Treatment and Rehabilitation

1
Treatment and Rehabilitation
2
Treatment

• Rest
• Ice
• Compression
• Elevation
• Price, Icer etc

3
Rehabilitation

• Phases 1-4
• 1 Immobilization
• 2 ROM mild strengthening
• 3 Strengthening and begin sport specific
• 4 Maintenance at RTP

4
Skeletal Injuries

• Fractures
• Traumatic
• Common Sites
• Femoral Shaft
• Epiphyseal Plate
• Patella

5
Skeletal Injuries

• Fractures
• Traumatic
• Common Sites
• Femoral Shaft
• Epiphyseal Plate
• Patella

6
Skeletal Injuries

• Fractures
• Traumatic
• Common Sites
• Femoral Shaft
• Epiphyseal Plate
• Patella

7
Consequences of Poor Treatment

• Mal or non-union
• Deformity
• Poor or loss of function
• Chronic pain
• Arthritis

8
Treatment

• Femoral Shaft Fx
• ORIF
• Epiphyseal Plate
• Extreme care to perfectly align plate borders
• ORIF
• Patella
• Extreme care to perfectly align joint surface
  borders
• ORIF

9
Rehabilitation

• Typical RTP 4-12 weeks
• Femoral Fx may be much longer
• Immobilization does not mean no movement
• Bone needs some stress to heal well
• Healing time 4-8 weeks
• Work above and below Fx site

10
Soft Tissue Injuries

• Dislocation/Subluxation (Patella)
• Meniscal Tear
• Sprain
• ACL
• MCL
• LCL
• PCL
• Tendon Rupture
• Patellar
• Quadriceps

• Tendinitis
• Patellar (Jumpers Knee)
• Quadriceps
• Strain/Contusion
• Quadriceps
• Hamstrings

11
Patellar Dislocation/Subluxation

• Deviation almost always lateral

12
Treatment

• Splint in position
• Patella will usually self reduce as the knee
  joint is straightened
• ICE
• Refer to physician for X-ray

13
Rehabilitation

• RTP 4-16 weeks
• Nonsurgical vs surgical
• Medial structures must heal
• Focus will be on ROM and strengthening of medial
  musculature

14
Meniscal Tear

• Horizontal
• Radial
• Bucket Handle
• Flap

15
Meniscal Tear

• Flap tear as viewed through an arthroscope

16
Treatment

• Some athletes will play an entire season with a
  torn meniscus-and may not know it.
• Treat the symptoms ice as needed.
• Refer to physician

17
Rehabilitation

• RTP 0-12 weeks
• Arthroscopic surgery
• Rehab usually is focused on return of ROM and
  abatement of surgical soreness.
• If meniscus is sutured, rehab may be longer

18
ACL Sprain

• What type of forces are being applied to this
  knee joint?
• Second most commonly injured knee ligament

19
Treatment

• ICE
• Surgical vs non-surgical
• Patellar Tendon vs Hamstring
• Allograft vs Autograft

20
ACL Reconstruction

• Screws holding graft in place

21
Rehabilitation

• RTP 12 weeks non-surgical
• RTP 6-9 months surgical
• Must regain full knee extension early
• Graft weakness at about one year
• Often one full season played before athlete
  returns to previous performance

22
LCL Sprain

• What type of force causes this injury?
• Third most commonly injured knee ligament

23
Treatment

• Most often non-surgical
• Splinted in 15-20 degrees of flexion

24
Rehabilitation

• RTP 2-6 weeks

25
MCL Sprain

• Most commonly sprained knee ligament

26
MCL Sprain

• Which side of the knee joint is being stressed?

27
Treatment

• Most often non-surgical
• Splinted in 15-20 degrees of flexion
• Occasionally reconstructed using hamstring tendon

28
Rehabilitation

• RTP 2-6 weeks non-surgical
• 4-8 weeks surgical
• ROM and strengthening

29
PCL Sprain

• Least common of knee ligament sprains

30
Treatment and Rehabilitation

• See other ligament slides

31
Knee Sprain what do you suppose has been damaged?
32
Patellar Tendon Rupture

• Result of chronic tendinitis or acute rupture?

