On this week’s episode of the podcast, I welcome Dr. Evangelos Pappas back onto the show to discuss current research on ACL rehabilitation. Dr. Pappas is a Senior Lecturer within the Discipline of Physiotherapy with expertise in sports medicine and musculoskeletal physiotherapy at the University of Sydney. He has published extensively in journals in sports medicine, musculoskeletal physiotherapy and biomechanics and he has presented his work in more than 50 national and international conferences. Dr. Pappas research passion is to develop programs that effectively prevent lower extremity injuries and identify rehabilitation techniques that provide optimal outcomes for injured athletes.
In this episode, we discuss:
-Biomechanical deficits that predispose athletes to ACL injury
-Treatment interventions and screening assessments for return to sport that reduce the likelihood of re-injury
-Training programs on ACL injury prevention
-Wearable technology’s impact on future ACL injury statistics
-And so much more!
Dr. Pappas is critical of physical therapy interventions that do not address deficits that could predispose the athlete to re-injury. He stresses, “Even though it is relatively easy to rehabilitate somebody after an ACL reconstruction in terms of regaining strength, range of motion, and even some proprioception, and even getting them ready for sports, I would strongly argue we are providing a disservice to this patient if we don't take it a step further and try to identify the biomechanical deficits that would potentially predispose them to an ACL tear and try and rectify those…”
ACL injuries not only affect the athlete at the time of injury and throughout rehabilitation but also may lead to lasting adverse health effects. Dr. Pappas states, “You have an athlete with an ACL tear at age 16 who develops osteoarthritis because that commonly happens within the next 10-15 years… They’re supposed to be in their most productive years and there are not many good choices because they are too young for a total knee replacement and their knee related quality of life is similar to someone who is 70 or 80 years old. We are very passionate about preventing those injuries because once they happen there are things we can do to prevent it from getting worse or getting another injury but just the fact that it happens it can really be a life defining event.“
The FIFA 11 + is a successful injury prevention program because it is incorporates an easy-to-follow dynamic warm-up into the daily practices of athletes. “The athlete does a 10 minute warm-up, they will have to do it either way. They have a choice of doing something that is ineffective like static stretching or they have the choice of doing something that is probably a little bit more fun and also effective… The same exercises that prevent the injuries are also good at making athletes run faster or jump higher and have a competitive advantage over their opponents.”
New research has found that athletes who have deficits in the single hop test still present a year post ACL reconstruction have a higher likelihood of re-injury. Dr. Pappas cautions, “Almost nobody should be returning to sport before 9 months after an ACL reconstruction. The knee will feel okay, especially if they had some allograft with no other side morbidity, but it's the job of the PT to discourage and convince the athlete to not return to sport earlier than 9 months after the ACL reconstruction.”
For more on Dr. Pappas:
Professor Evangelos Pappas trained as a physiotherapist in Thessaloniki, Greece before pursuing a Masters in Orthopaedic Physical Therapy at Quinnipiac University and a PhD in Orthopaedic Biomechanics at New York University in the USA. Prior to coming to the University of Sydney, He taught for 11 years at Long Island University-Brooklyn Campus in kinesiology, clinical decision making and musculoskeletal pathology and physiotherapy. His excellence in teaching was recognized by his nomination for the Newton award for excellence in teaching. A/Professor Pappas joined the University of Sydney as a Senior Lecturer in 2013 where he continues to lecture in the areas of musculoskeletal physiotherapy, and particularly as it relates to the upper and lower extremities.
Professor Pappas is also active in musculoskeletal research. His research has been funded by the National Institutes of Health and intramural grants. He has presented his work in more than 50 national and international conferences and he has been interviewed on the radio as an expert on knee injuries. His publications appear in top journals in the fields of physiotherapy, sports medicine and biomechanics. One of his publications received the T. David Sisk award for best review paper from Sports Health; a leading multidisciplinary journal in sports medicine. In addition, A/Professor Pappas has served on the research subcommittee of the awards committee of the American Physical Therapy Association.
Resources discussed in this show:
Kyritsis, Polyvios, et al. "Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture." British journal of sports medicine (2016): bjsports-2015. Link: http://bjsm.bmj.com/content/early/2016/05/23/bjsports-2015-095908.abstract
Myer, G. D., Martin, L., Ford, K. R., Paterno, M. V., Schmitt, L. C., Heidt, R. S., ... & Hewett, T. E. (2012). No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction evidence for objective return-to-sport criteria. The American journal of sports medicine, 40(10), 2256-2263. Pubmed link: http://www.ncbi.nlm.nih.gov/pubmed/22879403
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