Treatment approaches following foot and ankle injury.

A complete and effective rehabilitation program begins with a thorough subjective and objective evaluation of the problem and injury presented. Biomechanical changes, whether they are anatomically induced or as a result of a form of compensation, must be identified and properly addressed. During the initial phase of rehabilitation, the issues of pain and swelling often must be resolved before full range of motion and return to normal strength can be achieved successfully during the more advanced stages. It is important to incorporate the entire lower quadrant in exercises that are designed to improve proprioception and function, using both in open and closed kinetic chain exercises. Finally, the demands to which the patient is returning to must be recognized to successfully complete the recovery phase.

Musculoskeletal conditioning of the older athlete.

A musculoskeletal conditioning program has been shown to result in physical benefits for older individuals. Exercise may influence the rate of bone loss, muscular strength and mass, flexibility, and endurance levels. In turn, these factors may influence the potential for possible future injury. Special precautions should be taken for the older population with emphasis on environmental factors, hydration, and underlying health issues such as cardiorespiratory and orthopedic problems. These concerns may require modifications of the exercise program.

Rehabilitation following ulnar collateral ligament reconstruction of athletes.

All authors of this article are affiliated with the Kerlan-Jobe Orthopaedic Clinic, 501 E. Hardy Street, Suite 200, Inglewood. CA 90301, (213) 674-5200. Athletes involved in throwing activities often subject their elbows to repeated valgus forces. The ulnar collateral ligament (UCL) may become torn and reconstructive surgery may be required. The purpose of this paper is to review the anatomy and biomechanics of the elbow joint and present a rehabilitation program that can be used following UCL reconstruction of the elbow, with an emphasis on a return to throwing activities. J Orthop Sports Phys Ther 1991;14(3):100-105.

Rehabilitation of the knee after anterior cruciate ligament reconstruction.

From the Kerlan-Jobe Orthopaedic Clinic, 501 E. Hardy Street, Suite 200, Inglewood, CA 90301. New information regarding the isometric placement of the anterior cruciate ligament (ACL) substitute, revascularization process, and biomechanical stresses have all contributed to and been incorporated in the rehabilitation program after ACL reconstruction. Treatment protocols specifically designed for the patient following ACL reconstruction are imperative to return the individual to his or her preinjury status. Care is taken to limit the amount of stress placed on the ligament substitute especially at end of range extension. A program incorporating techniques for developing range of motion and strength while still preserving stability at the knee joint is still of the utmost importance. This program is a revision of a previously reported regimen from this facility (Brewster, Moynes, Jobe, J Orthop Sports Phys Ther 5:121-126, 1983) and is based upon clinical experience and research information. J Orthop Sports Phys Ther 1989;11(1):8-18.

Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction.

The purpose of this study was to examine individuals 5 years after ACL reconstruction and analyze changes involving strength, stability, function, and sports activities. Nineteen males and six females, mean age = 31.4 +/- 7.31 years, participated in this study. Fifteen subjects had received extraarticular and ten subjects had received intraarticular ACL reconstructions. Subjects completed a 100 point subjective functional activity questionnaire and a sports participation survey. Knee ligament stability was assessed during an objective knee examination. Isokinetic quadriceps and hamstring muscle strength were tested at 240 and 120 deg/sec using the Cybex II dynamometer. Anterolateral rotatory instability and positive Lachman were elicited on the operated leg for 80% of the subjects. No significant relationship was found between objective instability and the functional activity score. For the intraarticular group, a significant correlation (P less than 0.05) was found between increased quadriceps and hamstring strength on the operated leg and return to functional activities. Subjects' functional activity score was positively correlated (P less than 0.001) with their ability to participate in sports. Subjects participating in sports involving cutting and twisting motions were less successful in returning to their preinjury participation levels and reported more subjective complaints of pain, swelling, and/or instability. These results indicate that long-term progressive rehabilitation emphasizing increased quadriceps and hamstring strength to approximate the nonoperated leg may enhance successful return to functional and sports activities after ACL reconstruction.

Conditioning for skiing and ski injury prevention.

As the popularity of skiing has risen in the United States over the last two decades so has the incidence of skiing injuries. The possibility exists that a proper conditioning program may decrease the frequency and severity of musculoskeletal injuries that occur during skiing. To ascertain the most appropriate components of a ski conditioning program, a review of the literature regarding downhill and crosscountry skiing is presented. Specifically, the literature was evaluated to determine the most recent research findings in the areas of physiological demands in downhill and cross-country skiing, the frequency and types of injuries that occur during each type of skiing, and the most common mechanisms of injury for the major types of ski injuries. This information was used to devise a muscular strengthening and musculoskeletal stretching program that may be useful in conditioning for skiing and for prevention of ski injuries. J Orthop Sports Phys Ther 1987;8(9):428-437.