Hydrotherapy in ACL Rehabilitation: Difference between revisions
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==Introduction== | ==Introduction== | ||
[[Aquatherapy|Hydrotherapy]] is the delivery of physiotherapy treatment in an aquatic environment, utilizing the properties of water<ref>Aquatic Therapy Association of Chartered Physiotherapists (ATACP). About ATACP. Available from: https://atacp.csp.org.uk/content/about-atacp (Accessed 19/12/2022)</ref> | [[Anterior Cruciate Ligament (ACL)]] injuries are a common orthopedic condition, especially among [[Athletes with Disabilities|athletes]] and young people, which can have long term physical and lifestyle impacts<ref>Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381773/ Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture]. Dtsch Arztebl Int. 2018 Dec 24;115(51-52):855-862.</ref>. For example, post traumatic [[arthritis]], [[Meniscal Lesions|meniscus]] or [[cartilage]] injuries, [[knee]] instability, as well as impaired [[Quality of Life|quality of life]] and not returning to [[Sport Injury Classification|sport]]<ref name=":6">Filbay SR, Grindem H. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723618/#bib1 Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture]. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):33-47.</ref><ref>Kohn L, Rembeck E, Rauch A. Verletzung des vorderen Kreuzbandes beim Erwachsenen : [https://pubmed.ncbi.nlm.nih.gov/33084915/ <nowiki>Diagnostik und Therapie [Anterior cruciate ligament injury in adults : Diagnostics and treatment]</nowiki>]. Orthopade. 2020 Nov;49(11):1013-1028. </ref>. At present, recommended treatment options are surgical [[Anterior Cruciate Ligament (ACL) Reconstruction|reconstruction]], or conservative management, with both these approaches requiring [[Rehabilitation Frameworks|rehabilitation]]<ref name=":6" /> . Research continues to investigate how to optimize ACL rehabilitation, including utilizing hydrotherapy. [[Aquatherapy|Hydrotherapy]] is the delivery of physiotherapy treatment in an aquatic environment, utilizing the properties of water<ref>Aquatic Therapy Association of Chartered Physiotherapists (ATACP). About ATACP. Available from: https://atacp.csp.org.uk/content/about-atacp (Accessed 19/12/2022)</ref>. | ||
==Outcome | ==Outcome Measures of ACL Rehabilitation== | ||
* Instability episodes <ref name=":0">Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM. [https://www.ncbi.nlm.nih.gov/pubmed/15716249 Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee]. The American journal of sports medicine. 2005 Mar;33(3):335-46.</ref> | * Instability episodes <ref name=":0">Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM. [https://www.ncbi.nlm.nih.gov/pubmed/15716249 Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee]. The American journal of sports medicine. 2005 Mar;33(3):335-46.</ref> | ||
* Pain <ref name=":0" /> | * [[Pain Assessment|Pain]] <ref name=":0" /> | ||
* Issues with: | * Issues with: | ||
** Swelling, walking, climbing, stairs, kneeling, squatting, running, lateral motion, cutting, jumping <ref name=":0" /> | ** [[Oedema Assessment|Swelling]], [[Gait|walking]], climbing, stairs, kneeling, squatting, running, lateral motion, cutting, jumping <ref name=":0" /> | ||
* Measures of knee function: | * Measures of knee function: | ||
** Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) <ref name=":0" /><ref name=":1">Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. [https://www.nejm.org/doi/full/10.1056/NEJMoa0907797 A randomized trial of treatment for acute anterior cruciate ligament tears]. New England Journal of Medicine. 2010 Jul 22;363(4):331-42.</ref> | ** Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) <ref name=":0" /><ref name=":1">Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. [https://www.nejm.org/doi/full/10.1056/NEJMoa0907797 A randomized trial of treatment for acute anterior cruciate ligament tears]. New England Journal of Medicine. 2010 Jul 22;363(4):331-42.</ref> | ||
** International Knee Documentation Committee (IKDC) form, Lysholm and Tegner scores<ref name=":0" /> | ** International Knee Documentation Committee (IKDC) form, Lysholm and Tegner scores<ref name=":0" /> | ||
** Knee Injury and Osteoarthritis Outcome Score (KOOS<sub>4</sub>) <ref name=":1" /> | ** [[Knee Injury and Osteoarthritis Outcome Score|Knee Injury and Osteoarthritis Outcome Score (KOOS<sub>4</sub>)]] <ref name=":1" /> | ||
* Graft rupture (post-ACLR only) <ref name=":2">Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. [https://www.ncbi.nlm.nih.gov/pubmed/16084292 Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction]. Arthroscopy. 2005 Aug 1;21(8):948-57.</ref> | * Graft rupture (post-ACLR only) <ref name=":2">Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. [https://www.ncbi.nlm.nih.gov/pubmed/16084292 Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction]. Arthroscopy. 2005 Aug 1;21(8):948-57.</ref> | ||
* Contralateral ACL injury <ref name=":2" /> | * Contralateral ACL injury <ref name=":2" /> | ||
