Hip Arthroscopy Blog: Return to run

Arthroscopic hip surgery is increasingly common in the management of femoroacetabular impingement (FAI) for active patients.  FAI results from bony abnormalities in the proximal femur and acetabulum leading to both chondral and labral damage in the hip joint. The deleterious effects of FAI include pain and restricted joint motion, which can be particularly debilitating for the athletic population. Several studies have reported on the beneficial effects of surgery compared with non-operative management for FAI in athletes with recent systematic reviews citing an 87%-92% postoperative return to sport.1,2

At Midwest Orthopedics at Rush, we utilize a clinical database of over 1200 patients to evaluate outcomes and predictors for success in hip arthroscopy.  Currently, we are examining the ability for 57 patients who had been recreational or competitive runners preoperatively to return to run following surgery. We found that while 96% of these patients returned to running, they often run for less distance and less time than they had preoperatively. Patients elicit numerous reasons for their decrease in running, including ongoing pain, loss of interest in running, and a fear of re-injury. We also found that patients that had decreased their running for more than 8 months preoperatively had a longer return to run time at 10 months compared with 7 months for those that had a shorter than 8 month preoperative running decrease.

Thus, runners that undergo arthroscopic hip surgery for FAI have a high likelihood of postoperative return to run but they might not be able to regain all of their preoperative function.

1. Casartelli, N. C., Leunig, M., Maffiuletti, N. A. & Bizzini, M. Return to sport after hip surgery for femoroacetabular impingement: a systematic review. Br. J. Sports Med. (2015). doi:10.1136/bjsports-2014-094414

2. Alradwan, H. et al. Return to preinjury activity levels after surgical management of femoroacetabular impingement in athletes. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 28, 1567–1576 (2012).

Written by Shane Nho, MD, MS

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Back-Saver: A Common Romanian Deadlift Mistake and a Quick Fix

Athletes use Romanian deadlifts to be stronger for their sport. Bodybuilders do it to
build muscle. Regular people use Romanian deadlifts to look good and for general
strength and fitness.

In short, regardless of the training goal, unless we feel or have been advised by a
medical professional that they’re contradicted for a certain individual’s injury or
limitation, Romanian deadlifts are used in some form or fashion in the Performance
U training approach. Which leads me right into the next tip…

One of the common mistakes lifters make when performing Romanian deadlifts is
that they create more extension than desired in their lower backs, which reduces
the amount of hip extension involvement.

Remember, it’s a hip hinge movement – the extension should come from the hips
instead of the lower back.

Here’s what this common mistake looks like, along with a simple technique fix:

Written by Nick Tumminello

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Last week, I made the final decision to have my own dog humanely put to sleep. Skeeter was 15 years old and had been part of my life since 2001. She was diagnosed with cancer almost 2 years ago. In the end, it wasn’t the cancer but her overall quality of life that was the deciding factor. Let me explain.

Skeeter found her way into my life when I was living on St. Kitts for veterinary school. As a stray dog, she was a little under weight but overall healthy. And throughout the first 12 years of her life, she pretty much stayed out of trouble health-wise.

In December of 2013, I was in Florida taking the final exam for my acupuncture certification. Skeeter was staying at the emergency room where I worked. They were looking to get a new ultrasound machine and had a demonstration model in one day. They used her to check out the machine and accidently found a mass on her spleen. There was no evidence of rupture (many splenic masses, benign or malignant will rupture and bleed internally).

Since she was otherwise in good health, the doctors waited for me to return from my exam to fill me in on their findings. I was concerned but needed to know more information. I ran baseline blood tests (all normal) and took chest x-rays (also normal). This was the week of Christmas and I was uncertain about what to do next. So, I reached out to some friends for help.

Louie-Philippe de Lorimier is one of the world’s leading veterinary oncologists. I am lucky enough to know him as both a colleague and a friend. When I told him what was going on, I took a drive up to his office the next day in Montreal for an ultrasound and consult. We checked out and measured the mass on her spleen. We also found a few small suspicious areas in her liver. The ultrasound images were not conclusive, so we did an aspirate of the questionable areas to find out what cells were inside of them. An ultrasound of her heart didn’t show any masses (some forms of cancer spread here as well).

