ACL Post-Operative Rehabilitation

ACL Hamstring Tendon Graft Post-Operative Rehabilitation

Dr. Carey Winder
Baton Rouge Orthopaedic Clinic

ACL protocol is the same as bone patellar tendon bone except for the following:
1. When performing heel slides, make sure that a towel is used to avoid activating the hamstring muscles
2. Do not perform isolated hamstring exercises for 6 weeks
3. Partial weight bearing with crutches for 4 weeks

Week 1:
- Patient begins physical therapy 3-5 days post-op
- Initial therapy treatment consists of the following:

• EMS/bio feedback to quads


• Quad setting for 10 minutes


• SLRs for 5 min


• HSS sitting in chair (30 sec hold, 5 reps)


• Calf stretching against wall (30 sec hold, 5 reps)


• Patellar mobilization (emphasize superior glides)


• 90-40 open chain manual resistance


• ROM Passive: progress as tolerated (DO NOT MANUALLY FORCE ROM!)

To increase flexion:
May perform heel slides, wall slides, or chair flexions (wall slides preferred for hamstring grafted patients)

To increase extension:
May perform HSS, calf stretches, prone extensions (use biofeedback to relax the
hamstrings or manually teach relaxation of the hamstring during prone stretch)

Weight bearing:

• Weight bearing as tolerated with crutches.


• Continue use of crutches until gains quad control (3-6 weeks), then go to one
  crutch before FWB with no assistive devices

Cycling:

• May begin stationary cycling when can flex to 110 degrees (DO NOT USE STATIONARY BIKE TO INCREASE FLEXION!)

Bracing:

• Knee immobilizer when walking with crutches

Week 2 to 6:
- Will fit with a functional brace in the office. Wear the brace when ambulating to help protect from hyperextension injuries

• Continue above exercises


• Begin leg press from 90 to 20 degrees both legs.


• Progress to single leg press, stopping at 40, 60, and 90 degrees. When
  stopping hold position for 5 seconds.

Bracing:

• We measure for a functional brace such as the DonJoy Defiance at 3-6 weeks post-op:


• We use the brace to protect the patient from possible hyperextension injuries.

Begin proprioceptive training:

• Utilize the K.A.T. for balance, “stork” single leg balance with knee flexed to 20-30 degrees. Addition of biofeedback to enhance the VMO contraction is helpful. Use of sports cord may be instituted as long as patient has good quad control.


• Pool Walking Okay – make sure patient realizes to walk only and not to perform whip kick

Weeks 6-12:

• Lateral step ups


• Progress with proprioceptive training


• May begin running at 8-12 weeks when ROM normalizes and pain and swelling allow.


• Start on trampoline, progress as tolerated to cushioned surface, then hard surface.

Isokinetic test:

• At 180 and 300 degrees per second at 12 weeks.


• Include results in report to M.D.

3 to 6 months:

• Continue with above and may add partial squats, forward lunges with straight bar.


• Progress as tolerated.


• Do not perform if patient has patellar femoral symptoms!

6 to 12 months:

• Begin sport specific drills


• Return to activity based on KT-1000 scores and full ROM, Biodex test, and functional tests.

NOLA Nutrition

New Orleans, a city known for its culture, music, nightlife, and of course… FOOD! Many people know New Orleans as “The Big Easy” since everything there is laid back, simple, and easy-going. But “easy” may be the last thing that comes to your mind when trying to stick with your New Year’s health and sports nutrition resolutions while visiting the Crescent City. Well, here’s a list of 8 nutrition tips and tricks to help keep your goals on track while cheering on our #1 Tigers down in New Orleans.

1. Don’t skip breakfast. Better yet, don’t skip any meals! First of all, the food in New Orleans is way too good to pass on a meal. Secondly, and most importantly, skipping meals only leads to overeating once that hunger feeling hits you.

2. Plan ahead. Your trip will most likely be a busy one packed with French Quarter tours, fan pep rallies, BCS festivities, Tiger tailgating, and let’s not forget about the big game! Take some time before your arrival to look at your schedule and plan when and where you will eat. Yes, you’re in the Big Easy and may want to take it day by day, but having some sort of plan will prevent you from eating whatever is closest… for example, that Hot Dog from the Lucky Dog stand on Bourbon Street!

