endobj The failure Anterior cruciate ligament (ACL) primary repairs You ski fast. 12 0 obj 18 0 obj When a CPM machine is prescribed for use at home, it may or may not be covered by health insurance. For example, if you had an ACL reconstruction or meniscus repair, your running restriction will be different than if you had torn cartilage removed. Research is ongoing. Passive and active range of motion between 30 - 70 degrees for 4 weeks. Goals WebACL reconstruction rehab protocol Progression should be based on careful monitoring by the Physical Therapist of the patient's functional status. Apply gentle scar tissue mobilization; can use instruments/tools for scar mobilization towards week 6. Deep venous thrombosis (DVT) is another risk after knee surgery. V4qh%MTO](>#Yq(!@}du)^>>#tY`lOx2|mQc[ZyH0+A.s [P,"ZFMKQ'B#I` j^tbs^{'GnhUT*W S^o}cyDQ! Please note these are meant to be guidelines for rehabilitation to be followed by a WZX.'9fxIg d2,B)EabSGUTy,Y =G8 The ACL arises from the posteromedial corner of the medial aspect of the lateral femoral condyle in the intercondylar notch and inserted anterior to the intercondyloid eminence of the tibia, blending with the anterior horn of the medial meniscus. Is Physical Therapy Covered By Insurance? Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. WebPractice Overview. WebBenedict Nwachukwu, MD, MBA is an orthopedic shoulder, knee and hip specialist at Hospital for Special Surgery (HSS), nationally ranked as the best in orthopedics for 10 years by U.S. News & World Report.His academic credentials include undergrad at Columbia University, Harvard Medical School, Harvard Business School, residency at HSS, and Terminal knee extension, supine. Webimpingement. endobj The American Physical Therapy Association recommends against using CPM after uncomplicated total knee arthroplasty unless the person is unable to participate in active physical therapy and early mobilization. Goals Well-leg cycling, well body weight training, Goals. WebContact Rehab Services. If you have knee pain inside your knee, most Bay Area researchers have developed a new ACL Repair vs. Reconstruction: Heres the Latest, Why are ACL Injuries on the Rise in the NFL? Patient Gateway Please call 302-831-8893 to schedule an appointment.. WebIncrease ankle and lower limb muscle strength Immobilisation. Early emphasis on achieving full extension equal to the opposite side (including hyperextension within normal range, 10*). Scapular training: rows, protraction, lower trapezium work. We are open convenient hours for appointments Monday through Friday 7:30 am to 6:30 pm. Well-leg cycling, well body weight training, Goals. Exercises. WebPenn orthopaedic shoulder surgeons are experts in performing bone-grafting procedures, as well as muscle and ligament reconstruction or repair. Thank you, {{form.email}}, for signing up. These include a 2014 Cochrane review of 62 studies.. What to expect when undergoing this therapy. Empowering Workers. A motorized device gently bends the joint back and forth to a set number of degrees, and the amount of movement and speed can be adjusted by the physical therapist. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures. Aetna. Repeat the sciatic nerve glide 10 times. <> WebSoft tissue mobilization to ankle/foot/effleurage for edema. Toe curls, toe extension, toe spreads, hip and knee strengthening exercises. WebRehab Protocols To serve as a guide to physical therapy following your surgery, this section contains rehabilitation protocols specific to your procedure. Get information on latest national and international events & more. Dedham, MA . Clear signs designate these spaces. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving pre-injury level of activity. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. Patients will be in a hinged knee brace for 4 weeks post-op locked in full extension. 4 0 obj Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension. 40 Allied Drive. @vB(V$@omsEZ%mT~a}XIXUf?N#$1oYu?}_4ppT|PcP7*qjxoi@X-(4^~>wAXk,RjV6 `uU?cQ!i ,0o[3V Passive range of motion at 70 degrees in flexion, scaption, and abduction. 3727 Buchanan St #300 Patients are given a functional assessment/sport test at 3 months, 6 months, 1 year. Icing and elevation as per icing protocol (please see handout for full details). Empowering Workers. