hbbd```b``Z";d,d"? |1WwD >(E>[ X\j&7< 6whY+}v39v/1/wJU-nGQ v JCJX*?=XrtbgS#Nl|wk\6Ac /{h6*!(K6abZ}6M3RUl+pm@k=do3aCyF*wrVN7DixiDaLb^x)G. Tommy John Surgery | UCL Injury Overview | Dr. Christopher Ahmad Hrut LF?L . In a recent laboratory study conducted by the Arthrex Research Department using cadaver specimens, the thumb UCL with internal brace was four times stronger than the standard repair with suture alone. Thumb UCL Repair With Internal Brace Ligament Augmentation 110 0 obj <> endobj Ultrasound-Assisted Assessment of Medial Elbow Stability %PDF-1.7 Arthrex - InternalBrace <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Orthop & Spo Med Op Acc J 3(1)- 2019. %PDF-1.6 % The primary goal of this surgery is to enhance elbow joint stability while the ligament is healing and to allow earlier return to sport after UCL reconstruction. endstream endobj 503 0 obj <. %%EOF Repair and InternalBrace Augmentation of the Medial Ulnar Collateral <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The rise of ulnar collateral ligament reconstruction and the fall of ulnar collateral ligament repair. stream thumb ucl repair with internal brace protocol - store28dz.com Initiate Throwing: 14-16 weeks (3.22 Months for Comparison) Bullpens: 24 Weeks (5.52 Months) Live BPs: 30-33 Weeks . H00:GCp#r x This animation demonstrates repair of the ulnar collateral ligament of the thumb with the InternalBrace ligament augmentation procedure. Thumb Collateral Ligament Injury - Hand - Orthobullets PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois (} oA%Yv:JzFQA 0X"5o A%U- MLZ;?3%RO8?DnQN['y]{_5%x@iSt>K2! 128 0 obj <>stream Skier's thumb is an acute partial or complete rupture of the ulnar collateral ligament (UCL) of the thumb's metacarpophalangeal joint (MCPJ) due to a hyperabduction trauma of the thumb. endstream endobj startxref Rehab Protocol - Thumb UCL Repair (Internal Brace Only) Dr. Broering PRECAUTIONS Full time splint use except for ROM. REHABILITATION PROTOCOL: ULNAR COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION RADIAL COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION THUMB MP JOINT WITH INTERNAL BRACE A. J. Mencias, M.D. <>>> your repair for 4 more weeks. endstream endobj 80 0 obj <>/Metadata 3 0 R/Outlines 7 0 R/PageLayout/OneColumn/Pages 77 0 R/StructTreeRoot 32 0 R/Type/Catalog>> endobj 81 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 82 0 obj <>stream Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Late effect of dislocation (nonspecific) (905.6) Repair lateral collateral ligament, elbow, with local tissue (24343) Repair lateral collateral ligament, elbow, with tendon graft, including graft harvest (24344) Repair medial collateral ligament, elbow, with local tissue (24345) Repair medial collateral . 148 0 obj <>stream This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. sHSlC:">)n2oAGV?vtE6f?r83bSXk8[~@t(zQXA>)V|@)} 1&%_qU}VuA (nKS"(;VB| >`UVtXb#xEpF,Z%ZX["'XP <>/Metadata 554 0 R/ViewerPreferences 555 0 R>> See Tua at the University of Alabama, for examaple. With the UCL repair, the surgeon will repair your native ligament and re-attach it to it's respective insertion site. 1. 533 0 obj <>/Filter/FlateDecode/ID[<6B9C59BBC5B61A4384B9FC807F8AE13A><1E4DC5E074430D4EA5AA205F41080698>]/Index[502 56]/Info 501 0 R/Length 138/Prev 267459/Root 503 0 R/Size 558/Type/XRef/W[1 3 1]>>stream As the internal brace technique continues to mature, its application has been gradually expanded to include repair of the anterior talofibular ligament and deltoid ligament in the ankle, anterior and posterior cruciate ligaments, medial and lateral collateral ligaments and medial patellar ligaments in the knee, and ulnar collateral ligaments in . 