Dr. Satish

LATE FUNCTIONAL PHASE  

The late functional phase is characterized by a full range of motion, no effusion, and improved muscle strength and flexibility.Advanced closed chain exercises are added at this stage. The pro fitter continues Proprioceptive and balances training. 

Stair master and versa climber are utilized to build muscular strength and endurance as well as aerobic conditioning.Quadriceps and hip musculature stretching are added as increased emphasis being placed on flexibility at this stage. 

Isokinetic exercises include the progression to velocity spectrum training(60 to 400 degrees/sec), depending on the needs of the individual patient.Running is initiated when quadriceps strength approaches 80 percent. 

At first, an underwater treadmill system is used since the buoyancy of the water decreases the amount of force is significantly less during retro running versus forward running. Retro running has also been found to increase quadriceps strength at slow Isokinetic speeds. when running forward the patient is encouraged to maintain a controlled sprint rather than a jog. 

By staying on the ball of the foot, vertical or compressive loading is decreased.Before allowing the patient to return to sports activity, the therapist needs to do more than achieve normal range of motion and muscle strength. 

The components of the patient’s sport or activity should be incorporated into the rehabilitation program as well. For example, basketball players need to jump and land. Therefore jumping activities should be included in their program.

More importantly, they should be taught how to land to protect their knees.

Golfers rely on a great deal of tibial rotation throughout the swing, their program, therefore, should include an assessment of their swing and a modification made if necessary. Agility drills in the form of figure eights, carioca, and cutting manoeuvres are included here as they replicate components of most team and racquet sports. 

Prior to discharge from rehabilitation and the full return to sports activity, a series of tests must be satisfactory: 

1. Full range of motion.
2. Flexibility acceptable for the needs of the activity. 
3. Total work within 10 percent of the non-involved extremity as muscle strength is measured isokinetically.
4. Muscular endurance within 10 percent of the non-involved extremity as measured by the number of leg press repetitions using one-half the patient’s body weight. 
5. Functional power as measured by standing broad jump. 
6. Proprioception power as measured on BAPS board. Apprehension (lack of) with sport specific activities.