* Lachman and pivot-shift <ref>Kostogiannis I, Ageberg E, Neuman P, Dahlberg LE, Fridén T, Roos H. [https://www.ncbi.nlm.nih.gov/pubmed/18544668 Clinically assessed knee joint laxity as a predictor for reconstruction after an anterior cruciate ligament injury: a prospective study of 100 patients treated with activity modification and rehabilitation]. The American journal of sports medicine. 2008 Aug;36(8):1528-33.</ref> | * Lachman and pivot-shift <ref>Kostogiannis I, Ageberg E, Neuman P, Dahlberg LE, Fridén T, Roos H. [https://www.ncbi.nlm.nih.gov/pubmed/18544668 Clinically assessed knee joint laxity as a predictor for reconstruction after an anterior cruciate ligament injury: a prospective study of 100 patients treated with activity modification and rehabilitation]. The American journal of sports medicine. 2008 Aug;36(8):1528-33.</ref> | ||
* Passive range of motion (knee flexion & extension), muscle strength, thigh circumference (thigh girth, thigh muscle mass, knee joint swelling) <ref name=":3">Zamarioli A, Pezolato A, Mieli E, Shimano A. [https://content.sciendo.com/view/journals/physio/16/2/article-p3.xml The significance of water rehabilitation in patients with anterior cruciate ligament reconstruction]. Physiotherapy. 2008 Apr 1;16(2):3-6.</ref><ref>Tovin BJ, Wolf SL, Greenfield BH, Crouse J, Woodfin BA. [https://www.ncbi.nlm.nih.gov/pubmed/8047560 Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions]. Physical Therapy. 1994 Aug 1;74(8):710-9.</ref> | * [[Passive Knee Extension Test|Passive range of motion]] (knee [[Flexion Deformity of the Knee|flexion]] & [[Knee Extension Resistance Test|extension]]), muscle strength, thigh circumference (thigh girth, thigh muscle mass, knee joint swelling) <ref name=":3">Zamarioli A, Pezolato A, Mieli E, Shimano A. [https://content.sciendo.com/view/journals/physio/16/2/article-p3.xml The significance of water rehabilitation in patients with anterior cruciate ligament reconstruction]. Physiotherapy. 2008 Apr 1;16(2):3-6.</ref><ref>Tovin BJ, Wolf SL, Greenfield BH, Crouse J, Woodfin BA. [https://www.ncbi.nlm.nih.gov/pubmed/8047560 Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions]. Physical Therapy. 1994 Aug 1;74(8):710-9.</ref> | ||
* Active range of motion (knee flexion & extension) <ref name=":5" /> | * Active range of motion (knee flexion & extension) <ref name=":5" /> | ||
* 6 minute walk test (6MWT) <ref name=":5" /> | * [[Six Minute Walk Test / 6 Minute Walk Test|6 minute walk test (6MWT)]] <ref name=":5" /> | ||
==Advantages of Hydrotherapy in ACL/R Rehabilitation== | ==Advantages of Hydrotherapy in ACL/R Rehabilitation== | ||
Revision as of 15:56, 19 December 2022
Original Editor - Falcone Tseng
Top Contributors - Falcone Tseng, Chloe Waller, Kim Jackson and Wanda van Niekerk
Introduction[edit | edit source]
Anterior Cruciate Ligament (ACL) injuries are a common orthopedic condition, especially among athletes and young people, which can have long term physical and lifestyle impacts[1]. For example, post traumatic arthritis, meniscus or cartilage injuries, knee instability, as well as impaired quality of life and not returning to sport[2][3]. At present, recommended treatment options are surgical reconstruction, or conservative management, with both these approaches requiring rehabilitation[2] . Research continues to investigate how to optimize ACL rehabilitation, including utilizing hydrotherapy. Hydrotherapy is the delivery of physiotherapy treatment in an aquatic environment, utilizing the properties of water[4].
Outcome Measures of ACL Rehabilitation[edit | edit source]
- Instability episodes [5]
- Pain [5]
- Issues with:
- Measures of knee function:
- Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) [5][6]
- International Knee Documentation Committee (IKDC) form, Lysholm and Tegner scores[5]
- Knee Injury and Osteoarthritis Outcome Score (KOOS4) [6]
- Graft rupture (post-ACLR only) [7]
- Contralateral ACL injury [7]
- Lachman and pivot-shift [8]
- Passive range of motion (knee flexion & extension), muscle strength, thigh circumference (thigh girth, thigh muscle mass, knee joint swelling) [9][10]
- Active range of motion (knee flexion & extension) [11]
- 6 minute walk test (6MWT) [11]
Advantages of Hydrotherapy in ACL/R Rehabilitation[edit | edit source]
In principle:
- Early weightbearing [11]
- Postural and gait exercises in a supported environment [12]
- Water resistance induced muscular conditioning [12]
Outcomes of Hydrotherapy + Conventional Rehabilitation vs. Conventional Rehabilitation Only:
After 2 weeks post-ACLR, patients who underwent 3 weeks of combined hydrotherapy with conventional rehabilitation, had superior outcomes in proprioception, walking, muscle strength in the short and medium term, compared to participants exclusively in conventional rehabilitation programme [13]. Another trial found that ACLR patients placed through 9 weeks of aquatic rehabilitation immediately post-surgery had better clinical parameters in muscle strength and mass circumference, pain, swelling, and range of motion compared to those on land rehabilitation [9].