A few days later I got the results. The spleen samples showed no cancer cells but further testing was recommended. The samples from the liver showed cancer cells of hemangiosarcoma. This means that the mass in the spleen probably was also. Either way, the spleen had to be removed. If the mass (benign or malignant) continued to grow she was at risk for rupture and bleeding internally.

Later that week, I removed Skeeter’s spleen and biopsied her liver. Lucky for me I didn’t see any other masses in her abdomen and there was no evidence of internal bleeding. She did great through anesthesia and recovery. I then sent the liver samples (to confirm) and the spleen (to double check) out to the lab.

About a week later, I got the news. The spleen was also cancerous. This happens on aspirates vs. biopsies. When you get larger amounts of tissue, you get a better chance to know what is going on. Sometimes aspirates don’t get the base of the mass and just the outer shell.

Stage 3 hemangiosarcoma. One of the toughest types of cancer to deal with. It likes to spread from the spleen to places like the liver, lungs, heart and bone marrow. Average survival time with chemotherapy is about 9 months.

Time for a side bar. Cancer in pets. A few things about this. A dog’s life expectancy is much shorter than a person’s. So, if the dog would live to be 13 and got diagnosed with cancer at 11 we would only expect 2 years anyway. That influences how we treat cancer in veterinary medicine. Most importantly, we always aim for quality over quantity. We want whatever time for our patients and their families to be positive. In human medicine, they aim as best they can to cure you, or to get you 10, 20, 30 years or more from the time of cancer diagnosis. This means using much different doses of chemotherapy and other treatments. And when we talk about average survival time, it’s just that, an average of all the patients we have records on. It’s our best guess. Some live less, some more.

Most veterinary chemotherapy patients don’t lose their fur. Most don’t even know they are sick. Even fewer have vomiting or diarrhea from their treatment. And if they do, they usually respond well to supportive care and we can adjust doses of chemo. Again, always for quality over quantity.

Back to Skeeter. Having Dr. de Lorimier in our corner was a huge help. I had access to all the latest research, journals and studies. If I did nothing, I would have on average 3-6 months; with chemo, 9-12 months. Chemo would be one different medication each week for 3 weeks, (this would be one cycle) we would aim for 3-6 cycles. That means 9-18 weeks (3-4 months) of chemotherapy to get maybe another 4-6 months past that.

It took me a week to make my decision. I went back and forth. Read articles on low dose oral chemo (less invasive, but also less survival time). I added in acupuncture and Chinese herbal therapy to help support her while I pondered. The benefit of being a veterinarian is not only having access to all this information but also being able to do my own chemo. Some of the medications in her 3week protocol I was comfortable with. One I was not.

Ultimately, I asked Dr. de Lorimier for one more summer with my island dog. We both knew this meant going forward with injectable chemotherapy. In order to give the best chance, we also added in a new option. There is a mushroom derivative that has shown very promising results in hemangiosarcoma treatment. Hemangiosarcoma literally means blood vessel tumor. It likes to “seed” a patient similar to how you lay down grass seed. It then grows tiny tumors of cancerous blood vessels that can grow and grow until they rupture. This mushroom derivative has been shown to slow down the rate of growth of those new blood vessels.

So here is my 13-year-old dog, who had barely been sick a day in her life, now taking a literal pharmacy. She was on acupuncture and Chinese herbal therapy to support her immune system. She took Deramaxx (an arthritis medication) because hemangiosarcoma has been theorized to use the same receptors that joints use for arthritis to grow itself new tumors. To minimize her risk of getting an upset stomach following her chemotherapy, she took an anti-nausea medication the day before and a few days after one of her chemo drugs. She also had to take antibiotics if her white blood cell count was too low. And she was awesome about it. I got lucky. She liked canned dog food, so we just mixed it all together.

Her first drug in chemo was Adriamycin (doxorubicin). This was the one I traveled up to Dr. de Lorimier to have him calculate, adjust and administer for me (with his awesome team of nurses, Nancy and Carol). It is a great medication but I was not comfortable enough with it to give it at home.

A week later, I would check her blood count and if all was okay she got cyclophosphamide. This is an oral medication but it had the potential to irritate her bladder. So with it she got furosemide (Lasix, a diuretic) to help her make urine to flush out her kidneys and bladder. That also went well.

