REHABILITATION BELOW KNEE

REHABILITATION OF THE BELOW- KNEE INJURY

AND THE THREE- DIMENSIONAL PHYSIOTHERAPIST

BY DAVID FEVRE, MSC MCSP SRP

INTRODUCTION Looking through the various channels on my TV, I am wondering how long it will be before a reality TV show films celebrities training to be chartered physiotherapists. I can just imagine Gordon Ramsay getting irate with a patient who refuses to cooperate or letting rip with a professional sportsperson who has been injured in a big game. I actually think somebody like Ramsay would be refreshing for the profession. The guy is so dynamic and full of energy that you cannot fail to admire his enthusiasm. He also thinks on his feet. These are qualities that, in my view, are imperative to becoming a top physiotherapist. Ramsay’s approach to his work is what I would call “three-dimensional”, a quality that every physiotherapist needs. In sports medicine this three-dimensional quality is essential for clinical practice. In many situations you have to work with basic facilities in both treatment and rehabilitation settings. In specific treatment terms, expensive electrotherapy equipment will never be a substitute for the manual skills that can be utilised anywhere, that never need a power supply and that develop you as a physiotherapist. You just have to be prepared to put in the work to learn how to use those manual skills. In rehabilitation terms, this means adapting basic pieces of equipment to produce a multitude of sport-specific exercise drills.

Every physiotherapist needs to adopt a three- dimensional approach to rehabilitation. This utilises the therapist’s ability to devise specific functional exercises. The key areas to consider are muscle function, speed of movement, multi-joint linkage, sport- specific skills and reactive neuromuscular training. A general rehabilitation programme for the lower limb is presented.

TO BE PHYSIOTHERAPISTS? GORDON RAMSAY WOULD BE GREAT FOR THE PHYSIOTHERAPY PROFESSION – SO MUCH ENERGY AND ENTHUSIASM

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WILL THE NEXT TV REALITY SHOW BE CELEBRITIES TRAINING

The average single-station weights machine allows only a limited number of different exercises, may cost several thousand pounds, and is usually for non-functional activity. A plate-loading barbell, on the other hand, helps develop balance, coordination and strength, is relatively inexpensive, and can be used for about 180 standard gym exercises. By taking a three-dimensional approach, the number of exercises you can devise may be endless. That is not to say that some expensive pieces of equipment are not invaluable; for example, a multi-axial weighted pulley machine and a cable crossover unit allow the imaginative therapist to create a library of exercises. Isokinetic and balance units are expensive rehabilitation tools, but without the knowledge and appreciation of what these units bring to the rehabilitation stage they are often castigated for being non-functional and become redundant in idle hands. To utilise our skills we must incorporate and appreciate the many different rehabilitation tools that are available. Exercise rehabilitation programmes need to be specific and not just general photocopies. In terms of moving from one dimension to three dimensions, there are many other angles that we need to consider, appreciate and incorporate into our rehabilitation protocols. This list needs to be developed individually through

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