3. Balance out your day. New Orleans offers so many traditional foods, most of them high in fat, sugar, and calories. Don’t deprive yourself of these “must-try” Creole staples; just be sure to balance out the rest of your day. For example, if you know a big dinner awaits you, plan to eat a lighter breakfast and lunch and vice versa. This way you can stay on track with your goals as well as enjoy the city’s cuisine without any guilt.

4. Better your breakfast foods. No doubt, breakfast is the most important meal of the day as it jump-starts your metabolism and gives you energy for the long but fun Downtown day ahead.

•         Typical New Orleans breakfast foods include: high fat biscuits and gravy, cheesy grits, and hearty dishes with crab cakes, sausage, eggs, Beignets, and high calorie cheeses and hollandaise sauce.

•         Choose one day to eat a healthy portion of these traditional breakfast foods. On the other days, opt for these leaner choices: whole grain toast or English muffins, oatmeal, veggie omelet, eggs or egg whites (spiced with hot sauce and Tony Chachere’s!), turkey sausage, and fresh fruit.

5. Lighten your lunch. After walking around in the Quarter all day, you’re definitely going to build-up an appetite. You’re most likely to come across popular lunch foods such as Po-boys, Muffaletta’s, Jambalaya, Gumbo, Etouffee, Red Beans and Rice, and Fried Seafood dishes. Here’s some simple tricks to lighten up these foods:

•         Your server may ask if you want your Po-boy “dressed”(this means they’ll add lettuce, tomato, mayo, and possibly other sauces). Instead, opt for a “naked” Po-boy (ask for lettuce and tomato minus the high fat mayo and sauce).

•         Go “topless.” Save yourself some calories and carbs by eating your Po-boy or Muffaletta open-faced, without the top portion of bread.

•         Instead of French fries or Onion rings, order a side salad (light on the dressing) or steamed seasoned veggies.

•         When it comes to fried seafood and chicken dishes such as Po-boys, Platters, and Salads, always opt for the grilled or blackened version. Don’t worry! You won’t miss out on taste.  New Orleans cooks are always sure to spice it up just right with lots of Creole seasonings and spices.

•         For dishes such as Jambalaya, Gumbo, Etouffee, and Red beans, remember to watch your portions and skip that buttery piece of cornbread.

•         Ask the server for a “half portion” of rice with your Gumbo, Etouffee, and Red beans.

6. Downsize your Dinner. Dinner time is always a treat as you will be surrounded by many other tourists and locals living it up in the fun New Orleans atmosphere. In addition to the lunch tips, try to utilize these when it’s time to order dinner:

•         Read the menu. Be sure to thoroughly look over the restaurant’s menu in order to avoid some “trap food terms.” Trap foods may sound good and healthy, but may end up being the highest fat item! Try to avoid foods containing the words: crispy, crunchy, cheesy, creamy, au gratin, battered, buttery.

•         Steer clear of Stuffed. You will often see “Stuffed” foods such as crab, peppers, mushrooms, fish, and more. Keep in mind “Stuffed” consists of buttery and creamy rice, breadcrumbs, and crabmeat… probably not the best choice for your waistline.

•         Go for the grilled. Stick with Grilled Fish, Boiled Shrimp, and other Lean Meat dishes with sides such as seasoned steamed vegetables, red beans, greens, or boiled okra.

•         Go easy on the Dough. Monitor the amount of bread rolls, cornbread, crab cakes, or other high fat appetizer foods you eat because these calories can add up very quickly.

•         Remember portion control! Order a lunch size meal or split it with a friend. You can also pack half the meal in a to-go box and store it in your hotel refrigerator or ice chest to eat the next day.



7. Divide some Dessert. You can’t leave New Orleans without having a taste of some of its traditional dessert items: Beignets from Café Du Monde, Bread Pudding, Bananas Foster, Crème Brulee, Pecan Pie, and King Cake. If you order one or two desserts for the table to share, you will automatically avoid eating the entire thing alone.