The third week, I gave her Vincristine as an injection into her vein. This she also tolerated very well.

And we repeated this, after 2 cycles her liver lesions (I couldn’t remove all the cancer in her liver at surgery) had shrunk by 50%.

After 4 cycles, the liver lesions were completely gone. We were in remission. This was springtime. There were a few problems along the way. She had some coughing and vomiting occasionally but otherwise was her happy, cheerful self. The coughing and vomiting is a story for another day.

We did 6 total cycles of chemo. After that, most patients still have some visible evidence of cancer in them. Being that she was still in remission, there was no indication to continue chemo or an oral chemo (lots of patients will benefit from low dose oral chemo after injectable chemo to keep the cancer cells from growing).

At this point, I slowly weaned her off the mushroom extract and Chinese herbs. Partly because there was no indication for her to be on them, and partly because her appetite was not that great. After a few months of medications, herbs and such, her body needed a break.

Now, we were into summer and Skeeter had a great time. Fall came, she was still going strong. Got through winter with the help of arthritis medications. The following spring came and we checked for any evidence of re-growth of cancer (we had checked every 3 months since ending chemo) and still she was in remission.

This summer, she was noticeably slower and enjoyed napping more than going for walks. She got to visit some of her favorite places (a beach trip, hiking in the park and a trip to Ithaca, NY).

This fall, I checked again for cancer and still she was in remission. She turned 15 a few weeks ago. For a person, that’s roughly 110 years old. She would get confused about things, get stuck in corners, pace late at night. Tried some simple adjustments and treatments with her, not much improvement. Right along, I had kept her on arthritis medications, a joint supplement and a special food.

Finally the time came where it was a decision of quality over quantity. Sure I could keep her going, but last winter was rough enough on her. A year older would be just as tough, if not worse. In the last months, she stopped being active in the house. She would not greet people; she would not let them pet her. She just lay in her bed.

That was not the quality of life Skeeter had ever led. It was not the dignity she had filled my life with. It was time to change that.

With the help of friends and family near and far, I processed all these thoughts. With the love and support of those people, I came to the decision I had been avoiding since we had started down this road almost two years ago. And on a quiet day, I sat by the water with my dog, my friend and fed her BBQ ribs. I thanked her for the amazing good times and stories. She napped, curled up in a circle around my arm.

Later that afternoon, my friend Dr. Andrea Kitson helped me lay Skeeter to rest. The quality at which Skeeter lived her life is exactly how her life came to a close. Her story though lives on.

I can’t guarantee you an outcome like mine. I am lucky and thankful for all the 22 months I got with Skeeter. Dr. de Lorimier modified the chemo protocol specifically for her. With other patients, we may or may not see similar results. Talk with your veterinarian about options. It’s always best to get a referral to a specialist to find out about what’s available.

Matt Brunke, DVM, CCRP, CVPP, CVA
North Country Veterinary Referral Center
Resident, Veterinary Sports Medicine and Rehabilitation

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Don’t Fit Yourself to Exercises, Fit the Exercises to You

Going along with what I just discussed above, one of the biggest mistakes in training, which trainers and coaches often make, is attempting to fit the individual to the exercises instead of fitting the exercises to the individual.

All of us are the same species: human, just like all different makes and models of cars, trucks and vans are the same species: automobiles. But just like automobiles, humans come in all shapes and sizes. Your size and shape is caused by your structure, and structure determines function. Although both a mini-cooper and a mini-van are made up of the same basic parts (4-wheels, two axels, etc.) and can perform the same basic driving functions (e.g., go forward and reverse, turn right and left, stop and start) you’d never expect a brand-new mini-cooper to drive and handle the same as a brand-new mini-van because of the different ways their (same) basic parts are put together. This is exactly why it’s unrealistic to expect a guy who’s built like a football running back to move the same as a guy built like a lineman. In that, although both the running back and lineman can change levels, push, twist, pull, and so on, they may perform the movements in slightly different ways based on their structure.

In other words, there isn’t any exact exercise that matches the movement of everyone because there are individual variations in the way humans move. Therefore, one must choose the particular exercise variations that best fit how they move.

