Is it time to develop specific return to running criteria for ACL rehabilitation? An international survey of physiotherapists criteria for return to running following ACL injury.

OBJECTIVE: To determine return to running criteria currently used by physiotherapists following anterior cruciate ligament (ACL) injury. DESIGN: Self-reported online international survey. METHODS: An online survey of physiotherapists across Australia, the Netherlands and France. RESULTS: A total of 476 respondants participated in the survey across Australia (n = 153), the Netherlands (n = 162), and France (n = 161). For return to running criteria following a non-operative approach, the majority of respondents chose swelling (40.55%, n = 193/476), pain (38.24%, n = 182/476), knee extensor strength (34.34%, n = 163/476), single leg squat (31.93%, n = 152/476) and knee flexor strength (29.83%, n = 142/476). After ACL reconstruction, the highest responses were also swelling (41.18%, n = 196/476), pain (37.18%, n = 177/476), knee extensor strength (37.18%, n = 177/476) and single leg squat (33.19%, n = 158/476). From the identified themes the most common cutoff variables were pain between 0 and 3/10, swelling < grade 1+ and limb symmetry on strength and hop tests >70 %. CONCLUSION: Physiotherapists in Australia, France, and the Netherlands use many different return to running criteria and most of them use more than one criterion. Despite this, there was little consensus on the cut-off physiotherapists use to apply these criteria.

Implementing Velocity-Based Training to Optimize Return to Sprint After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Clinical Commentary.

After anterior cruciate ligament reconstruction (ACLR), return to sprint is poorly documented in the literature. In soccer, return to sprint is an essential component of return to play and performance after ACLR. The characteristics of running in soccer are specific (velocity differences, nonlinear, intensity). It is important to address these particularities, such as curvilinear running, acceleration, deceleration, changes of direction, and variations in velocity, in the patient's rehabilitation program. Force, velocity, and acceleration capacities are key elements to sprint performance. Velocity-based training (VBT) has gained much interest in recent years and may have a role to play in optimizing return to play and return to sprint after ACLR. Force, velocity, and acceleration can be assessed using force-velocity-power and acceleration-speed profiles, which should inform rehabilitation. The purpose of this commentary is to describe a velocity-based return to sprint program which can be used during ACLR rehabilitation.

Ligament Healing After Anterior Cruciate Ligament Rupture: An Important New Patient Pathway?

Recent studies have shown satisfactory functional results after spontaneous healing of a ruptured anterior cruciate ligament (ACL). However, current literature on this topic may exclude important parting selection, outcome measures, and long-term results. Rehabilitation protocols applied in those studies, as well as objective assessments appear far from the usual gold standard after ACL reconstruction. Ideally, outcomes measures should be based on the same testing procedures that are recommended to clear an athlete to return to sport following ACL reconstruction. There is still a lot to understand in how an injured ACL may heal, and therefore ACL injury management should be individualized to each patient and carefully discussed.

Is there any biomechanical justification to use hopping as a return to running test? A cross-sectional study.

OBJECTIVE: To assess the agreement and the correlation between asymmetry indexes of leg stiffness (AI(Kleg)) in running and hopping and the correlation between leg stiffness (Kleg) in running and hopping. DESIGN: Cross-sectional study. SETTING: Clinical facility. PARTICIPANTS: Twelve healthy runners (5 women and 7 men; mean (SD) age = 36.6 (10.1) years; activity level = 6.4 (0.9) on Tegner scale). MAIN OUTCOME MEASURES: A treadmill instrumented by photoelectric cells was used to collect data (flight and contact times) during running assessment (preferential and imposed velocity (3.33 m s-1) and during a hopping test. Kleg and AI(Kleg) were computed for each modality. Correlation tests were performed, and Bland Altman's plot was created. RESULTS: A significant and large correlation was found between Kleg in hopping and running at imposed speed (r = 0.6, p = 0.001). An acceptable agreement was found between the AIs in hopping and running, with a bias of 0.04 (-0.15-0.06) at imposed speed and 0.03 (-0.13-0.07) at preferred speed. CONCLUSION: Our results suggest that testing an athlete for asymmetry in hopping might help to understand what happens in running. For this purpose, further research is needed, especially in an injured population, to better understand the association between biomechanical asymmetry in hopping and running.

French physiotherapy management of rotator cuff related shoulder pain: An observational study.

BACKGROUND: Rotator cuff related shoulder pain (RCRSP) is a common and disabling cause of shoulder pain contributing to great socio-economic costs. Conservative management is recommended as first-line treatment, with studies performed in the United Kingdom, Belgium, the Netherlands and Australia finding practice generally consistent with guideline recommendations. Current French guidelines for management of RCRSP were published more than a decade ago, and it is unknown if French physiotherapists manage RCRSP in line with the current guideline recommendations. The aim of this survey is to evaluate if management delivered by French physiotherapists for RCRSP is in line with the current evidence. METHODS: A cross-sectional online survey was conducted and disseminated through various social media platforms and a mailing list from December 2018 to March 2019. RESULTS: Two hundred and six French physiotherapists completed the survey. The results demonstrated that the majority of physiotherapists provide care consistent with recommended guideline management, through the delivery of exercise and education. Ideology and specific parameters of treatment delivery, particularly exercise treatment, were highly variable among the cohort, but comparable to findings among physiotherapists in the United Kingdom, Belgium, the Netherlands and Australia. CONCLUSION: French physiotherapists are broadly consistent with providing guideline recommended care of RCRSP; however, heterogeneity exists in the ideals and practice of specific treatment delivery, particularly within exercise management.