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving pre-injury level of activity. Five things physical therapists and patients should question. CPM may help reduce the risk of DVT after knee surgery, although the evidence is not definitve. Experience. Use of the CPM machine may be continuous while you are in the hospital, other than at times when you are receiving other physical therapy or are getting out of bed to use the restroom. What is #hip #labrum reconstruction? WebHours We are open convenient hours for appointments Monday through Friday 7:30 am to 6:30 pm. The Memphis Industrial Rehabilitation Center is proud to offer a full array of services for both the injured and uninjured worker. It comes with a talus WebPenn orthopaedic shoulder surgeons are experts in performing bone-grafting procedures, as well as muscle and ligament reconstruction or repair. General Considerations DO NOT elevate surgical arm above 70 degrees in any plane for the first 4 weeks post-op (active/passive range of motion). <>/F 4/A<>/StructParent 4>> WebProtocol: Modified Brostrm-Gould Repair for Chronic Lateral Ankle Instability ICD 10 Codes: M25.37: Other instability, ankle and foot S93.4: Sprain of ankle S93.41: Sprain of calcaneofibular ligament S93.49: Sprain of other ligament of ankle The intent of this protocol is to provide the clinician with a guideline of the post-operative <>/F 4/A<>/StructParent 3>> 13 surgeons across 18 Melbourne locations highly trained in the diagnosis, treatment and management of all musculoskeletal conditions and injuries. <>/Metadata 939 0 R/ViewerPreferences 940 0 R>> Which to Choose? Exercises. Initiate active and light manual resistance exercises: mid-range external/internal rotation (without shoulder elevation; DO NOT go into end-range of motion. ?c^3 ('@")DsOrBN^`9r8'?sxMn \'N9 4sLHHMmoaLu":C'- K/nlk0BX hX[5H?|e &hcp F45mrl&/[@C95. |5,b|z'=Z8Yt6 kf+ FDa)JYinf?H-[ !AtS+1emB17uLfkSbW1y1DWi>N"a^I\9y~[Vu 5>?1KR=v~rBrgJ0BO'Y?|qlo^h-7[g03[PIgX?,!#sC. 7X;j U0,sGyTwZ>;xV6}^KnbH7X` 19 0 obj To return arm strength to near normal levels, surgery to repair the torn tendon is usually recommended. For example, if you had an ACL reconstruction or meniscus repair, your running restriction will be different than if you had torn cartilage removed. Brace will set to this range of motion. Is Your Calf Muscle Pain Just a Strain or Something Else? endobj Continuous passive motion (CPM) is a therapy in which a machine is used to move a joint without the patient having to exert any effort. [ 12 0 R] 2% Begin to incorporate sport or activity specific training. Web2 Progress exercise on leg press/hack squat as tolerated with emphasis on high reps, low resistance in range of 0 to 90 degrees Increase ROM for bilateral partial squats from 30 to 45 degrees of knee flexion Emphasize high repetition and low resistance weights Balance activities Isometric and isotonic training for hamstrings Months 3 to 6 This page will discuss ankle and foot fractures and the role that physiotherapists play in the rehabilitation of such injuries. WebSoft tissue mobilization to ankle/foot/effleurage for edema. Phone: 617-983-7271 Brigham and Women's Faulkner Hospital Rehabilitation Services 1153 Centre Street, 2nd Floor Boston, MA 02130. No active knee flexion X 4 No active knee flexion X 4 Continue to increase the intensity of exercises (i.e. WebThe anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia. WebIncrease ankle and lower limb muscle strength Immobilisation. <> Starting at week 2- begin light resistance pain-free strengthening for triceps and biceps training with theraband in neutral. ye]Q)z,lkT}:{e5j\h\CG:+`r=/R2UaWlU0.LcYsf;?6RVSxc? 13 surgeons across 18 Melbourne locations highly trained in the diagnosis, treatment and management of all musculoskeletal conditions and injuries. Depending on the joint, it may be used for most of the day or for just an hour at a time. NOTE:All progressions are approximations and should be used as a guideline only. Incorporate progressive and gentle functional exercises (squats/knee bends, modified lunges, step-ups). 2% Once your knee is fully straightened, flex and extend your ankle about 5 times, and then return to the starting position. WebRehab Protocols To serve as a guide to physical therapy following your surgery, this section contains rehabilitation protocols specific to your procedure. Follow Dr. Anseth on Twitter . To return arm strength to near normal levels, surgery to repair the torn tendon is usually recommended. They are most often caused by a sudden injury and tend to result in significant arm weakness. The exercise can be performed several times to help improve the way your sciatic nerve moves and glides in your low back and leg. This protocol is not intended to mandate the course of patient care. Exercises. Tel: (781) 251-3535 Fax: (781) 251-3532 The ACL arises from the posteromedial corner of the medial aspect of the lateral femoral condyle in the intercondylar notch and inserted anterior to the intercondyloid eminence of the tibia, blending with the anterior horn of the medial meniscus. