ACL REHABILITATION

same level or even regressed with modification to allow adequate motor skill acquisition and retention. Assessment of whether pro- gression of a functional skill is appropriate should be made using motor control principles and requires good observational skills.

CONCLUSION Exercise selection for ACL rehabilitation based on biomechanical rationale is now fairly well established. Progression based on motor control principles is sometimes less rigorously planned. Pressure to add more complicated skills-based or functional exercises into a programme can happen when signs of frustration or lack of adher- ence appear in patients. This often happens as a result of being unable to complete a skill task successfully and if this is not recog- nised, inappropriate progression is inadvertently applied before a patient is ready. In these cases, the more successful strategy is to vary the task to facilitate learning whilst ensuring that the diffi- culty level remains the same. Evaluation based protocols help ensure that progression is controlled for each individual but rely on good observational assessment skills in assessing good form during tasks.

Whilst surgical techniques for ACL reconstruction continue to develop, the basic rationale of rehabilitation remains fairly constant. Modifications will naturally occur as the more advanced surgery allows earlier pressure on the reconstructed knee. However, little is yet known on the effects of these different techniques on motor control as opposed to the mechanical integrity of the knee. As it is often the ability to regain pre-injury skill level that governs whether return to competitive sport is possible, this may well become the overriding factor which limits the speed of recovery. At present, accepted International Knee Documentation Committee guidelines use predominantly mechanical (knee laxity) or perfor- mance (hop distance) measures and it will be interesting to note longer term recurrence rates or reduction in competitive level in the future as the initial return to sport times decrease.

THE AUTHOR

Nicola Phillips PhD, MSc, MCSP is a chartered physiotherapist, direc- tor of Postgraduate Healthcare Studies at Cardiff University and course leader of the MSc in Sports Physiotherapy. Nicola completed her PhD in Cardiff University on the challenges of functional coping in ACL deficiency. She also works as a part time clinician at the Vale

www.sportex.net

Sports Injury Clinic, Glamorgan. Her main area of experience is in the field of sports injury management, with a specific interest in sports rehabilitation. Sports experience includes working with the Welsh and British Weightlifting teams, professional rugby union, 2 Olympic Games Holding Camps, 2 Olympic Games and 6 Commonwealth Games. Clinical interest within this field is in functional rehabilitation of knee and shoulder injuries.

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