Terminal Extension lag (TEL) is a condition that develops when active range of extension is smaller than passive range; frequently noticed in post-traumatic knees after injuries and Anterior Cruciate ligament reconstruction surgery. TEL is typically seen within 6 to 12 weeks after ACL reconstruction. Anterior cruciate ligament reconstruction surgery is a critical surgical intervention used to repair ACL tear; which is common among those who are engaged in physical demanding activities and Sportsmen. In the initial days following surgery terminal extension lag affects up to 10 to 35% of individuals. ACL is expectational because it's not just a static stabilizer of knee but also transfers proprioceptive information to the brain so to improve joint's dynamics. This study aims to compare effects of Dynamic Stability Drills (DSD) and Plyometric Training (PT) in reducing terminal knee extension lag in post-ACL reconstruction patients. This study will be a Randomized Clinical Trail and will be conducted in Physiotherapy Department of Bethania Hospital Sialkot. Non-Probability Convenience Sampling will be used to collect data. Total of 48 Participants of the age 20 to 40 years with terminal extension lag of moderate lag stage (typically 9-12 weeks post-op with 5-10° lag) will be selected as sample size. An informed consent will be taken prior study from all the subjects. Outcomes measure will be included Numerical Pain Rating Scale (NPRS) for pain, Single Leg Hope Test and Y Balance Test (Y-BAL) for Dynamic Stability, Universal Goniometer (UG) for Range of Motion, Sphygmomanometer for Knee Strength, International Knee Documentation Committee scores, (IKDC) for Knee function and Limb Symmetry Index (LSI) Calculations. Subjects will be divided into two groups by random number generator table. Both groups will receive a standard physiotherapy protocols which will include: Hot pack , TENS , Mobilizations, Stretching and Strengthening. Group A will receive Dynamic Stability Drills and Group B will receive Plyometric Training along with conventional treatment. Patient will come 3 time a week and data will be recollected after 6 weeks. Data will be analyzed by SPSS version 25.
Age 20-40
Both Genders (male & female)
History of Anterior Cruciate Ligament Reconstruction (ACLR) between 1-3 years
Moderate stage (5 to 10 ˚) of terminal extension lag after ACL reconstruction
Any other previously serious knee pain and/or surgery limiting of knee range of motion(2)
Any traumatic conditions around the knee, or any infectious or tumors conditions i.e.
Pregnancy, any recently underwent abdominal and back surgery
BMI ≥ 30 kg/m²
Parallel
Dynamic Stability Drills
Other interventionWeak 1-2 Stability Foundation Weight shifts (anterior/posterior, lateral, Double-leg stance on foam surface, Eyes-closed balance (double-leg), Isometric quad \& hamstring contractions, Wall sits + small ball between knees (activate adductors \& quads)Weeks 3-4: Progressive Dynamic Stability, Single-leg stance on foam, Thera-band perturbation drills (knees and hips), TKE (Terminal Knee Extension) on unstable surfaces, Step-downs from 6-inch height (with control),Lateral step-overs (slow \& controlled)
Plyometric Training
Other interventionWeak 1-2: Four types of plyometrics: A) bilateral off-set (alternating box jump) B) bilateral asymmetrical (split jump) C) bilateral symmetrical (30 cm drop jump) and D) unilateral (30 cm drop jump(13) Weak 3-4: 1. A lateral jump from left to right limb (A) with landing (B) and immediate jump back to the right limb (C) as opposed to just landing in which occurs during Stage 2(13). 2. Images of a countermovement or squat jump in place with maximal height. The removal of the box results in higher landing forces due to landing from a higher height(13
Single leg hope test
Jumping as far as you can on one leg while maintaining your balance and landing firmly is the goal of this challenge. The starting line and the landing leg's heel are used to estimate the distance
Limb Symmetry Index (LSI) Calculation
the Limb Symmetry Index (LSI) calculates the performance difference between two limbs, typically the affected and unaffected limbs following an accident; by dividing the score of the injured limb by the score of the unaffected limb and multiplying the result by 100. It's represented in percentage
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