Speaker: Know limitations of rehab after sports injuries

KOLOA, Hawaii – The efficacy of rehabilitation following sports injuries varies and the literature shows that it is more effective for some conditions than others, said a presenter at Orthopedics Today Hawaii 2018, here.

“The bottom line of rehabilitation is to know the limitations,” John D. Kelly IV, MD, said.

John D. Kelly

For overuse injuries with the absence of trauma, recent onset of symptoms and lower grade disability, Kelly said the literature shows there is a role for rehabilitation.

He said patients may be candidates for rehabilitation for ACL tears if there is no other ligament meniscal damage; unilateral ACL injury; one timed hop test score of 80% or more of the uninjured limb; a KOOS Activities of Daily Living Scale score of 80% or more; a global rating of knee function of 60% or more; and no more than one episode of giving way.

Kelly said there are no hard data in the literature to support rehabilitation for patella instability. However, brief immobilization may help; taping can activate vastus medialis oblique (VMO) muscle; gluteus medius therapy improves alignment; and closed chain is better than open chain for VMO.

Rehabilitation for patella tendonitis eccentric strength training results in a 50% to 70% increase in knee function. Kelly said it is recommended to start for patients with degenerative meniscal tears on a reasonable course of rehabilitation, especially patients with mild to moderate osteoarthritis. However, one should be prepared to switch over. Additionally, the literature shows rehabilitation for shoulder instability is better for patients with atraumatic posterior instability, a paucity of bone loss, lower demand and patients older than 25 years, he said. For spondylolysis spondylolisthesis, bracing has been not helpful; however, core exercises may help.

For lateral epicondylitis, Kelly said there is insufficient evidence to show a benefit for rehabilitation. Likewise, the literature has shown no clinically important difference between operative and nonoperative treatment for Achilles tendon ruptures. However, ankle instability rehabilitation may help patients with the recurrence of giving-way episodes. – by Kristine Houck, MA, ELS

Reference:

Kelly JD. Sports injuries and rehab: Techniques that work. Presented at: Orthopedics Today Hawaii 2018; Jan. 7-11, 2018; Koloa, Hawaii.

Disclosure: Kelly has no relevant financial disclosures.