2 0 obj Brotzman, S. & Novotny, S. (2018). Postoperative Rehabilitation 7-10 days postop The bulky compressive dressing is removed. A bP .a+ZY^tL3ab`y7*n&++c Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Abstract and Figures Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if. hV]OF+B^ UCL REPAIR WITH INTERNAL BRACE . Right after the surgery, the elbow is secured in a brace at a 60- to 90-degree angle. This design severely limits functional use of the thumb. <>/Metadata 102 0 R/ViewerPreferences 103 0 R>> PDF Elbow Ulnar Collateral Ligament (UCL) Repair Rehabilitation Protocol Thumb UCL Repair (Internal Brace) 0-2 weeks: The postoperative dressing is removed. 1 i^D=)ngloqvb_3.&3e/.[A GF;'YDL65_lZ4l$!`,yv I(=wY */xZFXDI6%t0^&2L7@~DSN1& A longitudinal incision was made over the thumb over the metacarpophalangeal (MP) joint, the skin flaps elevated, the extensor shroud released, tendon pulled back, the adductor attachment released and the ulnar collateral ligament identified. The rehabilitation protocol after a Ulnar Collateral Ligament Repair with Internal Brace surgery typically involves several phases. %PDF-1.7 Duration: 01:52. %PDF-1.6 % ULNAR COLLATERAL LIGAMENT OF THE ELBOW RECONSTRUCTION USING AUTOGENOUS GRAFT PROTOCOL 3 Progress shoulder isometrics to isotonics, emphasize rotator cuff strengthening (Avoid resisted external rotation until 6th week to minimize forces on repaired UCL) Week 6 Brace - hinged elbow brace set 0-130 degrees. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Tommy John vs UCL Repair Armored Heat 4 0 obj Dr. Allen Thumb UCL Reconstruction Rehabilitation Protocol Phase I: Immediate Post-Op (Weeks 0-2) . PDF Rehabilitation Protocol: Ulnar Collateral Ligament Repair Whilst both terms are often used interchangeably, the skier's thumb refers to the cause as being acute injury. PDF Thumb UCL Repair- Early Mobilization - UW Health % k,/f&;}P7# Lg W*lwHOPC(LZc>XgI3j:][1/+YX-?p%"6_NaWFv%k]|{6e@Ij Elbow Ulnar Collateral Ligament Repair with InternalBrace 3 0 obj <> 104 0 obj <>/Filter/FlateDecode/ID[<33B8DE36AB984B418169C7A4E24F203B><19F8EE0B324BFE44BA1CA95B759557F5>]/Index[79 50]/Info 78 0 R/Length 117/Prev 108309/Root 80 0 R/Size 129/Type/XRef/W[1 3 1]>>stream ( E`\Boy 'n"%QBiClMVmfzKRbq"j>Ws$ 3 0 obj 3BRKpw.4/Y. 6=J). hbbd```b``"'Iwh"HVqD``\y "g= ] l+ =&KU20R4@ US At the ulnar aspect of the thumb MCP joint, a longitudinal midaxial incision is made. Thumb UCL Repair- Early Mobilization This protocol is intended to provide the clinician with a . Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery Finger spring: Place a large rubber band around the outside of your thumb and fingers. Thumb UCL Repair With InternalBrace Ligament Augmentation What's New in Orthopedics 207K subscribers Subscribe 24 Save 3.8K views 1 year ago .more .more Notice Age-restricted video. . reported 92% success some returning overhead athletes to the same a high level of competition is an average of 6.7 months with UCL repair and internal brace . Finger and hand range of motion: maintain AROM and PROM @B 8XqhPTU&] ia$A{B;*QX% ]p7L`k?g.G{"z)UU(YY%y\*.ic-PtB *qjbeBA1~ J Orthop Sports Phys Ther. Elbow Ulnar Collateral Ligament (UCL) Repair Rehabilitation Protocol Kelly Holtkamp, M.D. x]kF_!BBf%I(BTb%]3NrqO%)(V}nu+;jvcyiwuY[_4*j{]e>gUQU~"_e? Restrictions: No heavy lifting greater than 0 lbs. %PDF-1.3 <> *`]hgTTS:MV{gXS&K|-3m The success of that surgery resulted in it being called the Tommy John procedure. 4 0 obj 4 0 obj Ulnar Collateral. 0 PDF Rehabilitation Guidelines for UCL Repair with Internal Brace. hbbd```b``3@$S=d`6;dq7.`.df`\0LE-`6H rlg4okAdaHMH %%EOF | Find, read and cite all the research you . Surgical management of acute combined injuries of the ipsilateral wrist cfzn(WH`&8:YUx~Ru1?-K)N(-cY2N[wH.A^Nu1T lTr[wyKt1+oE.Bj^&Q 2)A*a0'AY(|\k2E M * m| ""/+Gq <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Exercises: Continue all exercises listed above Elbow ROM in brace (-30 to 100) Initiate isometric elbow extension Initiate wrist isometrics &Dam[L1-J" iiBUq[{0R 3xVoEouUja,Jd> k '! The internalbrace is the underpinning of the repair procedure. x[k_!l&.]