To put it another way, the reason why we have exercise variations isn’t just to add variety to training, but because there are variations of normal in the way humans move. Some exercises just don’t fit well for certain people’s body.

Not only do we all move a bit differently based on our size and shape, which is dictated by our own unique skeletal framework and body proportions, but past injury, loss of cartilage, or natural joint degenerative processes such as arthritis can influence how we move. This is why attempting to fit every person to the same exercise movement is potentially dangerous. Doing so could cause a problem or further exacerbate an existing problem as it may go against one’s movement capability.

Despite these undeniable realities, some coaches and trainers continue to make ridiculous statements like “everyone should be able to squat like a baby” or “barbell exercises are the best way to get strong (for everyone),” and claim the only reason someone wouldn’t emphasize barbell exercises over all other exercise options is because they don’t want to spend time coaching/ learning them. Certainly it can’t be because some professionals don’t have an attachment to any specific training modality because they realize that trying to fit square pegs, triangular pegs and diamond shaped pegs into round holes simply doesn’t make sense from either a physiological or safety standpoint.

Use the Two C’s

With the above realities in mind, there are two simple criteria used in the Performance U training training approach when it comes to selecting exercises that best fit the individual:

  • Comfort—The movement is pain free, feels natural, works within your current physiology, and so on.
  • Control—You can demonstrate the movement technique and body positioning as provided in each exercise description. For example, when squatting, you display good knee and spinal alignment throughout, along with smooth, deliberate movement.

Keep in mind, by “comfort” I don’t mean the sensation associated with muscle fatigue or “feeling the burn,” as I addressed above: I’m talking about aches and pains that exist outside the gym or flare up when you perform certain movements.

To allow for comfort and control, you may have to modify (shorten) the range of motion or adjust the hand or foot placement of a particular exercise, such as a squat or a push-up to best fit your current ability. Or, as stated above, you may just have to avoid certain exercises and emphasis other variations.

Written by Nick Tumminello

Learn more about Physical Therapy Continuing Education courses from Northeast Seminars.

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Abdominal Scar Massage

What amount of scar massage is effective for abdominal scars?

Following a client’s abdominal surgery, a physical therapist may administer scar massage, or teach a client to perform scar massage. Currently, there are no protocols backed by literature for the correct amount of scar massage to apply specifically to an abdominal scar. However, there are parameters from a handful of studies that may serve as guidelines for determining the dosage of scar massage. The amount of scar massage that was found effective in these studies ranged from 10 to 15 minutes, and it was administered daily to three times per day. Three of the five articles involved the use of silicone gel, something I do not use in my clinical practice.

A critical component of dosing scar massage is to remember that every person with an abdominal scar has a different physiology and structure to her or his scar depending on the type of surgery performed. (Cesarean section, panniculectomy, exploratory, etc.). Clients should be reminded not to induce significant pain or burning during scar massage. Scar massage should not begin until the doctors post-surgical protocols allows. Generally, this is six weeks after the surgery.

During scar massage it is important to keep scar anatomy in mind. Some scars will only be in the most superficial layer of the skin. However, abdominal scars usually reach into deeper layers of our body. In fact, some scars may adhere to the organs and bowels[1]. These deep layers can be reached by working the more superficial layers of the scar first, and progressing deeper with massage pressure only if there is not significant pain or irritation[2]. Scar massage does not need to be too aggressive or last greater than 10-15 minutes.

For more information sign up for my newsletter and email list to download a FREE scar mobilization handout designed as a marketing and patient education tool for my practice. You will also receive the summary of articles referenced in the handout.

Related Downloads

Scar Massage Literature Review

Reference summaries and citations of abdominal scar massage research.

Abdominal Scar Massage

How to get your abdominal scar to look, feel, and move more normally in 15 minutes per day.

References (summaries provided in Download of Scar Massage Research)

  1. Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol. 2011; 17(41): 4545-4553.
  2. Lewit K, Olsanske S. Clinical Importance of active scars: abnormal scars as and the cause of myofacial pain. J Manipulative Physiol Ther. 2004, 27: 399-402.
  3. Wallace, K. Reviving Your Sex Life After Childbirth, Your Guide to Pain-Free and Pleasurable Sex after the Baby. 2014. Visit KatheWallace.com for publication notification.

