RTS Flashcards
late phase RTS management general
running progression
- running>sprinting
agility/plyometrics
- cutting/pivoting
- jumping/landing
late phase RTS management - sport specific
what do they need to do? practice drills?
incorporate ball/defender
unanticipated movement
research says LE RTS testing
85% of studies for RTS testing were for knee injury (82% were ACL)
6.2% studies looked at RTS after hip
2 studies looked at RTS after ankle sprain
most RTS criterion lack validity T or F
T
1 risk factor for injury
1 risk factor for having an injury is previously having that injury
RTS testing goal
Determine physical and psychological readiness
- While respecting biological healing
Reduce risk of re-injury
passing RTS criteria means
It means they are cleared to begin a RTS progression
does not mean the athlete can go right back to game play
RTS rates for ACL
Return to any sport: 82%
Return to pre-injury sport: 63%
Return to pre-injury competition level: 44%!!!!
Second ACL injury rates (Wiggins 2016 AJSM)
Under 25 yo and RTS: 23%!!!!!
problem
Only 13% of studies used some sort of objective measure
Even worse: of those 13% the majority used a Lachman as their ONLY objective measure
general principles of RTS testing
time (biology)
symmetry (ROM full - unless risk factor. Strength 90% contralateral at MIN)
objective measures
- ROM
- strength
- functional testing
patient reported
- function
- fear/confidence
RTS testing time (biology)
Follow tissue healing timeframes
Ligamentization, Bone Bruise, Mechanoreceptors
We can’t rush biology… yet
Time alone does NOT guarantee physical readiness
RTS testing - patient reported
function: make sure the tool you use is appropriate for the population - sport specific, body region specific
fear/confidence - growing literature base exploring psychological effects
general LE
strength training
- mmt is NOT good enough, use HHD 1RM, dynamometer
negative clinical exam
- special tests, ORM, effusion, etc
functional testing
- compare to uninvolved limb or norms if not healthy
LE ACL necessary measures
recommended objective cut off - 90% contralateral side
even if passing, can still fail for poor quality of movement
ACL-RSI score above 56
KOS score 90% or higher
LE ACL outcomes of symmetrical strength
6 months - 20% common deficits
12 months - 10-20% deficits
24 months 1/3 have > 10%
the problem - athletes return 6-12 months likely with deficits
quad strength -
associated with function and critical to dynamic knee stability - prolonged deficits to a critical dynamic stabilizer
lower limb symmetry index
single hop for distance
triple hop for distance
cross over hop for distance
6m hop for time
what are the findings ACL
in the first.2 yrs after ACLR, 30% of people who returned to level 1 sports sustained a reinjury compared with 8% of those who practiced in lower level sports
for every month that RTS was delayed, until 9. months after ACLR, the rate of knee reinjury was reduced by 51%
more symmetrical quad strength prior to RTS significant reduced reinjury rate
LE ACL conclusions
RTS does reduce second injury risk
Need to objectively measure
Can’t Assume
Time alone is not enough
RTS progression - graded exposure
Return to practice drills
Return to practice contact drills
Return to game (limited time)
Return to game full time
Progress using intensity, opponents, time/volume
There is a large gap in our healthcare system for this population
Solutions?
UE RTS recommendations
Very little evidence
75% use only time
Current Recommendations:(afrer shoulder dislocation?)
No pain/instability ( -apprehension)
Full ROM
90%+ strength (Higher if dominant arm is the involved arm)
No symptoms with sport specific exercise/drills
6 Months post-op for shoulder instability
UE throwers
Return to throwing progression (elbow or shoulder)
Progress intensity and/or distance, throw type
on field
After cleared for significant injury
ABC’s -> Bleeding -> Spinal/head injury -> Fracture/dislocation
on field if player wants to return
Determine if continuing to play will increase risk of injury severity
- Rules sometimes bent depending on the importance of the game
Determine if there are any impairments and if they can play safely with those
-Protective strength
-Neuromuscular control
-Protective sensation
-Functional testing: Running, cutting, jumping, push-up (Sport & Position specific)