8. Alcohol. New Orleans: The Party Capital of the World! It’s more than likely you will experience the nightlife the city has to offer.

•         First off, always remember to be smart and cautious with alcohol. No athlete will benefit from drinking alcoholic beverages, so keep this in mind when you’re down in the Quarter.

•         Also, be wary that the most popular French Quarter beverages (Hurricanes, Hand Grenades, and Daiquiris) are full of sugar and extremely high in calories. If you opt for any of these, go for the smallest size or split it with a friend.

•         I promise you won’t miss out on any of the fun by choosing one of these lighter beverages: Bloody Mary, Light Beer, Vodka Water with lemon or lime, or Southern Comfort with fresh lime juice.

•         Remember that all alcohol calories count and contribute to your daily intake, so be sure to monitor your drinks as well as the late night foods you may come across down in the Quarter.

LSU Food & Health Experts Offer Tips for a Healthy and Delicious Thanksgiving Meal

LSU Athletic Department's Registered Dietician Jamie Mascari was recently interviewed for a piece that ran on Louisiana State University's website. She was asked to discuss how student athletes, and others interested in eating well, handle the holiday season. Find out Jamie's tips and straegies that she suggests to maneuver holiday feasts without steering too far off your meal plans. To read the complete story, please click on the link below.

http://www.lsu.edu/departments/gold/2011/11/thanksgiving.shtml

Supplement Contamination = Positive Drug Test

Athletes must be very cautious with any type of dietary supplement. Even though the ingredient label may not list any known banned substances, contamination with banned ingredients is still possible. In addition, the Food and Drug Administration does not regulate dietary supplements, which means the supplements’ manufacturers are the ones responsible for ensuring the ingredient list is correct, not the government. This has led to many problems with athletes and positive drug tests.

In the following NUTRAingredients.com article: CLICK HERE for the full article

2 athletes were tested positive for the substance DMAA, also known as: 1,3-dimethlyamylamine, dimethlyamylamine, dimethlypentylamine, forthan, forthane, floradrene, geranamine, geranium oil, and geranium flower extract. These athletes argued that the product they took was contaminated and the DMAA was not listed on the ingredient list.

It is extremely important to remember that not all supplement products are safe, even if they are sold over-the-counter and have an ingredient list that seems okay. Before buying or trying any supplement, be sure to check FIRST with Sr. Associate Athletic Trainer, Shelly Mullenix, Head Strength Coach, Tommy Moffitt, and/or Sports Dietitian, Jamie Mascari. Being SAFE is always better than being SORRY.

Death of Teen: Synthetic Marijuana Takes Another Life

A recent story on msnbc.com shared the story of a 13-year old boy who tragically died after needing a lung transplant brought on by use of synthetic marijuana. it is just another example of the dangers we face when using these types of drugs. We know this is a man-made drug that is labeled not for human consumption for a reason. It's side effects are very random from person to person and use to use. Reports of psychosis, loss of appetite, very rapid heart rate and elevated blood pressure as well as heat intolerance are just a few of the symptoms that have been noted after even single use. Click the link below to read the story of this teenager whose life was cut short by the use of synthetic marijuana.

http://www.msnbc.msn.com/id/45062477

Synthetic Marijuana: Serious Consequences

Use of synthetic marijuana has been discussed within the LSU Athletic Department for some time now. Early warnings regarding the legality and dangers of smoking synthetic marijuana have been clearly outlined within LSU's ADAP Substance Abuse Policy. It is clear that this man-made product is very dangerous, having very negative consequences on one's ability to perform in the classroom and perform at high levels athletically. While we have heard cases of random deaths from the use of synthetic marijuana, it hit fairly close to home with the death of a Division I Men's Basketball player from Anderson University in South Carolina. Click the link below to read the details of this tradegy.

http://www.foxcarolina.com/story/15706199/coroner-synthetic-pot-killed-anderson-university-basketball-player

Texas Toast Tomato Sandwiches

Ingredients:
1 (9.5 oz.) package five-cheese texas toast
2 lb. assorted heirloom tomatoes
1/4 cup bottled blue cheese vinaigrette
6 tbsp. torn fresh basil
Salt and pepper
Garnishes: crumbled blue cheese, fresh basil leaves

Directions:
Prepare Texas toast according to package directions. Meanwhile, halve larger tomatoes and cut into 1/4-inch-thick slices; halve or quarter smaller tomatoes. Gently toss tomatoes with vinaigrette, basil, and salt and pepper to taste. Serve immediately over hot Texas toast. Garnish, if desired.

