Accelerated VS Traditional Rehabilitation

The selection, implementation, and adherence to a rehabilitation program post-surgery or post-injury is vital in regards to achieving the best clinical outcomes for patients. There is much debate as to whether traditional rehabilitation, which usually involves a resting period of 4-6 weeks, or an accelerated rehabilitation program, provides the best clinical outcomes for patients. Outcomes such as speed of recovery or return to normal activity, re-injury rate, muscle strength, tendon elongation, and complications, are all factors which are affected by the type of rehabilitation chosen. Traditional rehabilitation aims to immobilize or offload the area to allow the injury or surgical repair to heal, whilst accelerated rehabilitation aims to have the patient moving as soon as possible in a safe manner to decrease joint stiffness and other complications of immobilization (eg. blood clots, neuromuscular deconditioning, and chronic pain syndromes) (1,2).

Recent evidence suggests that implementing a rehabilitation program as early as possible following surgical procedures allows patients to return to full activity or sport in a smaller time frame (1,2). These rehabilitation programs should initially focus on regaining range of motion and balance, followed by basic strengthening exercises, and then finally progressing to dynamic, functional and sport-specific exercises.

Miyamoto, Takao, Yamanda, & Matsushita (2014) compared the two rehabilitation methods on patients who had undergone chronic lateral instability surgery, where the gracilis tendon was used as a graft to stabilise the lateral ankle. Over the initial 8 week period, each group was given different guidelines regarding immobilization, type of range of motion exercise, and weight-bearing (Figure 6). In the accelerated rehabilitation group (Group A) the athletes returned to sport after approximately 13.4 weeks (+/- 2.2 weeks), whereas in the traditional rehabilitation group (Group I) the athletes returned to sport after approximately 18.5 weeks (+/- 3.5 weeks).

Pearce et al. (2016) investigated the outcomes of accelerated rehabilitation after ankle ligament repair or reconstruction. They found that initial post-operative immobilization with early range of motion and protected weight-bearing was appropriate for returning patients to normal activity levels. This involved neuromuscular rehabilitation aiming to increase strength and stability (Fig. 3) around the ankle.

Over the past few years prescribing an accelerated rehabilitation program is becoming more and more common, as there tends to be a quicker recovery time and therefore quicker return to activity or sport. However, we must ensure that when we are implementing an accelerated rehabilitation program that it is safe to do so and will not result in re-injury. The most important thing when deciding between accelerated and traditional rehab is understanding that being too cautious or gung-ho can results in non-optimal outcomes for the patient (1,2).

References

1. Miyamoto W, Takao M, Yamada K, Matsushita T. Accelerated versus traditional rehabilitation after anterior talofibular ligament reconstruction for chronic lateral instability of the ankle in athletes. The American journal of sports medicine. 2014;42(6):1441-7.

2. Pearce CJ, Tourné Y, Zellers J, Terrier R, Toschi P, Silbernagel KG. Rehabilitation after anatomical ankle ligament repair or reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(4):1130-9.

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