Thank you to Katie McGee, DPT for assistance in preparing this summary and the educational handout.

Written by Kathe Wallace, PT, BCB-PMD

Learn more about courses taught by Kathe Wallace from Northeast Seminars.

Link to original article below:

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Perineal Tears and Lacerations after Childbirth

The perineum, the area between your vagina and anus, can often tear during delivery in order for your baby’s head to pass through the birth canal. If just the skin and some of the tissue under the skin is torn, this is known as either a 1st or 2nd degree tear. A woman with either of these types of tears may not even need stitches but could still experience pain or discomfort and have scarring.

A 3rd or 4th degree tear is present when the skin, underlying tissues, and part or all of the anal sphincter is torn. A woman with this type of tear may have anal incontinence meaning she has only partial or even no control over the passage of solid, liquid, or gas from the anus. Also, the tear may create pain with attempts at sexual activity[1]. These problems can be embarrassing and make it difficult for you to continue with your everyday life. However, you are not alone.

Unfortunately, many women experience these problems after childbirth[2]. The body takes time to heal, up to six weeks or longer if you had a 3rd or 4th degree tear. In general you should see daily improvement when you follow the ‘Vulvar and Perineal Care’ handout guidelines.

To help you in your recovery, follow the tips below. Remember that it is possible to return to your daily life without pain, to treat bladder and bowel incontinence, and resume a healthy, pleasurable sex life after childbirth.

OK, so I have a perineal tear. What can I do now?

  • PRACTICE good perineal hygiene techniques. It is difficult for a perineal tear to heal due the normal post-partum discharge called lochia. Wearing a protective pad is common, and  worn more often when urinary and/or fecal incontinence is present after delivery.  You should be sure to use gentle cleaning techniques for your perineum in order to  prevent it from becoming raw, and to keep the tear from reopening. Also, a tear can be reopened with wiping at the toilet, so pat the skin dry from front to back.
  • DO pelvic floor exercises. Pelvic floor exercises (sometimes called Kegel’s) will help you regain the strength needed to stop the passage of solid, liquid, or gas from the urethra or anus. Also, these exercises will promote blood-flow and healing of the area[3].  If you are experiencing any discomfort or pain with pelvic floor exercise, do not do them.  Consult your health care provider.�
  • MASSAGE your perineum. You can perform massage yourself to promote healing and to prevent adhesions. See my article and educational handout on abdominal scar massage, the benefits and techniques apply to the perineum and vulvar area as well.  These techniques are usually done 6 weeks after delivery.
  • See a Women’s Health Physical Therapist. We strongly recommend you consult with a women’s health physical therapist after childbirth. The body has a lot of recovery to do after delivery. Many women don’t even know the consequences of 3rd or 4th degree tear for many weeks after childbirth. A women’s health physical therapist is specially trained in issues related to childbirth.  They will evaluate you and let you know how to treat incontinence and perineal pain, assisting you in recovery from childbirth. To find a physical therapist in the United States, visit womenshealthapta.org and choose the “PT Locator” tab or visit Practitioner Directory at HermanWallace.com.

For more information see the download ‘Vulvar and Perinenal Care’ handout designed as a patient education tool for my practice.

This article was developed with Lindsy B. Campbell, SPT as part of an independent study project with the University of Washington, Department of Rehabilitation Medicine Division of Physical Therapy.


  1. Rathfisch, G. Effects of perineal trauma on postpartum sexual function. Journal of Advanced Nursing. 2010; 66(12), 2640-9.
  2. Groutz A, Hasson J, Wengier A, et al. Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol 2011;204:347.e1-4.
  3. Starr JA, Drobnis EZ, Lenger S, Parrot J, Barrier B, Foster R. Outcomes of comprehensive nonsurgical approach to pelvic floor rehabilitation for urinary symptoms, defecatory dysfunction, and pelvic pain. Female Pelvic Med Reconstr Surg. 2013 Sep-Oct; 19(5):260-5.
  4. Wallace, K. Reviving Your Sex Life After Childbirth, Your Guide to Pain-Free and Pleasurable Sex after the Baby. 2014. Visit KatheWallace.com for publication notification.