Southern Living July 2011

Spicy Chicken-Corn Chowder

Ingredients:
8 slices bacon, chopped
1 lb. skinless, boneless chicken breast, cut in bite-size pieces
1 1/2 cups chopped red sweet pepper
1 cup chopped sweet onion
1-2 fresh jalepeno peppers, finely chopped
4 cloves garlic, minced
1/3 cup all-purpose flour
6 cups reduced-sodium chicken broth
2 large Yukon gold potatoes, chopped
2 cups fresh sweet corn kernels
1 1/2 cups whipping cream
1/2 tsp. cayenne pepper
2 bay leaves

Directions:
In a 5-6 quart Dutch oven cook bacon until crisp. Remove with spoon; set aside. Reserve 1 tablespoon drippings in pan. Add chicken to pan. Sprinkle with 1/2 teaspoon each salt and black pepper. Stir over medium-high heat until chicken is no longer pink; remove. Add sweet onion and pepper to pan. Cook and stir until tender. Add jalapenos and garlic; cook and stir 3 minutes. Stir in flour. Cook and stir 1 minute. Add broth and potatoes. Bring to boiling; reduce heat. Cook, uncovered, 10 minutes or just until potatoes are tender; stirring occasionally. Stir in chicken, corn, cream, cayenne, and bay leaves. Simmer, uncovered, 15 minutes; stir occasionally. Discard bay leaves. Top with jalapeno slices, if desired.

Better Homes and Gardens

Strawberry-Ricotta Bruschetta

Ingredients:
2 tablespoon(s) packed brown sugar
2 tablespoon(s) balsamic vinegar
1/4 teaspoon(s) vanilla extract
1 pound(s) strawberries, hulled and cut into 1/3-inch slices
8 slice(s) (each 3/4 inch thick and 5 inches wide) rustic country bread
1 container(s) ricotta cheese
1 bunch(es) (about 32 leaves) basil, torn if large

Directions:
In large bowl, stir brown sugar, vinegar, and vanilla until sugar dissolves. Stir in sliced strawberries. Let stand 1 hour. Toast bread until golden brown. Cool completely. Spread 2 tablespoons on each bread slice. Alternate strawberries and basil leaves in a single layer, overlapping slices. Drizzle strawberry juices over top and serve.

Good Housekeeping

Barbecued Shrimp and Peach Kabobs

Ingredients:
12 (12 inches each) metal or bamboo skewers
1 tablespoon(s) packed dark brown sugar
1 teaspoon(s) ancho chile powder
1 teaspoon(s) sweet paprika
1/2 teaspoon(s) ground cumin
1/4 teaspoon(s) cayenne (ground red) pepper
Salt
Pepper
1 pound(s) (16- to 20-count) shelled deveined shrimp
3 medium peaches, cut into 1-inch chunks
1 bunch(es) green onions, dark green parts trimmed, cut into 2-inch pieces
Lime wedges, for serving

Directions:
If using bamboo skewers, soak skewers in cold water at least 30 minutes to prevent burning. Prepare outdoor grill for direct grilling on high. In large bowl, combine brown sugar, chile powder, paprika, cumin, cayenne, 1/4 teaspoon salt, and 1/4 teaspoon freshly ground black pepper. Add shrimp, peaches, and onion; toss until evenly coated. Thread shrimp, peaches, and onion alternately onto skewers.Grill 3 to 4 minutes or until browned and shrimp just become opaque throughout, turning once. Serve with lime wedges.

