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25 Jul 2020

Testing for Return to Sport

Flyball Athlete

Today I came across a blog that talked about Return to Sport Testing (RST).  The author(s) had done their own review of a review study to re-evaluate the claims made about RST.

 

Here’s the link to the original, but it doesn’t do us much good in canine rehab, other than to ponder the question.  Never the less, folks as nerdy as me might want to take a look at it!

https://blogs.bmj.com/bjsm/2019/05/09/keep-calm-and-carry-on-return-to-sport-testing-after-an-acl-injury-clinician-scientists-weigh-in-on-knee-injury-risk/

 

Okay, so this got me thinking about those post-op ACL dogs (TPLO, TTA, Extracap, Wedge Osteotomy, etc, etc.) that their owners want to get back into competition again.  I’ve rehabbed a fair number over the last few decades.  I look at each one differently and I have some favourite ‘end-stage exercises’ that I test in clinic and then prescribe.  

 

However, Return to Sport Testing, I’ve not looked at (or contemplated to be honest)!!

 

What sort of tests do we look at in humans for Return to Sport after ACL surgery?

 

For this, I found a good resource on Physiopedia.

https://www.physio-pedia.com/ACL_Rehabilitation:_Re-injury_and_Return_to_Sport_Tests#cite_note-:8-28

  • Quadriceps symmetry
  • Hamstring to Quadriceps strength ratio (which should be 85%)
  • Hop tests

 

Additionally, the following criteria seems to come into play:

  • Less knee effusion
  • Fewer episodes of knee giving way
  • Lower knee pain intensity
  • Higher quadriceps peak torque-body weight ratio
  • Higher score on the International Knee Documentation Committee Subjective Knee Evaluation Form
  • Lower levels of kinesiophobia

 

A systematic review by Barber-Westin and colleagues in 2011 investigated return to sport criteria in many studies and concluded that in order to give clearance to return to sport an athlete must have:

  • Less than 10% deficit in strength of the quadriceps and hamstring on isokinetic testing at 180°/s and 300°/s,
  • Less than 15% deficit in lower limb symmetry on single-leg hop testing (single hop, triple hop, crossover hop, and timed hop)
  • Less than 3 mm of increased anterior-posterior tibial displacement on Lachman or knee arthrometer testing,
  • Greater than 60% normalized knee separation distance on a video drop-jump test,
  • Absence of effusion
  • Full knee ROM
  • Normal patellar mobility,
  • No or only slight patellar crepitus,
  • Painless activities without swelling.

 

So, I ask myself, what would that look like in a dog.  We can’t get dogs doing one leg hopping!

Here’s what I’d check for:

  • Symmetry in thigh circumference (or no less than 1cm difference. 0 .5cm preferred.)
  • No drop in the pelvis with a 1-leg slide
  • Full knee ROM with no pain at end ranges
  • No effusion with activity
  • Weight bearing that is within 5% of the opposite rear leg.  (I’d be happier with 3%, but I find that post-op ACL dogs are often never fully symmetric in their weight bearing ever again.  In humans, it takes mental work to achieve it.  We can’t ask that of a dog.)

 

In regards to additional tests, this is where I would have to guess!

  • Destination jumping height (how high can they jump OR how many repetitions of a certain height can they jump?)
  • Ability to cut and turn (i.e. as with chasing a ball or the like) without signs of lameness afterwards
  • Ability to do 5 - 10 sprint starts without signs of lameness
  • No signs of offloading or lameness when in a state of fatigue (i.e. after a long hike or a long exercise session)

 

But I’m not going to profess that I know it all!  This is a new thought for me.  Other than testing and then prescribing exercises and watching how the dog does, I’ve not thought about any formal tests.  So, I’d LOVE to hear your thoughts!  

 

I’ll set up another Survey Monkey.  Please chime in with your thoughts and experiences!

https://www.surveymonkey.com/r/7MRLYR9 

Thanks!  

 

I hope this gets your brain spinning anyways!  It did mine!

Cheers!  Laurie

 

 

 

Tags: sport , sporting , athlete , return to sport , return to sport testing
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