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles Get information on latest national and international events & more. It may also be used after surgery to remove knee tumors in children with osteosarcoma. WebContinued pain in your foot and ankle; Your own risks may vary according to your age, the shape of your foot and leg muscles and tendons, your general health, and the type of surgery done. 2017;103(3):266-275. doi:10.1016/j.physio.2016.04.003. If you are ever uncertain or experience pain, speak with your healthcare team. <>/F 4/A<>/StructParent 1>> Patients will be in a hinged knee brace for 4 weeks post-op locked in full extension. Please call 302-831-8893 to schedule an appointment.. endobj WebContinuous Flow Centrifuge Market Size, Share, 2022 Movements By Key Findings, Covid-19 Impact Analysis, Progression Status, Revenue Expectation To 2028 Research Report - 1 min ago Continue with effleurage, soft tissue treatments, patellar glides, and passive range of motion. Parking They are most often caused by a sudden injury and tend to result in significant arm weakness. Weeks 1-2: (Follow-up at 1 week and 2 weeks after surgery with Dr. Nwachukwu) Brace. WebBenedict Nwachukwu, MD, MBA is an orthopedic shoulder, knee and hip specialist at Hospital for Special Surgery (HSS), nationally ranked as the best in orthopedics for 10 years by U.S. News & World Report.His academic credentials include undergrad at Columbia University, Harvard Medical School, Harvard Business School, residency at HSS, and Parking Patient parking is available in two hour increments. The exercise can be performed several times to help improve the way your sciatic nerve moves and glides in your low back and leg. 4 months: triplanar/sport-specific strengthening at a low intensities: Throwers program. This protocol is time based (dependent on tissue healing) as well as criterion based. WebRehabilitation Protocol for Anterior Cruciate Ligament (ACL) Reconstruction This protocol is intended to guide clinicians through the post-operative course for ACL Reconstruction. Active/passive range of motion : shoulder flexion, scaption and abduction to 90 degrees, external rotation to 70 degrees in neutral, internal rotation full range of motion in neutral. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. Your leg is then secured to the machine with straps. WebGuidelines and Measures provides users a place to find information about AHRQ's legacy guidelines and measures clearinghouses, National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) No active knee flexion X 4 7 0 obj Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Increase intensity of all exercises with focus on closed-chain, functional progression. This will include the number of hours to use it per day and whether the settings should be increased each day. stretch cord resistance, adding weight, increasing resistance of aerobic machines). Designed by Elegant Themes | Powered by WordPress, Go to the UD twitter page (external link)>, Go to the UD facebook page (external link)>, Go to the UD instagram page (external link)>, Go to the UD youtube page (external link)>, Go to the UD pintrest page (external link)>, Go to the UD linkedin page (external link)>, Hand Held Dynamometry for the Ankle Muscles Basic Facts, Medial Patellofemoral Ligament (MPFL) Reconstruction and Proximal, Repair of Rotator Cuff Tears (Uncomplicated), Repair of Rotator Cuff Tears with Retraction, Repair of Large Rotator Cuff Tears without Retraction > 2.5cm, Repair of Large Rotator Cuff Tears with Retraction >2.5 cm, Subacromial Decompression with or without Distal Clavicle Excision, Hand Held Dynamometry for the Shoulder Muscles, AGS 2019 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, Interval Throwing Program for Little League Age Athletes, Modified STAR Excursion Balance Test (SEBT). He teaches as an Assistant Professor of Orthopedics at Emory School of Medicine in Atlanta, Georgia. x\mo8 ^E4>Y[mPoE)ul3<3J.w.^a5s=cQ"X[gg->]C'qx?AOw{#_5a/gv? 7% (268/3741) 5. WebLearn more about the rehab, recovery time, & exercise protocols for AC shoulder joint reconstruction repair surgery. U.S. Centers for Medicare and Medicaid Services. PNF for elbow and wrist flexion/extension. DOWNTOWN LONDON Citi Plaza Goodlife 355 Wellington Street WebMEMPHIS INDUSTRIAL REHABILITATION CENTER. 3727 Buchanan St #300 WebACL reconstruction rehab protocol Progression should be based on careful monitoring by the Physical Therapist of the patient's functional status. 