Good Housekeeping

Seared Steak with Minted Watermelon

Ingredients:
8 ounces thin rice noodles
1 (1-pound) boneless 1-inch-thick beef sirloin steak
Salt
Pepper
1 shallot, finely chopped
1 stalk lemongrass, yellow and pale green part only, finely chopped
1 teaspoon sugar
1/4 cup fresh lime juice
1 tablespoon lower-sodium fish sauce
1/2 small (3 cups) watermelon, rind removed, cut into 1/2-inch cubes
1/2 seedless (English) cucmber, cut in half and thinly sliced
1/2 cup packed fresh mint leaves, finely chopped

Directions:
Prepare outdoor grill for covered direct grilling on medium. Prepare noodles as label directs. Drain, rinse under cold water, and drain again. Season steak with 1/4 teaspoon each salt and freshly ground pepper. Place steak on hot grill; cover. Cook 12 to 13 minutes for medium-rare or until desired doneness, turning once. Transfer steak to cutting board; let rest 10 minutes. Meanwhile, in large bowl, stir shallot, lemongrass, sugar, lime juice, and fish sauce until sugar dissolves. Thinly slice steak across the grain. Add to bowl, along with watermelon, cucumber, and mint. Toss gently until well mixed. Divide noodles among serving plates. Top with steak mixture and accumulated juices.

Good Housekeeping

MLB and the concern with Energy Drinks

Energy drinks have gained much popularity over the past few years. Many people, including athletes, use and rely on them as an energy booster fail to consider the negative and sometimes harmful effects from these beverages. Some MLB teams have noticed the dangers energy drinks can have on the body and have banned them from the players’ clubhouses.  (See link below)

Here’s a brief run-through of the composition of energy drinks:

SUGAR: Energy drinks are often loaded with sugar, which causes your blood sugar (energy levels) to come crashing down once the sugar leaves the blood. Yes, you may feel very energetic for a short while after drinking an energy drink, and this is because the high sugar content quickly stimulates your nervous system, giving you that feel-good feeling and buzz of energy. Keep in mind that the fast spike in blood sugar/energy will lead to an equal drop in blood sugar/energy. Some people may actually feel more fatigued than they were to begin with.

CAFFEINE: Caffeine is also found in large quantities in energy drinks. Caffeine in these amounts (and for those individuals who are sensitive to caffeine) increases your heart rate and body temperature, potentially leading to an irregular heartbeat, excess sweating, shakes, and anxious feelings. Also, caffeine generally produces both laxative and diuretic effects, leading to excess urination and the risk of becoming dehydrated. As an athlete, all of these effects can hamper performance tremendously.

OTHER INGREDIENTS: Some of the other common ingredients found in energy drinks are: Taurine, Guarana, Ginseng, Ginkgo Biloba, B-Vitamins, and many more. In addition, many energy drinks contain a special “energy blend” … sometimes not listing what actually makes up that blend. As a consumer, it is very important to realize that many of these extra ingredients don’t even contribute to increased energy levels. In addition, some ingredients, whether listed or not, may be a banned substance and can possibly show up positive on an athlete’s drug test.

BOTTOM LINE: Use a lot of caution if considering consuming an energy drink. If your energy levels are low, take a look at your diet and hydration… a few tweaks there can make a huge and positive difference!

Click here to read: "MLB teams limiting energy drink consumption, cite negative effects to players’ health"

Life after being a Lineman

Football linemen, known for their big and stout bodies, commonly experience many weight-related issues as a player. It can be tough for some of these players to follow a healthy diet as they strive to build and maintain their large stature. However, with proper guidance and nutrition education, football linemen (and ALL athletes) can achieve their dietary goals for both health and optimal sports performance.

It is not uncommon for football linemen, either ending their college or NFL football careers, to acquire diseases such as diabetes, high blood pressure, and heart disease. Many continue to eat the large quantities of food required for when they were players, not keeping in mind their drastic decrease in exercise levels. The article (see the link below) talks about former offensive lineman for the Cleveland Browns and the Baltimore Ravens, Orlando "Zeus" Brown, who recently died from diabetes complications.

