Human Performance Laboratory

ACL reconstructionEarly Rehabilitation:

Are We Doing Enough?Loading symmetry

Susan Sigward PhD, PT, ATC

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Human Performance Laboratory

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1. Labanca et al. Am J Phys Med Rehabil, 20152. Chan et al, ACSM 63th annual meeting,  20163. Roos et al, J Neuroeng Rehabil, 20144. Baumgart et al, Knee Surgery Sports Traumatology , 

2015 

1 month 3 months 5 months 1 to 2 years

Sit‐to‐stand32% lower vGRF 1

Body weight squat14% to 11% lower vGRF 2

Body weight squat317% lower knee extensor moment

Drop land19‐20% lower vGRF 4‐6

Normal gait, Full ROM,Quadriceps strength >80%,Begin running progression7

Agility exercisesSports specific exercises7

5. Paterno et al, Clin J  Sports Med, 20076. Paterno et al, JOSPT, 20117. Adams et al. JOSPT, 2012

Human Performance Laboratory

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0.2

0.4

0.6

0.8

1

1.2

T1 T3 T5

Knee ext mmt

Involved

Uninvolved

0.30

0.35

0.40

0.45

0.50

0.55

0.60

0.65

0.70

T1 T3 T5

GRF

Involved

Uninvolved

Loading asymmetry• Bilateral tasks/ squat

– Knee extensor moment deficits during an unweighted maximal depth squat at 1, 3 and 5 months post‐op ACLr (n=11). 

Human Performance Laboratory

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Human Performance Laboratory

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Human Performance Laboratory

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Human Performance Laboratory

Natural condition Instructed condition Feedback condition

* Ming‐Sheng (Matt) Chan‐Pilot data

Do they? Can they?Sit‐to‐standDouble‐leg stand

Stand‐to‐sitSquat

Human Performance Laboratory

Instructed

8

Human Performance Laboratory

Feedback

9

Human Performance Laboratory

ES: 5.3

12‐16 weeks post ACLr

Human Performance Laboratory

12‐16 weeks post ACLr

Human Performance Laboratory

Daily Activities• 12‐16 weeks post ACLr• submaximal demandsPractice throughout the day?

– Sit‐to‐stand– Double‐leg stand– Stand‐to‐sit– Squat

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Human Performance Laboratory

Daily Activities

Daily loading Daily data 

Time (seconds)

V fo

rce im

pulse/BW

Matlab, Mathworks, Natick, MA, USA 

plantar pressure inserts(Orpyx LogR, Calgary, Canada)0‐75 PSI, 100Hz

Human Performance Laboratory

12‐16 weeks post ACLr