5. Increase cnfidence. 6. Prmte early mbility. SQ prgressing t SLR. Heel slides (0-90 ). C-cntractin Q and H. Prne SLR. PWB with elbw crutches fr cmfrt. RJAH Femral Cndyle Micr# Rehab Guide 2016 Page 1
PHASE 2 Full active and passive Abductr/ Adductr/ Gluteal exercises. 1. Prmte early functin. AROM. Frm Week 1 E. 45º F. Ismetric Q in HE. Static Bike r Turbtrainer n/lw resistance as tlerated (part revlutin full revlutin as symptms dictate). DO NOT use cleats r clips n pedals. Gradually increase weight-bearing. Prgress 2. Prtect micr# site. 3. Aid jint nutritin. 4. Prevent adhesins. 5. Increase ROM. 6. Imprve muscular cntrl. PROM. SLR. Clam. t ne EC by week 5. Earlier prgressin, if instructed by surgen. Planks. Other muscle grups nt t be neglected Upper bdy active exercise resis/reps/sets/speed. Sft tissue mbilisatins. Hydrtherapy. Early PWB plymetrics. RJAH Femral Cndyle Micr# Rehab Guide 2016 Page 2
PHASE 3 FWB. Prne aut-ver press F develp int Q 1. Prgress functinal AROM. Frm Week 6 SLR n lag. stretch. activities. Cnt d verleaf AROM = Full E - 100º. Clams 10 reps with 10 sec hld ideal cntrl [L] & [R]. Directinal Planks 30 sec hld ideal cntrl. Gait with predictable changes in directin. Lunges <45 (aim fr ideal alignment and cntrl). Bridges (aim fr ideal alignment and cntrl). Prpriceptin single leg stance/wbble bards/trampette/crash mats/etc. Gymball and Theraband wrk. Step-ups (fr/ back/ sideways/ ver) height/ reps/ speed. PWB (parallel bars) jumps, hps, leaps cntrl technique/speed/reps. Sequencing f training: Train 3 4 x per week. Train strength and endurance n separate 2. Prevent AKP. 3. Prevent scar adherence. 4. Prevent jint stiffness. 5. Restre nrmal gait pattern. 6. Prmte apprpriate muscle strength, pwer and endurance. 7. Imprve neurmuscular/ prpriceptin/ sensrimtr perfrmance. 8. Maintain cardivascular fitness. 9. Encurage patient cmpliance. PROM. Single Leg Stance. Single Leg Squat 60º. Effusin. days. Have a minimum f 24 hurs between strength days. Chse numbers f sets and rest time between sets. Alternate upper/ lwer bdy exercises within sessin. Speed f cntractin shuld be mderate t fast, but cntrlled. RJAH Femral Cndyle Micr# Rehab Guide 2016 Page 3
PHASE 3 Frm Week 6 Cnt d. Vary lad/set/rest between sessins. Adjust if necessary based n symptms. Strength: 10 20 min CV warm-up (exceptin f jgging/ running). Chse a lad 1 12 RM. Endurance: Gradually prgress tward 45 min cntinuus CV exercise (exceptin f jgging/ running). Chse a lad 15 20 RM. Muscle balance exercises as apprpriate. Cre stability exercises as apprpriate. Flexibility exercises as apprpriate. RJAH Femral Cndyle Micr# Rehab Guide 2016 Page 4
PHASE 4 Nrmal symmetrical Gradually prgress frm PWB t FWB and duble 1. Prmte AROM. Frm Week 8 gait fted t single fted plymetrics as dictated by apprpriate AROM = Full E - neurmuscular cntrl, pain and swelling. strength, pwer PROM. 100º. Single leg stance 80% parity. Single Leg Squat 60º neurmuscular cntrl, pain and swelling is adequate. and endurance based n individual s needs. 2. Imprve 5 RM. Vertical Jump. 5 sec hld with gd neurmuscular alignment. perfrmance. Hp fr N/ minimal effusin. 3. Increase distance. N/ minimal pain. cnfidence. Phase 5 Frm Week 12 N/ minimal effusin Full pain free AROM 5 RM >80% parity Prgress frm jg run sprint Add agility drills when sufficient cntrl and cnfidence is achieved e.g. twist/ turn/ pivt/ 1. Prepare neurmuscular and psychlgical As indicated fr individuals gals. Hp fr distance cut/ accelerate/ decelerate/ directin. ability t return t >80% parity Prgress frm predictable agility t unpredictable Advance dynamic prpriceptive exercises e.g. unrestricted functin. vlleying ftball, thrwing, catching, racket and ball while balancing n Trampette. Perturbatin training e.g. therapist randmly nudges patient ff balance during a single leg thrw-catch drill. Sprt specific training terrain/ vlume/ peridisatin. RJAH Femral Cndyle Micr# Rehab Guide 2016 Page 5
PHASE 6 All Tests > 90% parity. Earliest return t cntact sprt training 1. Unrestricted Full sprting Frm Week 16+ Dependent n Cnsultant s apprval. Prgress t full restrictin free sprts and activities. cnfident functin. 2. Injury preventin. functin. Terminlgy Key: Abd Abductin [L] Left Add Adductin OKC Open Kinetic Chain AKP Anterir Knee Pain PWB Partial Weight Bear AROM Active Range f Mvement PROM Passive Range f Mvement CV Cardivascular Q Quadriceps E Extensin [R] Right Ecc Eccentric reps Repetitins EOR End f Range resis Resistance F Flexin RM Repetitin Maximum FWB Full Weight Bear ROM Range f Mvement H Hamstrings SLR Straight Leg Raise IRQ Inner Range Quadriceps SQ Static Quadriceps RJAH Femral Cndyle Micr# Rehab Guide 2016 Page 6