Written by Kathe Wallace, PT, BCB-PMD

Learn more about courses taught by Kathe Wallace from Northeast Seminars.

Link to original article below:

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When you say “He’s good to go” – do you really know???

After a patient athlete (an oxymoron if there was ever one!) has had an ACL reconstruction – “ When can I play”  rings in your ears as the treating physical therapist – often (in all likelihood) way too soon  –  Historically, we old timers (better known as PT’s with graying hair) have attempted to use specific isolated measures such as quadriceps strength (concentric and eccentric) which is helpful (actually probably remains one of our best measures with correlation to function of ~.70 + – which means  slightly greater than 50% of total variance is being explained by this single measure) but does not assess the functional contributions of the neurologic (sensory as well as reflexive/sequenced motor recruitment ) nor the multitude of inhibitory or skill factors associated with sport performance adequately.  We have used combinations of hop tests (if we use three together – we achieve an R2 of ~0.3 – 0.5  or 9 – 25 % of the variance).  The Lower Extremity Functional Test (LEFT) has been recommended as a great tool to consider related to return to play – unfortunately a recent article bring into question how to use it best as the women who did least well were more likely to sustain an injury during the up-coming competitive season while their male counterparts who performed best were more likely to be injured.

Int J Sports Phys Ther. 2013 June; 8(3): 216–227.

Key point:  Female athletes who completed the LEFT in >118 seconds were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in <100 seconds were more likely to experience a time‐loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 seconds or more.

Now in direct relationship to ACL reconstructed athletes and “when to return” a recent article has unfortunately brought this issue into focus:

Clin J Sport Med. 2012 Mar;22(2):116-21. doi: 10.1097/JSM.0b013e318246ef9e.

Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport.
Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE.

Sixty-three subjects who had ACLR and were ready to return to sport (RTS) and 39 control subjects.

Second ACL injury and sex.

Second ACL injury and athletic exposure (AE) was tracked for 12 months after RTS. Sixteen subjects after ACLR and 1 control subject suffered a second ACL injury. Between- and within-group comparisons of second ACL injury rates (per 1000 AEs) were conducted.

The IR of ACL injury after ACLR (1.82/1000 AE) was 15 times greater [risk ratio (RR) = 15.24; P = 0.0002) than that of control subjects (0.12/1000 AE). Female ACLR athletes demonstrated 16 times greater rate of injury (RR = 16.02; P = 0.0002) than female control subjects. Female athletes were 4 (RR = 3.65; P = 0.05) times more likely to suffer a second ACL injury and 6 times (RR = 6.21; P = 0.04) more likely to suffer a contralateral injury than male athletes.

An increased rate of second ACL injury after ACLR exists in athletes when compared with a healthy population. Female athletes suffer contralateral ACL injuries at a higher rate than male athletes and seem to suffer contralateral ACL injuries more frequently than graft re-tears. The identification of a high-risk group within a population of ACLR athletes is a critical step to improve outcome after ACLR and RTS.

So what does this mean for us:

These data point to several issues:  1) We are not doing this  (sending folks back to sport) as efficiently and safely as we might perceive;  2) Women do less well than their male counterparts when returning;  3) The “uninjured’ extremity is at greater risk of ACL injury than is the reconstructed ACL;  4) These data reinforce what has been a major recommendation of some of the “old guard “( again –  AKA gray haired PT’s)  which is that the last portion of the ACL reconstruction rehabilitation protocol MUST include a focus on a prevention program

Mark Paterno has the follow-up article in review which adds a very interesting element.  That is that nearly all the new ACL injures happen relatively early – basically in the first 6 months after return.  Also  a very interesting finding is that after more than 12 months from surgery, the injury numbers are reduced.   So for thought and discussion:   In all likelihood – We need to do a better prevention approach at the end of structured rehab following surgery and POSSIBLY:  We may need to consider delaying the return to sport for a time period – possibly for one year especially in the subset of young females as this could decrease the alarmingly high reinjure rate in these individuals  – NOTE: this is not a proven as the presented data have not tested this hypothesis but only provided as a hypothesis  to be evaluated.

Terry Malone, PT, EdD, ATC, FAPTA   (yes – a gray haired PT)

Learn more about Physical Therapy Continuing Education courses from Northeast Seminars.

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