Page 158 - Demo

Chapter 8156Table 1. Schematic display of the KROS protocol.Phase 1Takes place at the physiotherapist office. Focus on regaining a normal range of motion with limited effusion.Mobility Strength Activity and participation level- Passive mobilizations of the patellofemoral joint.- Focus on regaining range of motion (ROM), mainly full extension (active and passive).- Aim for full extension within 2-4 weeks.- Motor reactivation of the m. quadriceps (possibly with electrical stimulation), with isometric exercises, enhancing to concentric and eccentric exercises.- m. Quadriceps strength training in closed chain in ROM 0-60°, starting from week 4 in open chain in ROM 90-45°; starting from week 5 ROM every week with 10° increase.- Concentric and eccentric training the hamstrings, gluteal and calf muscles.- Step up and skate step. Start in the sagittal plane, enhancing to transition in the frontal plane.- Neuromuscular training focusing on quality of exercises.- Exercise gait and cycling.Phase 2Took place at the physiotherapist office and at the ice rink. Focus on getting subjects ready for training on skates.Mobility Strength Activity and participation level- Maintain full ROM - Training of the m. quadriceps:• in open chain from week 6 in ROM 90-20 °, week 7 in ROM 90-10 °, in week 8 in ROM 90-0 °. • in closed chain starting from week 8 to ROM 0-90 °- Step up and skate step into deeper knee angles and if possible on a less stable surface (e.g. Skate step on an exercise mat and a step up on a box with a soft top).- Intensify strengthening exercises for hamstrings, gluteal and calf muscles (less repetitions, higher resistance)- Expand of neuromuscular training with focusing on correct implementation.- Start with outdoor cycling- Cyclic forms of exercise, especially aerobic. If available, start exercising on a step trainer. The push off is aimed oblique posterior. - Start from week 10-12 with jogging - Agility training- Return to work (if applicable)Mark Zee.indd 156 03-01-2024 08:56