3 0 obj WebDownload Achilles Repair Rehab Protocol. *Avoid any extension beyond 30 degrees for 2 weeks post-op. endobj OK to stretch into flexion per patient comfort 2x/day immediately post-op. Avoid direct palpation to suture line (keep 2 inch no-touch zone around portals x 4 weeks). Technique. The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields.This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of -Stationary and road cycling as tolerated. The ACL arises from the posteromedial corner of the medial aspect of the lateral femoral condyle in the intercondylar notch and inserted anterior to the intercondyloid eminence of the tibia, blending with the anterior horn of the medial meniscus. doi:10.1002/14651858.CD004260.pub3, Liao CD, Huang YC, Chiu YS, Liou TH. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures. Procedures Performed: Acetabuloplasty Labral repair Labral debridement Labral reconstruction The labrum is rebuilt with the goal of restoring the functional anatomy of th twitter.com/i/web/status/1, #ChatGTP not quite ready for prime time in #orthotwitter This protocol is not intended to mandate the course of patient care. Begin two-legged aerobic exercises as range of motion allows (VersaClimber, stair machine, upper body ergometer, NordicTrac). 6 0 obj Exercises. Learn about procedures that can help you return to sports & delay or avoid an artificial knee replacement. Forget working out. Please call 302-831-8893 to schedule an appointment.. vF"3H@RDm/\`X}^ZWU-ag(~tx ;X]NzKs{ WebEffleurage, gentle soft tissue mobilization to ankle avoiding incisions. 2014;(2):CD004260. If, like many of our patients, you don't live in the Bay Area, we offer a complimentaryphone consultation service. Ask what type of mobilization will be done after surgery and when it will begin, and discuss what factors may lead to using CPM rather than active mobilization. One study found that CPM was less effective in people who were obese who had total knee replacements. They had poorer self-reported function after six months than those who were not obese. Progression will be based on individual patient presentation, which is assessed throughout the treatment process. Physiotherapy. WebRead latest breaking news, updates, and headlines. WebIncrease ankle and lower limb muscle strength Immobilisation. <> Soft tissue mobilizations to the incisions to decrease fibrosis and scarring; portals must be completely closed and authorization must be obtained from Dr. Stone (s/p 4 weeks). San Francisco, CA 94123, United States. Manual resisted scapular isometrics performed. WebRehabilitation Protocol for Anterior Cruciate Ligament (ACL) Reconstruction This protocol is intended to guide clinicians through the post-operative course for ACL Reconstruction. The stiffness of a joint can be a complication that limits outcomes and causes pain. NOTE:All progressions are approximations and should be used as a guideline only. For example, Aetna does not cover it following back surgery, foot surgery, hip arthroscopy or replacement, shoulder surgery, lymphedema after breast cancer, temporomandibular joint repair, surgical release of elbow contractures, and some other procedures. Continuous passive motion (CPM) is a therapy in which a machine is used to move a joint without the patient having to exert any effort. Slow Return to sports > 6 months if approved by MD and completion of Sports Test. ^^38?dp)lW^FAS1XEh~ This protocol is time based (dependent on tissue healing) as well as criterion based. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. WebProfessionalism. Toe curls, toe extension, toe spreads, hip and knee strengthening exercises. 14 0 obj Soft tissue treatments, gentle mobilization to posterior musculature and patella. If you are having difficulty viewing any of the documents, please clear your cache and restart your browser. WebMPFL RECONSTRUCTION REHABILITATION** The following is a protocol for postoperative patients following Medial Patellofemoral Ligament Reconstruction. Exercises. Because of this, some surgeons use CPM to try to prevent scar tissue formation and improve range of motion. 2013 Nov;14(4):188-98. doi: 10.1016/j.ptsp.2013.08.001. Brace will set to this range of motion. WebMPFL RECONSTRUCTION REHABILITATION** The following is a protocol for postoperative patients following Medial Patellofemoral Ligament Reconstruction. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Progression will be based on individual patient presentation, which is assessed throughout the treatment process. endobj Well body exercises: squats, lunges, step ups, bridges, stationary biking. Kannus et al. 15 0 obj To return arm strength to near normal levels, surgery to repair the torn tendon is usually recommended. NE Baptist Outpatient Care Center. