Photo Special To The Town CrierPhysical therapist Robert Abrams performs a manually resisted, lower-extremity Proprioceptive Neuromuscular Facilitation exercise with a patient recovering from knee surgery.

Young athletes and active adults are well aware of the tremendous social and health benefits that come from participating in sporting activities. The downside to being active is sustaining an injury.

Approximately 15 percent of all sports injuries involve the knee and its associated structures. While rest is the answer for many injuries, others inevitably require surgery. Postoperatively, physical therapy plays a vital role in returning to sports.

Rehabilitation is much more than gym exercises. Understanding joint biomechanics, functional movement, neuromuscular involvement, tissue healing time and one’s cognitive level is critical. Knowledge and exercise, combined with a manual-therapy approach, allows a physical therapist to address these issues.

The hands-on approach has many advantages. Initially, it helps to establish trust and build patient confidence and cooperation. The psychological benefits of manual contact are powerful. Its influence on physical healing is profound. Secondarily, a manual approach allows therapists to assess inflammation, joint mobility and muscle function.

Achieving full range of motion early is important. Therefore, soft-tissue mobilization is used. It allows the physical therapist to alleviate the swelling and soreness associated with surgery. Working out muscle spasms and tight, restricted areas also promotes mobility and decreased pain. Breaking down any adhesions or scar tissue that may form will further facilitate motion and improve the overall outcome.

Beyond the soft tissue, mobilizing the kneecap (patella) is often done. This technique ensures unrestricted movement and minimizes the chances of adhesions forming and mobility being impeded.

One of the most powerful manual therapy tools is Proprioceptive Neuromuscular Facilitation (PNF), a proven technique used to evaluate, treat, educate and strengthen.

PNF involves a variety of resisted strengthening movements between the patient and therapist. Whether you are walking, running or jumping, these compound movements occur along different angles and planes of motion. PNF allows therapists to strengthen and re-educate the muscles in these planes. Characteristics such as endurance, quality of muscle contraction, control, strength and stability can be assessed. Using varying grades of resistance, quick stretches and different handholds, we can facilitate these complex neuromuscular patterns. It’s dynamic, functional and fun.

In the physical therapy setting, a special emphasis is placed on balance training activities that improve position awareness – proprioception, typically diminished after knee surgery. Dynamic exercises re-educate the leg muscles to sense potentially harmful positions and facilitate a faster, protective reaction.

Plyometric and agility training is another key component to rehabilitation. These activities focus on coordinated jumping, bounding, leaping, landing and cutting mechanics. The drills improve reflexive and voluntary muscle response times.

A physical therapy program that blends manual treatment, dynamic activities and injury-prevention elements with gym exercises is a sound choice.

For more information, visit www.taylorpt.org.

Robert Abrams has practiced sports and orthopedic physical therapy since 2001. He works at Taylor Physical Therapy: Orthopedic and Sports Rehabilitation in Los Altos.

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