From PT In Motion:
Pre- and Post-ACLR Rehabilitation Shows Benefits 2 Years After Surgery
A study of individuals who undergo anterior cruciate ligament reconstruction (ACLR) shows that patients who participate in both pre- and postoperative rehabilitation not only get a head start on recovery, but also experience markedly better outcomes than patients receiving usual care even 2 years after surgery. The study was e-published ahead of print in the British Journal of Sports Medicine.
Researchers compared Knee Injury and Osteoarthritis Outcome Scores (KOOS) of 84 patients who participated in progressive pre- and postoperative rehabilitation between 2007 and 2011 with 2,690 patients who received usual care between 2006 and 2010.
Patients completed the KOOS—a knee-specific self-assessment instrument of injuries linked to posttraumatic arthritis—preoperatively and again 2 years after reconstruction surgery. Researchers found that patients who underwent a 5-week preoperative rehabilitation program, followed by a yearlong progressive rehabilitation program after surgery, reported what authors describe as "significantly better" scores than their usual-care counterparts at both measurement points.
Patients in the rehabilitation cohort were recommended to achieve 90% quadriceps strength, hamstring strength, and hopping performance prior to surgery. The postoperative rehabilitation varied by surgical circumstances and patient functional status, and was divided into 3 phases that began with quadriceps contractions and range-of-motion exercises and progressed to heavy resistance strength training, plyometric exercises, and sport-specific drills. Authors did not include a description of usual-care.
Researchers found that the rehabilitation program not only set the stage for better short-term outcomes, but also showed positive results long afterwards. "Compared to usual care, [the rehabilitation cohort] had superior preoperative patient-reported knee function, and still exhibited superior … function 2 years after the surgery, with 86–94% of patients scoring within the normative range in the different KOOS subscales," authors write.
Authors recommend that treatment strategies that include progressive pre- and postoperative rehabilitation for ACLR patients "be considered in the standard treatment protocol," but acknowledge that more research needs to be conducted to identify which parts of the rehabilitation programs are most responsible for the improvements.
Grindem H, Granan LP, Risberg MA, et al. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2014;Oct 28. pii: bjsports-2014-093891. doi: 10.1136/bjsports-2014-093891. [Epub ahead of print]
Our athletic trainer at Lexington Christian Academy, Andrew Carlson, takes pre-season measurements on all his baseball pitchers - everything from shoulder motion and strength, to hip strength and evaluation of scapular mobility. He has done this each of the last 3 years, and along with a preventative arm care program, he hopes to prevent injuries through the season. There are a few issues that are frequently popping up, but this year he has noticed some tightness around the upper body. Manual stretching with your athletic trainer or therapist is important, especially as internal rotation and flexion tends to tighten through the season, but self-stretching and self-mobilization of the upper body is very important. Here is a good series of active upper extremity stretching:
Here are is another great video from Eric Cressey discussing the importance of shoulder flexion in throwers - a must watch for pitchers and therapists/athletic trainers!
Here is a video from our friends at the American Academy of Neurology. The video has former NFL player, and concussion advocate, Ben Utecht. Thank you Ben for taking the time for advocacy!
This attached video is from Eric Cressey of Cressey Performance. He has two locations - Hudson, MA and Jupiter, FL. A wealth of baseball preventative knowledge can be learned from him and his team. Please enjoy this video. Thank you Eric!
There is a common misconception in the baseball community that you need to go throw to warm-up prior to a practice or game. While it is important to throw prior to playing, throwing should not be the first thing you do while preparing for play. A very common thing we see in the clinic are injuries that could have been prevented with a proper warm-up. Throwing is a very dynamic movement, that uses the whole body. In fact, it may be one of the most dynamic and comprehensive movement in sport. The whole body needs to work together, with no breaks in the kinetic chain, to perform an adequate throw. The shoulder can move at a rate of over 7000 degrees per second - pretty impressive! That can put a lot of stress on your body - and obviously the harder you throw, the higher the stress.
Step One - Dynamic Warm-Up
Prior to a football, basketball, or soccer practice, you see the team going through a dynamic warm-up. Those sports are also start/stop sports, just like throwing. As we said earlier, throwing a baseball is one of the most comprehensive movements in sport - should you not make sure your body is prepared as it would be for those other sports? We'd like to see someone "ready" to throw when they pick up the baseball - not "getting ready". Those who throw immediately are being too aggressive with their warm-up. Throwing has been demonstrated to "tighten up" your body/arm. Those who are more aggressive with their warm-up, i.e. jumping right into throwing, increase their injury risk. Younger athletes with growth-plate still wide open may even be more susceptible to injury.
