Ep 25: ACL rehabilitation from A to Z, with Dr Erik Meira
Mar 1, 2021
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Dr. Erik Meira, a specialist in ACL rehabilitation, joins Drs. Dan Chapman and Chelsea Cooman to break down the stages of recovery after ACL surgery. He discusses critical strategies for the acute phase and the significance of tailored assessments and pain management. The conversation highlights overcoming quad strength plateaus, transitioning to dynamic exercises, and the essential training needed for return to sports. Meira also emphasizes the importance of symmetry in strength and biomechanics adjustments for optimal recovery.
Effective ACL rehabilitation requires careful management of the acute phase to minimize swelling and enhance range of motion.
Transitioning back to sport involves tailored functional training and ensuring strength symmetry to prevent reinjury and foster confidence.
Deep dives
Initial Phase of ACL Rehabilitation
The acute phase of ACL rehabilitation involves assessing the patient's range of motion, managing swelling, and ensuring pain control. Evaluating the patient's support system and personal beliefs is crucial, as these factors can influence recovery. Emphasis is placed on regaining knee extension while keeping swelling minimal, and various techniques such as elevation and compression are employed to aid recovery. The goal during this phase is to foster a calm environment for the knee to heal, with initial visits focused more on gentle, controlled activities rather than aggressive interventions.
Strengthening Focus in ACL Rehab
As the rehabilitation progresses, attention shifts to building quadricep strength through controlled exercises and avoiding strategies that may diminish quad engagement. Exercises are tailored to ensure that the knee is utilized effectively without compensatory patterns that can lead to dysfunction. Partial arc exercises are recommended over full arcs to ensure optimal loading of the quads while preventing discomfort. The continuum from isometric contractions to progressive loading is important as it prevents patients from adapting to strategies that do not utilize their quads effectively.
Return to Sport Considerations
The transition back to sport involves a combination of functional training and sport-specific drills to ensure athletes can perform at their capabilities. Quad strength indices and hop tests serve as critical metrics for determining readiness, with a focus on ensuring that at least 90% symmetry is achieved in strength before returning to high-intensity activities. Return-to-sport protocols involve graded exposure to activities, allowing athletes to regain confidence while monitoring for compensatory strategies that could signal a return of old habits. Post-rehabilitation assessment is essential to determine if adjustments are necessary, particularly for athletes with a history of ACL injuries, as they may revert to compensatory patterns without appropriate retraining.
Dr Erik Meira joins Drs Dan Chapman and Chelsea Cooman to discuss ACL rehabilitation at every stage: acute, strengthening, plyometric, and returning to sport. Dr Meira breaks down the typical timelines and priorities, shares his favorite interventions, and outlines progression criteria for each stage of rehabilitation.
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