At 18:56 13/12/98 EST, you wrote:
>So, as was commented originally: "Why anyone would do leg extensions in a
>seated position is a good question". Indeed! Why on earth would anyone
>regularly choose to do ANY isolated or 'strict' exercise? Surely, physios
>should have realised many years ago that simple actions such as walking or
>stair climbing (later with added loads) which offer concurrent biarticular
>action of the knee and hip extensors and flexors (plus some functional
>adduction) would have offered superior and more functional early stage
>rehabilitation of the knee than seated knee extensions?
>
>
>
I don't know about American or South African Physios Dr Siff, but here in
Australia Physios have realised the importance of functional "closed chain"
rehab for many years. Since a paper was published in 1991 in Sports
Medicine (Palmitier, Kai-Nau, Scott and Chao. Kinetic Chain Exercise in
Knee Rehabilitation. Sports Medicine 11 (6): 402-413) most physio's worth
their salt are instituting closed chain programmes as early as possible ,
with virtually all knee surgeons eliminating open chain knee extension from
their post operative protocols. From what I can gather, the preoccupation
in the States with all things mechanical means that isokinetic machines are
very popular there. Any Physical therapy/Rehab text book emanating from the
US invariably has an entire chapter devoted to isokinetics. In practice in
Sydney, I think there are only a handful of isokinetic machines, usually in
clinics at Universities where they are used for research purposes.
i think the message is also making it's way to Human Movement and Exercise
Science programs, as many of the Gym instructors now have an excellent
knowledge of the biomechanics and arthrokinematics of open vs closed chain
work (although some don't!)
In my opinion, the greatest challenge for many would be to rehab a patient
with , for instance an ACL recon using no machine based resistance training
at all. This is possible, and successful , indeed the use of exercises as
you suggest along with proprioceptive and change of direction exercises is
more logical than isolating one joint, and leads to greater confidence on
ther part of the patient on return to sport. I use fairly simple equipment
like Profitters, slide boards, steps, rebounders. There is also evidence
that proprioceptive training poist ACL recon produces better results (don't
have the refs on hand, will post them when i do)
In summary you have hit the nail on the head, but in my experience most of
my colleagues have been on side with your comments for some time
regards
Matt McEwan
B App Sc (Physio)
M App Sc (Sports Physio)
Parkside Sports Physiotherapy
Sydney, Australia
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