Post on 27-May-2020
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Return to play preparation following ACL reconstruction: Implications for the hockey player
Joe Eischen PT, SCS, ATC, CSCS Mayo Clinic Sports Medicine Center
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Necessary Milestones:
• Full range of motion.
• Minimal to absent effusion.
• Normal gait.
• Progression of neuromuscular lower extremity control exercises.
• Progression in core training.
• Tolerating aerobic progression.
• Tolerating low level agility drills.
• Proper loading and unloading mechanics.
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Return to play programs following ACL reconstruction:
• What does the literature say about returning the hockey player following ACL Reconstruction?
• Not much…
• Tyler, McHugh. Neuromuscular Rehabilitation of a Female Olympic Ice Hockey Player Following Anterior cruciate ligament Reconstruction. JOSPT 2001; 31 (10): 577-587.
• Pierce, Laprade, Wahoff, O’Brien, Philippon. Ice Hockey Goaltender Rehabilitation, Including On-Ice Progression, After Arthroscopic Hip Surgery for Femoral acetabular impingement. JOSPT March 2013, Vol. 43, Number 3.
Many articles on soccer and basketball:
• Bizzini, Hancock, Impellizzeri. Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer. JOSPT April 2012, Vol. 4, Number 4.
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How do we safely and effectively return a hockey player to the game?
• Skating treadmill:
• Safe.
• Improve mechanics.
• Build endurance and power.
• Build player confidence.
• Build medical staff confidence.
• Individual skating progression.
• Partner skating progression.
• Non-contact team drill progression.
• Re-introduction to contact.
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Dartfish and the skating treadmill
• Team approach:
• Interaction of skating coach, PT and patient.
• Assess fundamentals of skating.
• Progressive reintroduction of joint to skating.
• Patient excitement.
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See it, feel it, do it………..
• Through the analysis of the patient’s skating with the skating coach and Physical Therapist patient is made aware of potential flaws.
• Baggage prior to injury.
• Flaws related to current MSK status.
• Leads to:
• Education of patient on rationale of various training exercises.
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Skating video
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Dartfish Analysis:
Trunk Tilt:
10 degree difference while on right side.
Concerning for:
Ligament dominance movement fault with valgus stress to right knee.
Trunk dominance movement fault.
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Dartfish Analysis
Hand rotation:
Will this lead to more valgus stress at the knee?
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Dartfish Analysis
Side view
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Now Let’s Train It!
• Refocus rehab/training based on what we are seeing in our skating analysis.
• Better patient buy-in.
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Bibliography • Bizzini, Hancock, Impellizzeri. Suggestions From the
Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer. JOSPT April 2012, Vol. 4, Number 4.
• Tyler, McHugh. Neuromuscular Rehabilitation of a Female Olympic Ice Hockey Player Following Anterior cruciate ligament Reconstruction. JOSPT 2001; 31 (10): 577-587.
• Pierce, Laprade, Wahoff, O’Brien, Philippon. Ice Hockey Goaltender Rehabilitation, Including On-Ice Progression, After Arthroscopic Hip Surgery for Femoral acetabular impingement. JOSPT March 2013, Vol. 43, Number 3.
• Hewett, Ford, Hoogenboom, Myer. Understanding and Preventing ACL Injuries: Current Biomechanical and Epidemiologic Considerations-Update 2010. NASPT Vol. 5, No. 4, December 2010
• Adams, Logerstedt, Hunter-Giordano, Ax, Snyder-Mackler. Current Concepts for anterior cruciate ligament Reconstruction: A Criterion-Based Rehabilitation Progression. JOSPT, July 2012, Vol. 42, No. 7.
• Reid, Birmingham, Stratford, Alcock, Giffen. Hop Testing Provides a Reliable and Valid Outcome Measure During Rehabilitation After Anterior Cruciate Ligament Reconstruction. Physical Therapy. Vol. 87, No. 3, March 2007.
• Crieghton, Shrier, Shultz, Meeuwisse, Matheson. Return-To-Play in Sport: A Decision-based Model. Clin J Sport Med, Vol. 20, No. 5, September 2010.
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Thank You