33
Treatment

• Surgical
• As this tissue does not tend to shred when it
  tears as an ACL does it can be surgically
  repaired
• With luck an avulsion of the tibial tuberosity
  has occurred, why?

34
Rehabilitation

• RTP 6-12 months
• 6-8 weeks NWB
• Slowly regain ROM
• Regain strength as ROM improves

35
Quadriceps Tendon Rupture
36
Quadriceps Tendon Rupture
37
Treatment

• Surgical
• As this tissue does not tend to shred when it
  tears as an ACL does it can be surgically
  repaired

38
Rehabilitation

• RTP 6-12 months
• 6-8 weeks NWB
• Slowly regain ROM
• Regain strength as ROM improves

39
Patellar Tendinitis
40
Treatment

• 1-4 weeks
• Dont force stretches or strengthening
• Tissue must calm down first
• Gradual return to full activity

41
Rehabilitation

• RTP 1-4 weeks
• Dont force stretches or strengthening
• Tissue must calm down first
• Gradual return to full activity

42
Quadriceps Tendinitis
43
Treatment

• 1-4 weeks
• Dont force stretches or strengthening
• Tissue must calm down first
• Gradual return to full activity

44
Rehabilitation

• RTP 1-4 weeks
• Dont force stretches or strengthening
• Tissue must calm down first
• Gradual return to full activity

45
Quadriceps Strain/Contusion
46
Treatment

• ICER
• Try to maintain normal gait, NWB if needed

47
Rehabilitation

• RTP 1-8 weeks
• Slowly work on return of ROM
• Strengthening may begin as ROM returns
• Dont forget eccentric training

48
Hamstring Strain/Contusion
49
Hamstring Strain/Contusion
50
Treatment

• ICER
• Try to maintain normal gait, NWB if needed

51
Rehabilitation

• RTP 1-8 weeks
• Slowly work on return of ROM
• Strengthening may begin as ROM returns
• Dont forget eccentric training

52
Conditions/Disorders

• Bursitis
• Chondromalacia
• Iliotibial Band Friction Syndrome
• Myositis Ossificans

• Osgood Schlatters
• Osteochondritis Dessecans
• Patellofemoral Pain Syndrome
• Plica Syndrome

53
Bursitis
54
Treatment

• ICER
• Protect from further contusion

55
Rehabilitation

• RTP 2-6 weeks
• ROM will improve as swelling subsides

56
Chondromalacia

• Pain is not from the fraying itself but from the
  irritation of the deeper tissue

57
Treatment

• Improve patellar mechanics either through
  exercise, taping or surgery
• Patellar shaving/drilling
• Tibial tubercle transposition
• ICER

58
Rehabilitation

• RTP 2-12 weeks
• Focus on patellar mechanics-watch Q-angle

59
Iliotibial Band Friction Syndrome
60
Treatment

• ICER
• Decrease aggravating activity

61
Rehabilitation

• RTP 1-2 weeks
• Treat symptoms and stretch TFL

62
Myositis Ossificans
63
Treatment

• Protect from re-aggravation
• If normal activity exercise/stretching is painful
  then cut back
• May require surgical excision

64
Rehabilitation

• RTP 2-12 weeks
• Calcification usually will resolve on its own
• Maintain overall fitness level

65
Osgood Schlatters
66
Treatment

• Treat Sx
• ICER
• Rest is most important
• Dont make it hurt
• Watch for bone growth

67
Rehabilitation

• RTP 1-9 months
• Play as able and protect from contusion

68
Osteochondritis Dessecans
69
Treatment

• Surgery

70
Rehabilitation

• RTP 3-12 months
• 1 month NWB
• ROM
• Strengthening

71
Patellofemoral Pain Syndrome
72
Treatment

• See Chondromalacia

73
Rehabilitation

• See Chondromalacia

74
Plica Syndrome
75
Treatment

• Will calm down as aggravating activities
  decrease.
• Usually a post season surgery

76
Reabilitation

• RTP1-3 months
• As soreness subsides acivity may be resumed