Question

1. POST KNEE SURGERY: Design a post Physical Therapy rehab program for a someone who is recovering from ACL surgery. Consult local re- sources and therapy textbooks for the most updated information. 2. BODY MECHANICS: An internist refers a 275-lb patient with joint pain and gait abnormalities to you. Would walking in water or cycling be the most efficient exercise? Give a sample 5 day program for each type of exercise. State your reasons for not using other forms of exercise. 3. ORTHOPEDICS: You're working with a throwing athlete who's rec had rotator cuff surgery and a total of 12 PT sessions. Your referral pa suggests gradual strengthening and stretching over 3 months. By then the athlete wants to be on a basic str routine to get back to their pre-season training program. List the ROM exercises, modified strength exercises and routine you'd use for this athlete. Site examples from the literature of at least 2 programs for athletes following a published training format. 4. OUTCOMES MANAGEMENT: You are a trainer who has successfully completed exercise therapy programs with 5 clients. You have kept your exercise cards and progress notes current and have maintained daily records on session days.

Answer 1

Physical therapy for the knee joint is divided into four phases.

Phase 1: Helping the Knee to Heal

Phase 2: Tossing the Crutches

Phase 3: Getting Stronger

Phase 4: Almost Back to Normal

Phase 1: Helping the Knee to Heal

The main goals of Phase 1 are to protect the knee so it heals properly, to begin work on restoring range of motion of the joint, and to restore normal use of the quadriceps (thigh muscles). You'll likely need crutches during this stage, and also wear a full-length knee brace, although not all surgeons put ACL patients in a brace, as there's evidence this isn't necessary for a successful recovery.

Week 1

In the initial post-operative period, you'll focus on learning to walk with your crutches on level surfaces and up and down stairs. Your physical therapist may use ice to help control swelling (and instruct you to do the same several times a day at home). He also may use neuromuscular electrical stimulation (NMES) to help improve your ability to contract your quads and start you on gentle exercises to restore range of motion to the knee

Phase 2: Tossing the Crutches

Swelling should be under control and you should be able to easily contact your quadriceps. The goal of this phase is to stop using crutches and begin to walk normally while still providing protection for your healing knee. Your therapist will continue to ice your knee and use NMES.

Week 2

Strengthening your hips will be key to allowing you to progress from using to two crutches, to using one, to putting them away altogether. At the same time, you'll do exercises to improve control of your quads and to strengthen the hamstring muscles in the back of your leg. You may start using a BAPS board in the seated position for balance and proprioception, which is your awareness of the location and movement of your knee.

Week 3

By the end of this week through the following week, you'll be walking almost normally. The only thing that might give away the fact that you've had surgery may be a slight bend in your knee, which will disappear as your range of motion improves. Your hip exercises may become more advanced, and you may begin to use light weights while doing straight leg raises. You'll progress to using the BAPS board in the standing position.

Phase 3: Getting Stronger

During this phase of ACL rehab, the goal will be to get your leg even stronger, so that by the end you'll have progressed from walking to light jogging.



Weeks 4 through 6

Among the exercises, you'll be doing during these three weeks are exercises to improve balance; squats and lunges to strengthen your quads and glutes (the muscles in your backside); plus the straight leg raises and advanced hip-strengthening exercises you've been doing already. By the end of week 6, you may move on to gentle plyometrics and hopping. You'll no longer need icing or NMES.

Weeks 7 and 8

Besides having you continue with the exercises you've been doing and perhaps adding resistance to some of them, your physical therapist may test the integrity of your ACL. If you no longer have knee pain and your knee is stable, by the end of week eight you can begin to jog.

Phase 4: Almost Back to Normal

During this phase, you'll progress from jogging to running. It's important to not overstep your abilities, though: Even if you're feeling great, it's too soon to participate in high-level sports that involve a lot of starting and stopping or cutting.

Weeks 8 through 12 and beyond

You'll continue with your regular exercise regimen. At four to six months after ACL surgery, your physical therapist may have you do single leg hop testing to see if your knee is stable enough for high-level athletics that require sudden starts and stops or cutting maneuvers. If you're an athlete and he gives you the go-ahead, you should be able to get back to playing sports.

Q2.