All athletes need to remember that nutritious diet habits not only fuel their bodies for their sport, but it is also essential for ensuring healthy bodies for years to come. 

Click here to read: "Weighty Challenge: A Lineman's Life After Football"

Eating for Strong Bones

-Samantha B. Cassetty, M.S., R.D., GHRI nutrition director, Good Housekeeping

Tailoring your Tiger Tailgate

Well, it's that time of year again. A time of pre-game tailgating, football viewing parties, and post-game celebrations. As a New Orleans native and LSU Tiger fan, I must say I've experienced some of the best tailgates anyone could imagine. There is nothing like some good old Southern Hospitality as you walk the grounds of the most dedicated football fans in Louisiana. But, with that Southern Hospitality comes FOOD. Lots and lots of delicious Southern Comfort food. Some popular Louisiana tailgate dishes include: Jambalaya, Seafood and Andouille Gumbo, Fried Catfish, Hot Boudin sausage and the traditional BBQ dishes such as Hamburgers, BBQ chicken, Pulled pork sandwiches, and more!

Tailgating is not just in Louisiana; it is an All-American tradition! It would be wrong of me to tell tailgaters to completely change their favorite football foods, but here are some ideas to Tailor your Tailgate in a healthy way!

Small changes to menu items can make a big difference in the nutritional content of your meal.

This football season, try to:

• Choose lean cuts of meat such as:
• Skinless chicken
• Loin/round of beef
• Extra Lean ground beef
• Ground Turkey
• Pork Loin
• Turkey Sausage
• Cook with Olive oil or Canola oil
• Use 100% whole wheat hamburger and hot dog buns
• Throw some fresh vegetable on the grill- spice/season them up!
• Create your own fruit tray
• Prepare finger sandwiches on whole wheat bread
• Serve salsa, hummus, and bean dips with:
• Carrots
• Celery
• Cucumbers
• Whole grain crackers

More Tailgating Tips:

• Take a step back from the tables of food and browse at the choices before digging in.
• Always go for the grilled options.
• Watch your portions: fill your plate with more fruits and veggies rather than meat and rice dishes.
• Sip water throughout the day to stay hydrated.
• Snack on fruits, veggies, baked chips, and nuts instead of cookies and other sweets.
• Monitor alcohol intake. Alcohol calories add up extremely fast. More importantly, it has NO sports performance benefit. Be smart when it comes to alcohol.
• Balance is key! No food is good or bad. All foods fit into your nutrition plan if you make sensible choices.

Here are some substitutions that can decrease the fat and calories in many of the typical tailgate foods:

Instead of:	Try:
High fat beef burgers	Extra lean beef or ground turkey burgers
White buns	100% Whole wheat buns
Gumbo/ Jambalaya made with white rice and smoked sausage	Gumbo/ Jambalaya made with brown rice and smoked turkey sausage
Cheesy spinach dip or queso dip with potato chips	Chunky salsa, low fat bean dip, or hummus with raw veggies, baked chips, or whole wheat pita bread
Fried chicken and Fried fish	BBQ or grilled chicken and fish
Sodas, Sweet Tea, Fruit punch, other flavored beverages	Water, Unsweet Tea, Diet soda, Crystal Light

Food Safety is a must for all tailgates.
From the time you buy the food from the grocery to when you pack up all your leftovers, you should always keep your food safe.

• Chop and prep meats and vegetables the day before, using separate knives and cutting boards to prevent contamination.
• Pack raw meats and vegetables separately in a cooler, tighly in foil, and cover completely with ice.
• Have a food thermometer on hand and clean after each use.
• Cook all foods to a safe temperature:
• Fish: 145 degrees
• Beef, Pork, Veal, Lamb, and Egg Dishes: 160 degrees
• Poultry, Casseroles, and Leftovers: 165 degrees
• Wrap leftovers in foil and store in ice.
• Throw out all refrigerated foods that have been sitting out for over 2 hours.

Have a happy and healthy football season!

Best of luck to your favorite teams!