The dynamic warm-up should include the whole body, as throwing is not just an upper extremity movement. Athlete's should make sure to include both arms, shoulders, hips, and legs in their warm-up. Over all, an adequate dynamic warm-up should take 15+ minutes. Here is a sample of what we are talking about:
Pre-Practice/Pre-Game Dynamic Warm-Up
Line to Line Jog
Walking Knee Hugs
Walking Hip Stretch
High Knee Extend
Walking Quad Stretch
Knee to Armpit
Forward Hops (DL & SL) - 10x/ea
Lateral Hops (DL & SL) - 10x/ea.
DL Vertical Jumps - 10x
SL Squats - 2x15/ea.
Step Two: Arm Specific Warm -Up
Just like the whole-body dynamic warm-up, the arm specific warm-up is essential to adequately prepare your body to throw. These should be done for 10 or so repetitions each. The below list is a minimum, and can be done in 3 minutes. Feel free to do more, especially during the colder months. It should be quick and easy, but will prepare you adequately enough. Most high level throwers will do a version of this before they throw.
Pre-Practice/Pre-Game Arm Specific Dynamic Warm-Up
Should Circles - Both Directions
Alternating Arm Swings (Up and Down)
Hugs (Across Body)
Active IR/ER or 90/90s
Reverse Throws (D1/D2 PNF Movements)
Cross Body Stretch (Holding 2-3")
Forearm Flexion/Extension (Holding 2-3")
Step Three: Post-Throw Arm Care - Next Blog Post!
Performance Physical Therapy and our parent company Orthopedic & Sports Physical Therapy want to wish Clinton Hollon good luck later this month as he leaves for Clearwater, FL. He will be rejoining his Blue Jays in Spring Training. Clinton has worked extremely hard over the last few months and hopefully his hard work pays off. His focus this off-season has not just been rehab - he was able to enjoy the birth of his beautiful boy Carter. Carter's mother, Heather, is a lefty, so Clinton secretly hopes for Carter's inner southpaw to shine as he grows!
Clinton's rehab has been steady from the beginning - big thanks to Dr. James Andrews and his surgical team. Clinton began throwing off the mound just recently, and with slow-motion video, he has taken this time to correct some issues with his form that will both decrease stress on his elbow and increase velocity of his fastball. He has corrected his position of his landing leg; hip and shoulder angles while in the balance position; and his timing between his upper and lower halves. We hope with all this work in both rehab and his throwing program, he has a successful year with the Blue Jays organization and can continue to work his way up to the big show.
The video above shows a 25 pitch bullpen off the mound - very helpful for us to have the ability to work on this while in the clinic. Ubersense is the app on the iPad we use for slow-motion video. Very helpful tool for anyone from baseball player, to golfer, tennis, or any other sport where form and function is very important. Our athletic trainer, Andrew Carlson, has even used it during basketball shooting drills.
Over the next few weeks there will continue to be posts regarding baseball and upper extremity injuries. We'll focus on prevention, injury rates, pre-season conditioning and items to focus on to stay healthy throughout the year.
-Your Friends as PPT/OSPT!
Now that football season is officially over, and basketball season is wrapping up in the next 1-2 months, baseball season is about to be getting lots of attention. Spring training is beginning for pitchers and catchers, with position player report shortly as well. High school spring sports begin in 10 days, and their practices and games begin before the pros!
We will be posting periodically over the next few months regarding injuries in sports, with an emphasis on baseball. Here's an interesting tid-bit to think about - a 2011 study published in the American Journal of Sports Medicine took a look at Epidemiology of Major League Baseball Injuries, and it determined that professional baseball players are 10.6x more likely get injured in April than in September! Even at the big league level, athlete's lack of preparation shows! Are you or your student-athlete(s) prepared for the season to come? Many factors determine injury susceptibility, and we will be diving into some of these over the next few blog posts. In the meantime, take advantage of the time left before Spring seasons pick up and get prepared!
National Athletic Training Month is held every March in order to spread awareness about all that athletic trainers do - for more information about the National Athletic Trainers' Association and what Athletic Trainers do for the community in which they work, please visit www.nata.org.
From Science Daily:
A synthetic graft for ACL reconstruction has been developed that integrates with the native bone, promotes growth of new ligament tissue, and stabilizes the knee. Connecting the femur to the tibia, the anterior cruciate ligament (ACL) rupture is one of the most devastating injuries in sports. No other injury has sidelined more athletes for a season or even the rest of a career. And ACL sprains and tears affect more people than just the pros.
See Link Here: http://www.sciencedaily.com/releases/2014/12/141230132858.htm