A smaller case study of 3 subjects demonstrated no risk of harm in utilizing hydrotherapy to accelerate rehabilitation of ACLR [11].
Considerations for ACL hydrotherapy rehabilitation design:
| Accelerated Hydrotherapy Programme [11] | |
|---|---|
| Goal: | Treatment: |
| Gait Retraining | Gait training |
| Quadriceps and hamstring strengthening | Closed kinetic chain exercises, Open kinematic chain exercises |
| Strengthening & endurance training | Running, Cycling, Deep-water running techniques |
| Hip and calf maintenance and strengthening | Hip exercises and calf raises, kicking and vertical kicking |
| Balance and proprioception (perturbation protocol) | Balance and proprioception exercises |
| Plyometric training | Jumping, running, shuttle runs, side steps with increased speed |
| Sports-specific rehabilitation | Agility exercises making use of a ball |
Video Examples of Hydrotherapy Protocols & Case Studies:[edit | edit source]
ACL Hydrotherapy Rehabilitation Progression Timeline, Principles, & Advantages - Hydroworx
Acute Partial ACL & PCL Injury in Male Recreational Basketball Player (conservative management) - Hydroworx
ACL-R Patellar Autograft (5.5 weeks post-op with regression) - Hydroworx
ACL-R in Female Soccer Goalie (4 weeks post-op with delayed rehabilitation) - Hydroworx
Unhappy Triad in Female Volleyball Player (8 weeks post-op) - Hydroworx
Gait Retraining and Lower Limb Mobility Exercises - Sports Med Mumbai
References:[edit | edit source]
- ↑ Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R. Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture. Dtsch Arztebl Int. 2018 Dec 24;115(51-52):855-862.
- ↑ 2.0 2.1 Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):33-47.
- ↑ Kohn L, Rembeck E, Rauch A. Verletzung des vorderen Kreuzbandes beim Erwachsenen : Diagnostik und Therapie [Anterior cruciate ligament injury in adults : Diagnostics and treatment]. Orthopade. 2020 Nov;49(11):1013-1028.
- ↑ Aquatic Therapy Association of Chartered Physiotherapists (ATACP). About ATACP. Available from: https://atacp.csp.org.uk/content/about-atacp (Accessed 19/12/2022)
- ↑ 5.0 5.1 5.2 5.3 5.4 Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. The American journal of sports medicine. 2005 Mar;33(3):335-46.
- ↑ 6.0 6.1 Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. New England Journal of Medicine. 2010 Jul 22;363(4):331-42.
- ↑ 7.0 7.1 Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy. 2005 Aug 1;21(8):948-57.
- ↑ Kostogiannis I, Ageberg E, Neuman P, Dahlberg LE, Fridén T, Roos H. Clinically assessed knee joint laxity as a predictor for reconstruction after an anterior cruciate ligament injury: a prospective study of 100 patients treated with activity modification and rehabilitation. The American journal of sports medicine. 2008 Aug;36(8):1528-33.
- ↑ 9.0 9.1 Zamarioli A, Pezolato A, Mieli E, Shimano A. The significance of water rehabilitation in patients with anterior cruciate ligament reconstruction. Physiotherapy. 2008 Apr 1;16(2):3-6.
- ↑ Tovin BJ, Wolf SL, Greenfield BH, Crouse J, Woodfin BA. Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Physical Therapy. 1994 Aug 1;74(8):710-9.
- ↑ 11.0 11.1 11.2 11.3 11.4 Momberg BL, Louw Q, Crous L. Accelerated hydrotherapy and land-based rehabilitation in soccer players after anterior cruciate ligament reconstruction: a series of three single subject case studies. South African Journal of Sports Medicine. 2008 Dec 1;20(4):109-14.
- ↑ 12.0 12.1 Torres-Ronda L, i del Alcázar XS. The properties of water and their applications for training. Journal of human kinetics. 2014 Dec 1;44(1):237-48.
- ↑ Peultier-Celli L, Mainard D, Wein F, Paris N, Boisseau P, Ferry A, Gueguen R, Chary-Valckenaere I, Paysant J, Perrin P. Comparison of an innovative rehabilitation, combining reduced conventional rehabilitation with balneotherapy, and a conventional rehabilitation after anterior cruciate ligament reconstruction in athletes. Frontiers in surgery. 2017;4:61.