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 9 0 R 19 0 R 20 0 R 21 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> A range of motion protocol that limits full extension in the early phases of rehab. When surgery is medically indicated, CPM therapy may be covered by your health insurance. One of the benefits of bending your own joint is not only are you making gains in terms of mobility, but you are also engaging muscles around the joint that require strengthening. report an incidence of up to 174 cases per 100 000 persons per year in a Finish population. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving pre-injury level of activity. Fractures of the ankle joint are common amongst adults. DO NOT elevate surgical arm above 70 degrees in any plane for the first 4 weeks post-op (active/passive range of motion). Nurse appt post op day 2 to check dressings. Terminal knee extension, supine. Knee pain in growing kids is common and often ACL Surgery has advanced too slowly. !+fST'6Y/Nx RG(:u>J'`NH?A?nTa`zIG]FH2b{MEjVe4unojl[ endobj It is worth discussing your specific case with your healthcare team to determine if CPM is a good idea for you. Closed incision sites. Talk to your healthcare provider about any concerns you have. <> Integrity. Does Physical Therapy Really Help Arthritis Pain? 2013 Nov;14(4):188-98. doi: 10.1016/j.ptsp.2013.08.001. Swimming (no fins until > 12 weeks), outdoor cycling. The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields.This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of Good scapular strength and stability demonstrated with range of motion. WebMEMPHIS INDUSTRIAL REHABILITATION CENTER. Patient Gateway No portal mobilizations at this time. WebTears of the biceps tendon at the elbow are uncommon. The Memphis Industrial Rehabilitation Center is proud to offer a full array of services for both the injured and uninjured worker. Your physical therapist should inform you about what to expect. WebGeneral Considerations It is important to recognize that all times are approximate and that progression should be based on careful monitoring of the patient's functional status. Toe curls, toe extension, toe spreads, hip and knee strengthening exercises. Early emphasis on achieving full hyperextension equal to the opposite side. Light duty use of the affected arm immediately following immobilization. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles Gait training to normalize walking pattern. Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension. Patient to wear knee brace while sleeping for 4 weeks post-op. WebAdvanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks. Nurse visit at Day 14 for stitch removal. Read our. Tel: (781) 251-3535 Fax: (781) 251-3532 endobj Passive and active range of motion between 30 - 70 degrees for 4 weeks. From pre-hire screenings to fitness programs for the aging workforce we are committed to providing innovative approaches for employers to assist in reducing Progression of program of increasing intensity to sport specific tasks and activities of daily living. Some insurers may cover CPM for some types of surgery (especially knee surgeries) and not for others, in which they consider its use experimental. A range of motion protocol that limits full extension in the early phases of rehab. Webimpingement. Passive and active range of motion between 30 - 70 degrees for 4 weeks. visit at 4 weeks, will discontinue use of post-op brace at that time. He or she can tell you the risks that most apply to you. WebTears of the biceps tendon at the elbow are uncommon. WebContact Rehab Services. Well-leg cycling, weight training, and swimming for cardiovascular. Please call 302-831-8893 to schedule an appointment. <> Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. If there are concerns regarding the patients clinical presentation. endobj Please consult with the referring physician prior to making adjustments to the protocol. Progression will be based on individual patient presentation, which is assessed throughout the treatment process. Strength and stability achieved for sport. 1 0 obj WebA fracture is an interruption of the continuity of bone. kV=f-+Ga)4tQ>Y: Qp|b.lk.O~b]QW@tB1w]y q At regularly scheduled appointments, your physical therapist will measure mobility and range of motion of the joint and track your progress. MD appt at 12 weeks, no overhead lifting. Effect of body mass index on knee function outcomes following continuous passive motion in patients with osteoarthritis after total knee replacement: a retrospective study. {4p0T2uD1v>gAz/}Y/>>g6;~S"8T%VH(iew1q8. 