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ACL REHABILITATION ACL REHABILITATION ACL REHABILITATION ACL REHABILITATION
RECENT ADVANCES RECENT ADVANCES RECENT ADVANCES RECENT ADVANCES
TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL TOWARDS FUNCTIONAL
APPROACHAPPROACHAPPROACHAPPROACH
DR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhDDR.KANNABIRAN,M.P.T,PhD....Senior consultant manipulative sports physiotherapist ,coimbatore
Professor in physiotherapy,RVS college of physiotherapy
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WHAT PHYSICAL THERAPY AFTER
ACL RECONSTRUCTION
�AGE
�TYPE OF INJURY
�RECONSTRUCTION- GRAFT,SURGEONS PROFILE,TYPE OF FIXATION
�PRE OP STATUS
�SCOPE FOR SUPERVISED PT
�RECENT BIOMECHANICAL UPDATE
�FUNCTIONAL APPROACH
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EXISTING
• Home Versus Supervised Therapy
• Home Exercise Versus Weight Machines
• Aquatic Therapy• Open Versus Closed
Chain Exercise• Progression Based on
Objective Criteria
What's new?
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GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING GENERAL IMPRESSION REGARDING
EXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLSEXISTING ACLR PROTOCOLS
Based on
Muscle
Strength
Ignored
Proximal
Muscle control
6 months
Too early to
return to sports
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BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE BIOMECHANICAL UPDATE
HIP & KNEE STRATEGIESHIP & KNEE STRATEGIESHIP & KNEE STRATEGIESHIP & KNEE STRATEGIES
KNEE STRATEGY
KNEE EXTENSOR MOVEMENT
QUADRICEPS ACTIVATION
HIP EXTENSOR MOVEMENT
HIP ENERGY ABSORPTION
HIP STRATEGY
KNEE EXTENSOR MOVEMENT
QUADRICEPS ACTIVATION
HIP EXTENSOR MOVEMENT
HIP ENERGY ABSORPTION
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IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS IMPAIRED GLUTEUS MAXIMUS
MUSCLE PERFORMANCEMUSCLE PERFORMANCEMUSCLE PERFORMANCEMUSCLE PERFORMANCE
Sagittal Plane Frontal/Transverse Plane
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THOUGHT PROCESS
• NEED FOR CHANGE DUE TO INCREASING
RESPONSIBILITY
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A FUNCTIONAL APPROACHA FUNCTIONAL APPROACHA FUNCTIONAL APPROACHA FUNCTIONAL APPROACH
IN IN IN IN KNEE REHABILITATIONKNEE REHABILITATIONKNEE REHABILITATIONKNEE REHABILITATION
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Functional approach
• A functional approach in rehabilitation is the key
concept underpinning the management.
• Functional movement is defined here as the
unique movement repertoire of an individual.
• Functional rehabilitation is defined here as the
process of helping a person to recover their
movement capacity by using their own
movement repertoire(whenever possible).
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DEVELOPING A FUNCTIONAL
PROGRAM
1. The focus on functional
movement
2. The principle of
skill/ability level
rehabilitation
3. The code for motor
adaptation
….that ought to
participate in this
particular movement
& accompany the
stabilization of the
body.
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MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR MOTOR COMPLEXITY MODEL FOR
FUNCTIONAL PROGRAMFUNCTIONAL PROGRAMFUNCTIONAL PROGRAMFUNCTIONAL PROGRAM
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DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL DEVELOPING A FUNCTIONAL
PROGRAMPROGRAMPROGRAMPROGRAM
“Simplified complexity” in tensional fields.Shaded circles represent tension created by
muscle groups
ADAPTIVE CODE & PHYSICAL STIMULATION FOR PROPRIOCEPTION
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MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE MERGE ADAPTIVE CODE
REHABILITATION SIMILARITY REHABILITATION SIMILARITY REHABILITATION SIMILARITY REHABILITATION SIMILARITY
SPHERESSPHERESSPHERESSPHERES
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AMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUTAMAZING CLINICAL SHORTCUT
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CHALLENGING CHALLENGING CHALLENGING CHALLENGING
ENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENT
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When cognitive becomes autonomous
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FUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIESFUNCTIONAL APPROACH COMPOSITE ABILITIES
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FUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATIONFUNCTIONAL APPROACH REHABILITATION
(RE(RE(RE(RE––––ABILITATIONABILITATIONABILITATIONABILITATION))))
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FUNCTIONAL APPROACH REFUNCTIONAL APPROACH REFUNCTIONAL APPROACH REFUNCTIONAL APPROACH RE----ABILITATIONABILITATIONABILITATIONABILITATION
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FUNCTIONAL APPROACHFUNCTIONAL APPROACHFUNCTIONAL APPROACHFUNCTIONAL APPROACH
ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS ADVANCED COMPOSITE WORKOUTS
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BALANCE/BALANCE/BALANCE/BALANCE/
POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE. POSTURAL STABILITY CHALLENGE.
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BALANCE/POSTURAL BALANCE/POSTURAL BALANCE/POSTURAL BALANCE/POSTURAL
STABILITY CHALLENGE. STABILITY CHALLENGE. STABILITY CHALLENGE. STABILITY CHALLENGE.
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TAKE HOME TAKE HOME TAKE HOME TAKE HOME
• Rehabilitation with current concept
• Enhance hip strategy
• Functional Re-Abilitation motor complexity
• Differentiate demand & risk in rehab.
• Think movement not muscles
• Team work
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DEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGSDEPENDS ON HOW WE SEE THINGS
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INVESTIGATE THE BIG TALK !