Young athletes and active adults are well aware of the tremendous social and health benefits that come from participating in sporting activities. The down side to being active is sustaining an injury. Roughly 15% of all sports injuries involve the knee and its associated structures. While rest is the answer for many athletes, others inevitably require surgery. Post operatively, physical therapy plays a vital role in returning these athletes back to their sport.
Rehab is much more than gym exercises. Understanding joint biomechanics, functional movement, neuromuscular involvement, tissue healing time and one’s cognitive level is critical. Knowledge and exercise combined with a manual therapy approach allows a physical therapist to address these issues.
A hands-on approach has many advantages. Initially, it helps to establish trust, build patient confidence and cooperation. The psychological benefits of manual contact are powerful. Its influence on physical healing is profound. Secondly, a manual approach allows us to assess inflammation, joint mobility and muscle function.
Achieving full range of motion early is important. Therefore, soft tissue mobilization is used. It allows the physical therapist to alleviate the swelling and soreness associated with surgery. Working out muscle spasms and tight, restricted areas also promotes mobility and decreased pain. Breaking down any adhesions or scar tissue that may form will further facilitate motion and improve the overall outcome.
Beyond the soft tissue, mobilizing the knee cap (patella) is often done. This technique ensures unrestricted movement and minimizes the chances of adhesions forming and impeding mobility.
One of the most powerful manual therapy tools is PNF. Proprioceptive Neuromuscular Facilitation is a proven technique used to evaluate, treat, educate and strengthen. Although the term sounds complicated, the technique is not.
PNF involves a variety of resisted strengthening movements between the patient and therapist. Whether you are walking, running or jumping these compound movements occur along different angles and planes of motion. PNF allow us to strengthen and re-educate the muscles in these planes. Characteristics such as endurance, quality of muscle contraction, control, strength and stability can be assessed. Using varying grades of resistance, quick stretches and different hand holds we can facilitate these complex neuromuscular patterns. It’s dynamic, functional and fun!
In the physical therapy setting a special emphasis is placed on balance training activities that improve position awareness (proprioception). Proprioception is typically diminished after knee surgery. Dynamic exercises help re-educate the leg muscles to sense potentially harmful positions and facilitate a faster protective reaction. These exercises form the foundation of the patient’s injury prevention program.
Plyometric and agility training is another key component to the athlete’s rehab program. These activities focus on coordinated jumping, bounding, leaping, landing and cutting mechanics. The drills improve reflexive and voluntary muscle response times.
A physical therapy program which blends manual treatment, dynamic activities and injury prevention elements with gym exercises is a sound choice. Well rounded rehab must always be graded to meet the patient’s needs and goals.