Sports & Orthopedics

We have 18 years of exclusive experience in sports and orthopedic physical therapy, including most surgical procedures. We are proud of the reputation we have built in Bozeman working with all levels of athletes, including professional. You can be assured that your board certified physical therapist is evidence based, meaning up to date with the best intervention for your problem.


Pediatric Physical Therapy

Children are not smaller adults. We have exclusive experience in pediatric sports physical therapy and extensive experience with many conditions unique to pediatrics including scoliosis, hip conditions (SCFE, Perthes, dysplasia), persistent pain (including CRPS), and growth related conditions (Sever’s, Osgood Schlatter’s Disease, Little League Shoulder, etc.).


Dance Medicine/ Performing Artists

If you are a performing artist, you understand how important it is to find a physical therapist experienced in working with dancers and musicians. Minimize time away from the stage by working with a board certified physical therapist who understands your unique demands.


Occlusion training is a method to enable one to gain strength under light loads by occluding blood flow to a limb. It is safe and we have been using occlusion training under certain situations for a few years; those who have surgical precautions that prevent them from loading the limb or have lifting restrictions can benefit.

OCCLUSION TRAINING

(BLOOD-FLOW RESTRICTION)


ISOKINETIC TESTING

The most important measurement prior to returning to sports is quad strength. Unfortunately, most physical therapists do not use or have access to appropriate tools to accurately test strength.

Isokinetic testing determines maximum dynamic strength through a limb’s entire range of motion.  Computer analysis will determine specific weaknesses that can also be addressed by using this machine through different modes of resistances (isotonic, isokinetic, isometric and passive). 

Other methods of strength testing include dynamometers and 1RM testing. Unfortunately, both these methods are found not to be an equal alternative to isokinetic testing particularly when the person’s strength is approaching symmetry (Sinacore, 2017).

Two reports from isokinetic testing are generated for you and your surgeon. First, a maximum isometric contraction will determine the peak force in foot-pounds of the quadriceps and how long it takes to produce the peak force (rate of force development). Second, an isokinetic measurement produces a report of peak torque at each point in the limb’s range of motion (pictured below). This can identify exactly where in the range the quadricep strength is not symmetrical to the non-surgical side.  

Because isokinetic machines are costly, they are not commonly found in physical therapy clinics. Fortunately, Build Physio & Performance believes in the importance of accurate testing and has one available on site.

Isokinetic testing is used in the NFL combine, large research facilities and performance centers. Testing is a regular part of our rehab program for all joints.  Even if you are doing your rehabilitation elsewhere, we are happy to test your strength and provide this information to your physical therapist and/or physician to assist in directing care.

VISIT our webpage dedicated to ACL topics HERE

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ACL REHABILITATION & return to sports testing

We are committed to preparing our patients for return to sporting activity using evidence based testing and rehabilitation.  Sadly, only 5% of ACL patients receive evidence based rehab guidelines (Ebert 2017).  You can trust that your rehabilitation after surgery will be with someone who has rehabilitated hundreds of ACLs over the last 18 years, has worked directly with numerous orthopedic surgeons, mentors PT’s across the globe and is actively involved in ACL research.

The re-injury rate after ACL reconstruction is 20-30%, most occurring in the first 12 months after surgery.  To prevent a second ACL surgery, an assessment of your knee’s function will determine when you are ready to return to full activity. In the past, time from surgery (typically 6 months) was the only factor used to clear a person for sports.  In fact, only 13% of research papers cited include any measurable objective criteria to clear an athlete back to sport (Barber-Westin 2011).  Evolving research has helped us realize that we need to closely evaluate strength, performance measures, neuromuscular control and psychological readiness.  If specific criteria are not met, there is a 4x greater risk of ACL rupture (Kyritsis 2016). Return to Sports Assessments should be conducted by a physical therapist who has experience conducting reliable and valid tests and most importantly, interpreting results. 

RETURN TO SPORTS TESTING INCLUDES:

STRENGTH.  Quad imbalance is a significant predictor of knee-re injury and patient satisfaction in ACL patients.  Quad strength can be accurately tested with an isokinetic machine and should be at least 90% of the non-surgical side.  For every 1% in quad symmetry, there is a 3% reduction in re-injury (Grindem 2016).  Patients are also more likely to have reached “functional recovery” at 1 year from surgery if their quads were symmetric at Return to Sports testing (Ithurburn 2017).  

FUNCTIONAL TESTS.  Performance measures include specific tests that assess single limb hop distance and jump landing technique.  We know that higher single leg hop performance at the time of assessment predicts better self-reported function at 1 year from surgery (Logerstedt 2012).  Further, those with symmetric single leg hopping distance as well as high self-reported function are 4x more likely to have successful sports participation (Schmitt 2016).  The ability to pass these tests is correlated closely with strength; however, these tests can also identify if and how an athlete is compensating for their injury.

Rehabilitation also includes sport specific training that addresses known risk factors for ACL injury.  We have worked with most types of athletes, even rodeo.  Integrating sport specific training into rehabilitation will improve psychological readiness and confidence which is as important as physical recovery.  We will also work with your athletic trainer or strength coach, if applicable, to ensure you transition back to training seamlessly.

VISIT our webpage dedicated to ACL topics HERE

References

Barber-Westin S, Noyes F.  Factors used to determine return to unrestricted sports activities following anterior cruciate ligament reconstruction.  Arthroscopy.  2011;27(12):1697-1705.

Ebert JR, Edwards P, Yi L, Joss B, et al.  Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction.  Knee Surg Sports Traumatol Arthrosc.  2017 Sep 5.

Grindem H, Snyder-Mackler L, Moknes H et al.  Simple decision rules can reduce re-injury by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.  Br J Sports Med. 2016;50:804-808.

Ithurburn M, Altenburger A, Thomas S, Hewitt T.  Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of Return To Sport demonstrate reduced knee function 1 year later.  Knee Surg Sports Traumatol Arthrosc.  2017;Sept 26(1320–1325):1-8

Kyritsis P, Bahr R, Landreau P, et al.  Liklihood of ACL graft rupture: not meeting six clinical discharge criterior before return to sports is associated with a four times greater risk of re rupture.  Br J Sports Med.  2016;50(15):946-51.

Logerstedt D, Grindem H, Lynch A, et al.Single legged hop tests as predictors of self-reported knee function after ACL reconstruction.Am J Sports Med.2012;Oct;40(10):2348-56

Sinacore JA, Evans AM, Lynch BN et al. Diagnostic accuracy of handheld dynamometry and 1 rep max tests for identifying meaningful quadriceps strength asymmetries. J Orthop Sports Phys Ther. 2017 Feb;47(2):97-107.