Brigham & Women's Hospital - Return to Sports Guidelines.pdf - Protocols - ip-gina

Department of Rehabilitation Services

Physical Therapy

Lower Extremity Functional Progression Following Stress Injury Protocol

The intent of these guidelines is to provide the athlete with a framework for return to sports activity

following injury. These guidelines should not take the place of medical advice if attempting to return to

sports following an injury. If an athlete requires assistance in the progression of a return to sport

program they should consult with their primary care physician, surgeon, or physical therapist.

The progression is designed for a ¼ mile track (440 yards equals one lap, and four laps equals a

mile).

STAGE I: WALK-JOG

1. Walk four laps (one mile).

2. Walk three-quarter lap (330yds); jog one-quarter lap (110yds). Repeat this pattern for

3 more times. Then walk one-quarter lap (110yds)

3. Walk half a lap (220yds), jog half a lap. Repeat this pattern two more times. Walk

one lap (440 yds).

4. Walk one lap (440yds); jog one lap (440 yds). Repeat this pattern one more time.

Walk 100yds.

5. Walk one lap; jog two laps (880 yds). Walk 440yds.

6. Walk half a lap (220yds); jog three laps (¾ a mile). Walk half a lap (220 yds).

7. Walk 100 yds, jog 4 laps (one mile), walk 100 yds.

STAGE II: JOG- RUN

1. Jog ¾ lap, run ¼ lap, repeat this pattern three times, then jog ¼ lap.

2. Jog half a lap, run half a lap, repeat this pattern three times, then jog one lap.

3. Jog one lap, run one lap. Repeat.

4. Jog one lap, run two laps, jog one lap.

5. Jog one lap, run three laps, jog half a lap.

6. Jog one lap, run four laps, jog half a lap.

STAGE III: SPRINTING

1. Run 50yrds at 50% speed. Run 50yrd two times at 75%speed. Run 50yrds two times

at 100%speed. Take as much rest as needed between intervals.

2. Sprint 100 yds two times with 5 min rest.

3. Sprint 100 yds four times with 5 min rest.

4. Sprint 40 yds six times with 3 min rest.

5. Sprint 40 yds ten times with 2 min rest.

Lower Extremity Functional Progression Following Stress Injury Protocol

Functional activity progression for patients with lower extremity stress fracture.

STAGE IV: AGILITY DRILLS

Agility drills are used for sports involving jumping and cutting. Complete a warm up of a one

mile run then initiate agility exercises. Complete one cycle of each exercise at 50% effort, then

progress to one cycle at 75% effort and then one cycle at 100% effort. Distance and sprint

running are then completed.

1) FIGURE OF EIGHT RUNNING: Run a figure of eight pattern with two

10-foot diameter circles and then with two 5-foot diameter circles. Complete

three cycles of each figure of eight at 50%, 75% and 100% effort.

2) CARIOCA: Run sideways crossing legs in front of and then behind the lead

leg for 20 yards, rest 5 seconds, and repeat four times to complete one cycle.

Complete three cycles of carioca at 50%, 75% and 100% effort.

3) BACKWARD RUNNING: Run for 20 yards, rest 5 seconds, and repeat four

times for each cycle. Complete three cycles of backward running at 50%, 75%

and 100% effort.

4) BOX RUNNING: Mark out a 5 yard square box. Initiate the run by running

the box five times clockwise and then five times counterclockwise. Complete

three cycles at 50%, 75%, and 100% effort.

5) VERTICAL JUMPING: Jump with 50% effort and mark the spot on the

wall. Repeat jumping to that mark 10 times. Change the mark to the 75%

effort jump and jump to that mark 10 times. Change the mark to the 100%

effort jump and jump to that mark 10 times.

STAGE V: PROGRESSION TO PRACTICE AND GAMES

Practice sessions are not initiated until functional rehabilitation is successfully completed. All

practice sessions are initiated with a warm-up that includes; 1) light running and stretching 2)

gradual increase in speed to full speed running, 3) completion of agility activities with gradual

increase in intensity and 4) gradual increase in speed and intensity of movements specific to

sport. After practice, complete a cool down of running and stretching.

Based on:

Duke Sports Medicine Protocols, Duke University, Durham, North Carolina.

uthor:

evie

ers:

Amy Butler, PT

Reg Wilcox, PT

1/06

Stephanie Boudreau, PT

Updated 9/07

Debbie Canoa, PT

Lower Extremity Functional Progression Following Stress Injury Protocol

Functional activity progression for patients with lower extremity stress fracture.

