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FAQ on the ACL Cross Bracing Protocol

1. What is the ACL Cross Bracing Protocol?
The ACL Cross Bracing Protocol is a non-surgical method developed by orthopaedic surgeon Merv Cross OAM and Dr. Tom Cross for healing a ruptured Anterior Cruciate Ligament (ACL). It involves bracing the injured knee at a 90-degree angle, which closely aligns the torn ends of the ACL, facilitating natural healing and potentially avoiding reconstructive surgery.

2. How successful is the ACL Cross Bracing Protocol?
Initial studies show promising results. The protocol has demonstrated a high rate of ACL healing. A published case series revealed that 90% of participants showed signs of ACL healing on MRI scans after 3 months. More recent data from a larger patient pool shows healing in 94% of participants. The re-rupture rate is reported to be around 11%.

3. Who is a good candidate for the ACL Cross Bracing Protocol?
Ideal candidates are typically those who have experienced an acute ACL rupture (4-7 days post-injury) and meet specific criteria. These include a gap distance between the torn ACL tissue of less than 4-6mm (depending on patient height), no ACL tissue displaced outside the intercondylar notch, and an intact femoral origin of the ACL. Assessment by a specialist like Dr. Tom Cross is crucial to determine eligibility.

4. What does the ACL Cross Bracing Protocol involve in the initial weeks following injury?
The protocol starts with first-aid instructions and involves wearing a range of motion brace initially set to 30°-90°, and then fixed at 90° for the first 4 weeks, combined with non-weight bearing (NWB) on crutches or a scooter. Patients also need to use anti-coagulant medication to mitigate risk of DVT for the first 60 days. Weekly physiotherapy sessions are required for exercise progressions, and regular brace adjustments take place.

5. What type of brace is recommended for the ACL Cross Bracing Protocol?
Dr. Cross recommends the Bauerfeind SecuTec Genu Brace with additional 90° extension blocks (specifically requested). The ASCENDER ROM KNEE BRACE is another approved option. The brace must allow for specific range-of-motion limitations as prescribed in the protocol.

6. How does the protocol progress over time?
The protocol involves a gradual progression in brace range of motion, weight-bearing status, and exercises. Starting with a fixed 90-degree brace and non-weight bearing, the brace angle is progressively increased, and weight-bearing is gradually introduced. Swimming and stationary biking can be commenced in the brace. More intense activities like running and agility exercises are introduced later, after several months of rehabilitation.

7. When can a patient expect to return to play after following the ACL Cross Bracing Protocol?
The timeline for return to play is approximately 12 months. This includes a graded progression through strengthening exercises, running programs, and agility drills. Return to training is usually possible around 6 months, with a full return to play at 12 months, contingent on successful healing and functional recovery.

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Subject: Understanding and Mitigating Exercise-Induced Fatigue for Improved Performance and Reduced Injury Risk

The podcast summarises key findings from the provided text on exercise-induced fatigue, its connection to injury risk, mechanisms behind fatigue, and evidence-based recovery protocols. The document highlights the importance of comprehensive recovery strategies encompassing nutrition, hydration, sleep, and specific interventions like cold water immersion and compression garments.

Key Themes and Ideas:
Fatigue as a Risk Factor for Injury: The text establishes a clear link between fatigue and injury. The data "a high percentage of injuries occur late in each half of a game, suggesting that fatigue is a risk factor for injury." This underscores the need for proactive fatigue management.

Multi-faceted Mechanisms of Fatigue: Fatigue is attributed to a combination of central and peripheral factors. Central fatigue involves decreased maximal voluntary muscle contraction and sprinting ability, while peripheral fatigue includes muscle soreness, damage, and inflammation. Other contributing factors include glycogen depletion, dehydration, muscle damage, mental fatigue, jet lag, and poor sleep.

Recovery Time and its Impact on Injury Rates: Full recovery from intense exercise can take between two and four days. Crucially, the text notes that "injury rates are increased when there are less than 6 days between matches." This emphasizes the need for adequate recovery periods to prevent overuse injuries. The document warns that “When playing two matches per week, the 3-day recovery time between two successive matches may consequently be insufficient to fully recover."

Evidence-Based Recovery Protocol: The text outlines a multi-pronged recovery protocol with a strong emphasis on nutrition, hydration, and sleep, alongside interventions like cold water immersion and compression garments.

Conclusion:
Effective fatigue management is crucial for optimizing athletic performance and minimizing injury risk. This requires a holistic approach encompassing proper nutrition and hydration, adequate sleep, and targeted interventions. The protocol presented provides a framework for implementing evidence-based recovery strategies.