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Knee ACL Post Reconstruction Surgery-Understanding how tissues behave in relation with the CNS

Updated: Dec 7, 2022

by Monica Lita

My client, soccer athlete, one month into rehabilitation for ACL reconstruction surgery after a really unfortunate injury while playing.

Because the knee still swollen, no patellar degrees of freedom and up regulated tone of the surrounding muscles (quadriceps group, lower leg posterior compartment, pain referral lateral lower leg) we have applied as an initial rehabilitation approach:

- Scar tissue myofascial release extra and intra layers;

- Patellar brown fat pad release;

- Manual force inputs of the patella (knee cap) in different direction;

- Manual force inputs around medial and lateral coronary ligaments and other tendinous structures attached to femur/tibia and fibula;

-CARs (Controlled Articular Rotations)

-Capsular CARs,

-Isometric contractions and ENGs-Eccentric Neural Grooving in different knee flexion combined with tibial medial or lateral rotation, all in a prone position and supine (not shown). The intent is to down regulate the tone of the muscles by influencing the length-tension relationship of the musculotendinous units involved in different knee joint position.

To understand human movement dynamics it’s important to consider that the position of the joints influence force transmission, muscles are not working independently one by each other and there’s relationships in terms of force conduction between muscles of one compartment. There are a variety of pathways created at the level of intramuscular or intermuscular as also extramuscular where different connective tissue structures are blending one into each other acting as a continuum Bioflow to help transmitting force contraction.

It's needed an accurate feedback from the client to work in ranges right under the level where pain starts to kick in…by doing so we influencing the knee intrinsic and extrinsic articular innervation to decrease overall the pain.

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