40 Allied Drive. 9 0 obj WebACL reconstruction rehab protocol Progression should be based on careful monitoring by the Physical Therapist of the patient's functional status. Webimpingement. WebCriteria to enter Phase 2 of mid stage rehab 10 -16 weeks Administer Tampa Kinesiophobia Scale upon entrance and exit of phase Administer The ALC-RSI at end of phase No pain and no effusion on a stroke test1 Full knee ROM2 Quadriceps bilateral comparison 75%5 Moderate load OKC and CKC exercises 50 90 degrees, 8 12 The angle and speed used are determined by your doctor and physical therapist. WebHours We are open convenient hours for appointments Monday through Friday 7:30 am to 6:30 pm. American Physical Therapy Association. CPM is most often used in addition to other physical therapy modalities. 5 0 obj General considerations. Continue to increase strength, endurance, balance, and sport specific training drills. Protection of the repaired tendon(s) Pain control, Post-operative weeks 0-2: Touch down weight bearing, Post-operative weeks 3-6: 15% 40% weight bearing progression, Brace: hinged knee brace locked at 45 degrees at all times until week 6, Avoid hip flexion coupled with knee extension, Passive knee range of motion (ROM) with no hip flexion during knee extension, Post-operative weeks 3-4: Begin pool walking drills (without hip flexion coupled with knee extension), hip abduction, hip extension, and balance exercises, Cardiovascular Exercise: Upper body circuit training or upper body ergometer (UBE), Progression Criteria: 6 weeks post-operative, Post-operative weeks 6-7: Unlock hinged knee brace, weight bearing as tolerated with weaning from crutches, Good control and no pain with functional movements, including step up/down, squat, partial lunge (do not exceed 60 of knee flexion), Avoid loading the hip at deep flexion angles, Non-impact balance and proprioceptive drills beginning with double leg and gradually progressing to single leg, Begin hamstring strengthening start by avoidance of lengthened hamstring position (hip flexion combined with knee extension) by working hip extension and knee flexion moments separately; begin with isometric and concentric strengthening with hamstring sets, heel slides, double leg bridge, standing leg extensions, and physioball curls, Cardiovascular Exercise: Upper body circuit training or UBE, Ability to carry out functional movements without unloading the affected leg or pain while demonstrating good control, Single leg balance greater than 15 seconds, Normal (5/5) hamstring strength in prone with the knee in a position of at least 90 knee flexion, Good control and no pain with sport and work specific movements, including impact, Post-activity soreness should resolve within 24 hours, Continue hamstring strengthening progress toward strengthening in lengthened hamstring positions; begin to incorporate eccentric strengthening with single leg forward leans, single leg bridge lowering, prone foot catches, and assisted Nordic curls, Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to the other and then 1 foot to same foot, Movement control exercise beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities, Initiate running drills, but no sprinting until Phase IV, Cardiovascular Exercise: Biking, elliptical machine, Stairmaster, swimming, and deep water running, Dynamic neuromuscular control with multi-plane activities at low to medium velocity without pain or swelling, Less than 25% deficit for side to side hamstring comparison on Biodex testing at 60 and 240 per second, Continue hamstring strengthening progress toward higher velocity strengthening and reaction in lengthened positions, including eccentric strengthening with single leg forward leans with medicine ball, single leg dead lifts with dumbbells, single leg bridge curls on physioball, resisted running foot catches, and Nordic curls, Running and sprinting mechanics and drills, Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to other and then 1 foot to same foot, Sport/work specific balance and proprioceptive drills, Stretching for patient specific muscle imbalances, Cardiovascular Exercise: Replicate sport or work specific energy demands, Dynamic neuromuscular control with multi-plane activities at high velocity without pain or swelling, Less than 10% deficit for side to side hamstring comparison on Biodex testing at 60 and 240 per second, Less than 10% deficit on functional testing profile. 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