ACL case Study Flashcards
What would you observe in general
Alignment- limb position, shape, deformity, valgus and varus of the knee region, bony points
Atrophy- muscle wastage, muscle bulk and site, could be neurological
Colour- necrosis, dying tissue. Issues with circulation, death of limb, sepsis
Deformity- flat foot, ruptured tendon, ankle dislocation
Swelling- oedema, who swollen it is, where is swelling, causing pain?
What would you expect to observe in someone with an ACL tear
Swelling of the knee region bodies inflammatory response to injury, increased movement of fluid and white blood cells to injured area, the release of chemicals and compression of nerves in area of injury can cause pain, pain and ROM would be affected, may observe colour change due to bruising
What would you palpate in general
Swelling, temperature and atrophy
What would you palpate in a ACL Injury
Swelling
Why would you use active range of movement in general
Grade 3 on Oxford scale, it tests innert and contractile tissue, stretches and pulls load, transfer acceptance,
Behavioural pain scale- willingness to move, pain behaviours, reluctance and avoidance
It’s looking for quality of movement, smoothness, co ordination, fear, pain, range of movement
Use goniometer to quantify rom
When and where In movement is pain felt
Why would you use active ROM for an ACL injury
Use it to test where in the movement there is pain, BPS- fear, reluctance, willingness to do movement
End feel, quality of movement, smoothness
Use of goniometer to quantify rom
You use it in a ACL because it is a test of innert tissue
Why would you use passive movement in general
Feel quality of movement, further range, resistance or muscle spasm, any symptoms produced
What could limit PROM- end feel, pain response, ROM achieved, any other symptoms produced
What would you expect to see in the PROM of someone with an ACL injury (you would only use PROM for an incomplete tear as hyper mobility is a contra indication of PROM)
Empty end feel, no pain response due to no nerve endings being attached to the ligament as it is a complete tear, quality of the movement
Why would you use the Lachmans test for the ACL
Mushy end feel indicates positive Lachmans test
What treatment could you use for a ACL injury
PA, AP joint mobilisations, exercises- single and double legged squats, step ups, incorporate running
Why would you use joint mobilisations, and what it is
It’s a skilled passive movement of physio to increase ROM, joint mobility and decrease pain applied where there’s reduced mobilisation of a joint that can be restored, you use to restore movement to a joint,
Scientifics behind AP and PA movements
Unobservable articular accessory motion between adjacent joint surfaces (roll, glide and spin) these accessory motions take place with all active and passive movement and are necessary for full pain free rom, can’t occur independently
What dosage, reps,FITT, SIN factor
3 sets 10 reps, once a day, 80% of maximal effort, must target strength, length or Rom in this case strength and ROM, must have overload to build strength, the overload principle is 4 stages motor learning, increase in muscle strength but no increase in size then true hypertrophy
Weakness in hip flexors and extensors (4/5)
Step ups to make harder wear weighted backpack for more resistance, and with sit to stand these are functional activities which encourages neuroplastic changes, squats, single and double leg, starts with 3 sets, 10 reps at least 3 times a week, for the overload principle to come Into place resistance must be increased so deadlifts/ squats could be done with higher weight, reps increased, increase how many reps are done per week, LOAD MUST BE INCREASED FOR FURTHER INCREASE IN STRENGTH, REPS CAN BE REDUCED, incorporate FITT principles which increase strength,
Power ans endurance
To increase strength
Loads must exceed 80% of maximum, 10 reps 3 times a week, must increase resistance to increase strength