Department of Rehabilitation Services

Physical Therapy

Return to Sport after Knee Injury / Surgery Guidelines

The intent of these guidelines is to provide the athlete with a framework for return to sports activity

following injury. These guidelines should not take the place of medical advice if attempting to return to

sports following an injury. If an athlete requires assistance in the progression of a return to sport program

they should consult with their primary care physician, surgeon, or physical therapist.

Phase 1: Functional Balance and Core Strengthening

Goals:

•

Enhance single leg weight bearing strength at varying angles of knee flexion.

•

Improve side to side symmetry in lower extremity running mechanics.

•

Improve single leg balance.

•

Improve core stability and coordination.

Exercises:

•

Lunges

•

Single leg squatting exercises

•

Treadmill training with a mirror to enhance symmetry in running mechanics.

•

Balance activities (level surface, uneven surfaces, soft surfaces).

Criteria to progress to Phase II:

•

Able to single leg squat to 60 degrees knee flexion and hold for at least 5 seconds.

•

Symmetry in running mechanics on a treadmill (6-10 mph).

•

Acceptable single leg balance performance involved extremity compared to uninvolved.

Phase II: Functional Strength

Goals:

•

Improve lower extremity strength.

•

Enhance force contribution symmetry during bilateral weight bearing activities.

•

Enhance single leg landing force.

Exercises:

•

High intensity balance training activities.

•

Continue lower extremity weight bearing strengthening activities.

•

Begin perturbation training.

•

Single leg landing activities to improve dynamic muscular control.

Return to Sport after Knee Injury / Surgery Guidelines

Criteria to progress to Phase III:

•

Side to side symmetry in peak torque knee flexion and extension.

•

Plantar force total-loading symmetry measured during bipedal squat to 90 degrees knee

flexion (less than 20% discrepancy between sides).

•

Single-limb peak-landing-force symmetry on a 50 cm hop (less than 3 times body mass and

within 10% in side-to-side measures).

Phase III: Power Phase

Goals:

•

Improve single-limb power production.

•

Improve lower extremity muscular endurance.

•

Improve lower extremity biomechanics during plyometric activities.

Exercises:

•

Mid-level intensity double-limb plyometric jumps.

•

Low-level intensity single-limb repeated hops.

•

Focus on proper technique during plyometric activities.

Criteria to progress to Phase IV:

•

Single-leg hop for distance (within 15% on uninvolved side).

•

Single-limb crossover triple hop for distance (within 15% on uninvolved side).

•

Single-limb timed hop over 6 meters (within 15% on uninvolved side).

•

Single-limb vertical power hop (within 15% on uninvolved side).

•

Reassessment of tuck jump (either an 80-point score or 15% improvement)

Phase IV: Sport-Specific Symmetry

Goals:

•

Equalizing ground reaction force attenuation strategies between limbs.

•

Improving confidence and stability with high intensity change of direction activities.

•

Improving and equalizing power endurance between limbs.

•

Using safe biomechanics (increased knee flexion and decreased knee abduction angles)

when performing high-intensity plyometric exercises.

Exercises:

•

Power, cutting and change-of-direction tasks that are modified to the athlete’s individual

sport.

Return to Sport after Knee Injury / Surgery Guidelines

•

Provide verbal and visual feedback to assist the athlete develop safe biomechanics during

plyometric moves.

Criteria for integration back to sports:

•

Drop vertical jump landing force bilateral symmetry (within 15%).

•

Modified agility T-Test (MAT) test time (within 10%).

•

Single-limb average peak power test for 10 seconds (bilateral symmetry within 15%).

•

Reassessment of tuck jump (either an 80-point score or 20% improvement).

References:

Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate

ligament reconstruction: Criteria-based progression through the return-to-sport phase. Journal of

Orthopedic Sports Physical Therapy. 2006. 36; 385-399.

Myer, GD, Paterno MV, Hewett TE. Back in the game. A four-phase return-to-sport program for

athletes with problem ACLs. Rehab Management . 2004. 30-33.

uthor:

evie

ers:

Reg Wilcox, PT

Debbie Canoa, PT

Stephanie Boudreau, PT

9/07

Return to Sport after Knee Injury / Surgery Guidelines

Brigham & Women's Hospital - Return to Sports Guidelines.pdf

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