Hi all,
Thanks lads for the useful info re; my last post on the subject. With this post I thought that I could provide some info on the subject, an updated treatment protocol sourced from one of the Orthopods at the facility, and some info on my patient.
Patella tendon rupture is fairly rare, third in terms of number of injury to the knee extensor mechanism after patella fracture and quad tendon rupture. Surgery is nearly always indicated so as to allow recovery of motion and strength. Post surgery the Rx protocol is as follows.
0-3d= No WB, knee brace locked in ext, no exercise or modalities.
4-13d= TWB, knee brace locked in ext, active flx to 45 and passive ext to 0 (no active ext), swelling control with ice, gentle medial lateral glide, isometric hamstring exs, contralateral quad exs.
2-4w= PWB, knee brace locked in ext, active flx to 90 and passive ext to 0 (no active ext), isometric quads (no SLRs) + above.
4-6w=WBAT and crutches discontinued when good quads control, knee brace locked in ext, full active flxn and passive extn, + above.
6-12w= WBAT, knee brace discontinued when good active quads control and normal gait are obtained, aggressive medial/lateral glides, SLR without reistance + above, and stationary cycling at 8 weeks.
12-16w=FWB, quads strengthening and neuromuscular retraining.
16-24w = FWB, running and sports/work specific training.
>6m= may return to jumping and contact sport when 90% of strength of contralateral extremity.
Of course this protocol is slighty different for every pt. My pt was a fit guy (boxer), however he had received no PT Rx since discharge (well over 3months post op when seeing me)!! Thus his AROM was only 5-80 deg and he also had decreased strength with severe quads wasting and quads lag. He had seen the orthopod the week before who immediately took him off the sticks, removed the brace and referred to the clinic for physio. So my initial Rx session focused on increasing ROM. I found the old hold/relax quite good for this with immediate beneficial effects.
One interesting part of my Ax was palpation of the tendon. It felt really wide and flat, unlike normal, where it is quite narrow with palpable edges. My supervisor said that this was quite common in these tendon injuries and often occurred after achilles surgery too. He said that narrowing of the tendon and scar mangement was an important part of physio treatment. As we have not been taught much about this at school I thought I would open this up to the crew and see if you have any ideas on this. I was reading in Brukner and Khan that cross friction massage is one option.
Thats it, hope you were not all bored to death, take it easy!
Nico
Subscribe to:
Post Comments (Atom)
2 comments:
hey nico
When doing my musculo prac I had a patient who had a surgical repair of an achilles tendon rupture and was again a fit, young guy (kickboxer!) who presented with similar problems as your guy here, muscle wasting and weakness and reduced ROM. So calf raises, bilateral at first, and ankle mobs were used to treat these impairments. But the thing we worked on most during our treatment sessions were techniques to break up the scar adhesions and reduce its thickness, and this was what the patient was most concerned about. On advice of my supervisor, massage and ultrasound were both administered aggresivly, as well as advice on self massage at home. While i havnt tried it myself, my supervisor reported that a previous student had used the cross-friction mobs on the achilles tendon post-repair with good effect. But in the end the tendon will always be thicker and feel tougher than before, due to the nature of the injury and repair.
Bini :)
Good thoughts, y'all.
Did either of you use the eccentric training program? (you remember the eccentric training program for the Achilles tendon, eh Nic?).
I am pretty sure that that it is a good late stage option for reforming supple, strong tendon-tissue that has closer to normal properties.
The 'Outcomes Based Massage' book has a good bit on friction massage.
Post a Comment