Day 1 to 5 :

Walk in water

Walking in water is a good exercise to start off with as it helps you get a feeling for how you can create resistance. Walking in water can target your arms, core, and lower body. You can increase the intensity by using hand or ankle weights.

1. Start off walking in shallow water, around waist height.
2. Lengthen your spine and walk by putting pressure on your heel first and then your toes, instead of walking on your tiptoes.
3. Keep your arms at your side, in the water, and move them as you walk.
4. Engage your core and stand tall as you walk.
5. Continue walking for 5-10 minutes.

2. Water arm lifts

This exercise will help strengthen the muscles in your arms. Using foam dumbbells will help add more resistance.

1. Stand in water up to your shoulders.
2. Hold the dumbbells at your side, with your palms facing up.
3. Draw your elbows in close to your torso as you lift your forearms to the height of the water.
4. Rotate your wrists to turn your palms facedown.
5. Lower your arms back to the starting position.
6. Do 1-3 sets of 10-15 reps for each exercise.

3. Lateral arm lifts

This exercise, which targets your upper body, is also best done with foam dumbbells.

1. Stand in water up to your shoulders.
2. Hold the dumbbells at your side.
3. Raise your arms to the side until they’re level with the water and your shoulders.
4. Lower your arms back down to your sides.
5. Do 1-3 sets of 8-14 repetitions.

4. Back wall glide

This exercise helps to activate the muscles in your core and lower body.

1. Hold onto the pool ledge, tuck your knees into your chest, and press your feet into the wall.
2. Push off from the wall and float on your back as far as you can.
3. Draw your knees into your chest, press your feet down to the bottom of the pool, and run back to the wall.
4. Continue this exercise for 5-10 minutes.

5. Jumping jacks

Jumping jacks work the muscles in both your upper and lower body. You can add resistance with wrist and ankle weights.

1. Stand in water at chest level.
2. Start with your feet together and your arms at your side.
3. Jump by moving your legs outward and, at the same time, bringing your arms over your head.
4. Jump again to return to the starting position with your feet together and your arms at your side.
5. Do 1-3 sets of 8-12 repetitions.

6. Leg shoots

This dynamic exercise works your core, low back, and legs.

1. Keep your feet off the bottom of the pool during this exercise.
2. Tuck your knees into your chest.
3. Explosively press your feet and legs out in front and float flat on your back.
4. Draw your knees back into your chest.
5. Press your legs out behind you so you’re floating on your stomach.
6. This is 1 repetition. Do 1-3 sets of 8-12 repetitions.

7. High-knee lift extensions

This exercise can strengthen the muscles in your core and lower body. Add ankle weights to increase the difficulty.

1. Stand in water at waist height.
2. Engage your core as you lift your right leg, bending your knee until your leg is level with the water.
3. Pause with your leg lifted for a few seconds.
4. Extend your leg straight out and hold this position for a few seconds.
5. Slowly lower your leg down, keeping it straight.
6. Repeat this move with your left leg.
7. Continue for 5-10 minutes.

8. Leg kicks

This exercise works the muscles in your core and legs. Use ankle weights to make it more challenging.

• Hold onto the pool ledge or hold a kickboard.
• Flutter-kick your legs.
• Scissor-kick your legs open and closed.
• Do a breaststroke kick with your legs.
• Follow with dolphin kicks.
• Do each kick for 1-3 minutes
• Q3.

• There are three types of range of motion exercises

  1. Passive

  2. Active

  3. Active assistive

  Passive range of motion

  Passive range of motion is the movement applied to a joint solely by another person or persons or a passive motion machine. When passive range of motion is applied, the joint of an individual receiving exercise is completely relaxed while the outside force moves the body part, such as a leg or arm, throughout the available range. Injury, surgery, or immobilization of a joint may affect the normal joint range of motion.

  Active range of motion

  Active range of motion is movement of a joint provided entirely by the individual performing the exercise. In this case, there is no outside force aiding in the movement.

  Active assisted range of motion

  Active assist range of motion is described as a joint receiving partial assistance from an outside force. This range of motion may result from the majority of motion applied by an exerciser or by the person or persons assisting the individual. It also may be a half-and-half effort on the joint from each source.