On to topic #2 from @ACLStudyDay home study session:
Return to run post-ACLR with @rwilly2003 ! Notes to follow in this thread...
@ACLStudyDay@rwilly2003 Resolving basic fundamentals is impt prior to running - edema, ROM, strength, etc - or these impairments may persist/be magnified once pt returns to running
@ACLStudyDay@rwilly2003 Recreational running may become exercise of choice for some athletes who choose NOT to return to pre-injury sport
@ACLStudyDay@rwilly2003 Little evidence supporting that running is harmful to those with knee OA!
**Caution: we don't know long-term data on running post-ACLR.
@ACLStudyDay@rwilly2003 Post-op impairments that must be addressed:
- pain
- psych
- ROM
- muscle force production
- effusion
- altered coordination
@ACLStudyDay@rwilly2003 Running:
- 2.5x BW on impact
- 5-6BW's of TFJ and PFJ contact force
- rapid energy storage/release, cumulative loads + these peak loads
- avg 10k run, runner takes 7000 foot strikes
***Consider how these loads increasein other running sports (jumping, sprinting)
@ACLStudyDay@rwilly2003 "Heavy, slow resistance training is the absolute foundation for recovery for all our athletes for return to sport and return to daily activities."
Heavy, slow resistance training --> plyometrics --> graded return to running
@ACLStudyDay@rwilly2003 Impaired running biomechanics do NOT seem to "smooth out" as post-ACLR pts continue to run. Need to address during rehab.
@ACLStudyDay@rwilly2003 Post-ACLR running biomechanics:
- Peak VGRF not different between limbs
- impact forces (loading rates) not different between limbs
- BUT individ w/ quad weakness have LOWER peak VGRF (can't control load as well, but this doesn't allow efficient storage/release of energy)
Recs for RTRun:
- full ext ROM
- flex within 5% opp limb
- pain <=2/10 VAS
- absent/trace effusion
- HS&Quad LSI >70%
- Hop tests >70%
@ACLStudyDay@rwilly2003 Rich's recs (modified Rambaud):
- full ext ROM
- flex within 5% opp limb
- min/absent pain w/ repetitive hops
- absent/trace effusion
- HS&Quad LSI >=80%
- Iso quad torge 3.0 Nm/kg
- Hop test >70% LSI
- Walk 7000 steps/day, 4000/bout
- IKDC >=70%
- min 12 wks post ACLR
@ACLStudyDay@rwilly2003 Quad strength testing: Isometric dynamometry best.
- 5 sec hold make test
- Torque = force x moment arm length.
- Force (kg) x 9.81 to get N
- Moment arm length = dynamometer to lat fem condyle
- Divide by body mass to get N*m/kg
- Avg values post-ACLR quad torque 3.0-3.2 N*m/kg
@ACLStudyDay@rwilly2003 Base resistance training based on 1RM (ACSM position statement, MSSE 2009):
Use 1RM calculator app (free) which estimates your 1RM based on weight and reps you can do
Goal: train at least >=75% 1RM to gain strength
@ACLStudyDay@rwilly2003 Quad program example: DAPRE protocol (Herrington & Al-Sherhi JOSPT 2007): 1) determine 6 RM 2) set 1 = 10 reps 50% 6RM 3) set 2 = 6 reps 75% 6RM 4) set 3 = max reps 6RM 5) set 4 = adjusted based on set 3 (Table 3)
Example: "Interval Timer - HIIT Training" (for Android and iPhone):
- can program warmup, interval and cool-down
- alarm will sound over music when it's time to switch
@ACLStudyDay@rwilly2003 Treadmill and overground running very similar in terms of:
- TFJ loads, both for total peak TFJ & medial compartment
- PFJ loads
- decr PFJ loads by 15-20%
- decr TF contact forces by 7.5-11%
@ACLStudyDay@rwilly2003@3 How to address asymmetrical loading pattern:
- can't just increase cadence (asymmetry persists)
- use metronome for external pacing
@ACLStudyDay@rwilly2003@3 SUMMARY KEY POINTS:
- Quad strength critical
- hopping as bridge to running
- time and performance-based criteria to clear to run
- address biomechanical changes early
- use an app to guide dosage
/end
@ACLStudyDay@rwilly2003@rwilly2003 We've talked hopping before/after running. You think someone needs unilateral hop (R to R) >70% such as in Noyes hop tests before doing a contralateral unilateral hop (R to L) such as w/ running necessary to begin to run? This is my main struggle w/ this criteria.
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Finally getting to review a few of the @ACLStudyDay home sessions! First up: Managing ACL injuries and athlete RTS with @clare_ardern! Notes to follow in this thread....
@ACLStudyDay@clare_ardern#ACL rehab goals: 1) protect the meniscus 2) QUADS QUADS QUADS (strength) 3) injury free sport participation