WWW.SPORTEX.NET Figure 3: Single hop test

without turning backward and measure the time taken to perform the test.

3. Side hop test (Fig.2) The player is asked to hop transversely more than 30 cm for 10 repetitions as quickly as possible and the time taken to perform the test is measured. 4. Single hop test (Fig.3) The player is required to hop forward as far as they can and the distance covered is measured.

Rehabilitation schedule Range of movement (ROM) exercises These can be performed in various starting positions as the injury progresses from its acute stages: ● Long sitting with heel resting on a slippery re-education board (formica surface). A sheepskin pad can be placed under the heel to reduce friction even more. Knee flexion can be assisted further by placing a band around the foot, pulling on the band during knee flexion

● Lying on back with feet up in the air, legs and bottom against a wall. Bend the knee, sliding the heel down the wall

● Sitting on a stool, with foot resting on the floor. Knee flexion is assisted with a low friction floor surface and a sock on the foot

● Long sitting with thumb and index finger either side of the patella. Move the patella, lateral to medial allowing the patel- la to return to its natural position. This ensures mobilisation of the lateral structures of the patella, which often restrict glide of the patella

● Long sitting with thumb and index finger either end of the patella. Move the patella, inferiorly allowing the patella to return to its natural position. This will maintain/correct patel- la orientation and in conjunction with vastus medialis oblique (VMO) exercises improves the timing and force of the muscular effect on the patella

● Continuous passive motion (CPM) using a CPM or isokinetic unit may be useful in certain cases.

Strengthening exercises Emphasis during knee rehabilitation must focus on strengthening the controlling musculature throughout a range of motion that does not damage the already compromised joint. Some of the most common exercises used in rehabilitation schedules for meniscal surgery are listed below and are discussed individually.

Figure 4: Quadriceps strengthening exercise

Hamstring strengthening exercises Some overflow to produce muscle activity in the hamstring muscle group, in what are considered to be primarily quadriceps strengthening exercises, has been noted in various research papers (1,2). Isolated and co-contraction hamstring work should be encouraged as the athlete progresses through the moderate and minimal protection phases (Phase 2 and 3) of rehabilitation in the post surgical menisectomy patient. However, following meniscal repair, open kinetic chain (OKC) knee flexion in prone lying should be avoided in the maximum protection phase (Phase 1) due to semi-membranosis and popliteus attachments to medial and lateral menisci respectively Core stability exercises Isometric, concentric and eccentric contraction of the musculature around the abdomen, pelvis and hip joint are introduced via func- tional exercises. These exercises will have an overflow effect onto distal joint segments such as the knee joint. Balance and proprio- ceptive elements can also be incorporated into these exercise drills. This increase in workload is assisted with the use of various pieces of inexpensive and simple equipment, such as a Swiss Ball, medi- cine ball, rocker board and bungee cords of various resistances.

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Quadriceps strengthening exercises 1. Quadriceps isometric exercises in prone lying, sitting and then progressing to the supine position are commenced immediately in the post-operative athlete. In the prehabilitation of an injured athlete these exercises may be too easy unless the individual has marked quadriceps wasting. From research this exercise produces most muscle activity in vastus medialis, biceps femoris and glu- teus medius (1). 2. Normally, the post-surgical patient will then progress to straight leg raises, initially using the weight of the limb and then a weighted boot or sandbag for resistance. It should however be recognised by the therapist that this exercise produces elec- tromyographic (EMG) values for rectus femoris as well as the vasti muscle group (2). 3. As the pain in the joint reduces, more progressive quadriceps exercises can be introduced. Leg extension applies resistance to the distal end of the tibia. In Figure 4, changing the length of the lever arm on the shin can alter the torque on the quadriceps. This exercise provides stimuli to both rectus and vasti groups of the quadriceps with variations of increased muscle activity through- out the changing angle of knee extension (2).