>d!EMeK-y2+^]=2>P?tq:LzN=VA5X\SWZiu*zzmjN5Ru= QRN>`:N}x^_o?y,A\C/WiNQu)Ftz#CBk_QoTk-)WUT^\QBOSRM]8zb'ai+Zd|oc5&hYGkC(KURumUHkf]*A+KU"1OZ&AUh )M4p0m|iMLku=uJ Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Nexus Day Surgery Centre on LinkedIn: Thumb UCL Repair With hb``d``jd```y Traditional custom-fitted thumb spica orthosis In a recent cadaver study by Gil et. &H<0LElM0i""(P f4G0 H2a`70&E00v$`?W r At 6 to 12 weeks, begin adductor and interossei strengthening, avoiding valgus stress on thumb MCP. Joint destruction compresses nerve roots, resulting in pain, paresthesia, sensory loss, dysautonomia, and spasticity. Walters BL, Cain EL, Emblom BA, Frantz JT, Dugas JR. Above protocol adapted from Dugas and Wilk: Wilk KE, Arrigo CA, Bagwell MS, Rothermich MA, Dugas JR. Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Following Internal Brace Surgery. 60 0 obj <>/Filter/FlateDecode/ID[<0AF1E1B641B34B46855587C2A48FF27B><237A0C35EE1B4C46B05DEA8683FB9A51>]/Index[49 44]/Info 48 0 R/Length 76/Prev 328473/Root 50 0 R/Size 93/Type/XRef/W[1 3 1]>>stream Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Thumb UCL Repair with InternalBrace Ligament Augmentation Volume 3 ssue 1 Coprig Kevin ilk et al. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. <>/Metadata 558 0 R/ViewerPreferences 559 0 R>> 1 0 obj 4 0 obj JCM | Free Full-Text | Clinical Research Progress of Internal Brace 0 1 0 obj At 6 weeks after surgery, the supportive brace should be worn with activities, but you may do light tasks, such as typing without it. stream % <> PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine 1). 3 0 obj x[[oF~70/ 8m6EMc/El%{JaeQlQCwnz5fy3iboob9jV Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com Elsevier. <> <> Shoulder isometrics (no shoulder internal rotation) Biceps isometrics . The repeated microtrauma is a result of a lack of muscle protection and destroys cartilage, ligaments, and disc spaces, leading to vertebrae destruction, joint instability, subluxation, and dislocation. endobj They demonstrated a significantly greater resistance to gapping with valgus stress with the UCL repair with internal brace (mean SD, 0.35 0.16 mm) compared to UCL reconstruction (0.53 0.23 mm). thumb ucl repair with internal brace protocol &H+JIKv)ATPJ};CH 4 0 obj Phase I (weeks 0 to 3): Splint for one week, then transition to a hinged elbow brace with gentle motion from 30 to 110 progressing to 10 to 125 at week 3. <> General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, <>/Metadata 83 0 R/ViewerPreferences 84 0 R>> <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> PDF ULNAR COLLATERAL LIGAMENT REPAIR with INTERNAL BRACE Postop protocol SYMPTOMS: The thumb may be swollen, bruised and painful. r e c . ULNAR COLLATERAL LIGAMENT (UCL) REPAIR REHABILITATION PROTOCOL Brace: Hinged elbow brace open to achievable and comfortable ROM as determined by therapist ROM: 0-100 by week 4 Progress active elbow flexion as tolerated Full shoulder and wrist ROM Therapeutic Exercises: Wrist isometrics (pronation, supination) 7-10 day post-op OT to fabricate a custom FA based thumb spica AROM of the wrist and IP of thumb >W ` 8;d3^ The length of each phase varies depending on each patient and depends on tissue healing and progression. stream PDF Thumb UCL Repair- Conservative UCL Repair With Internal Bracing - The Wave of the Future? -Hand based thumb spica brace (comfort cool) . The ulnar collateral ligament (UCL) does not play a large role in elbow stability for most activities of daily living, but it does undergo tremendous stresses with overhead throwing and is susceptible to injury in overhead athletes. PubMed PMID: 30862273. 2 WEEKS (1st Visit) Fit with custom hand based thumb spica splint (Please allow thumb IPJ motion) OT INSTRUCTIONS - Ok to work on wrist, CMP, IPJ motion, & scar massage Surgery may also require repairing the avulsion fracture using a pin, screw, or bone anchor. These tears often occur as a result of a radially directed force on an extended thumb. the thumb. UCL Repair Ulnar Collateral Ligament Repair Protocol Ulnar Collateral Ligament Repair Protocol Phase I: Immediate Post-Surgical Phase (Days 1 - 21) Goals: Protect healing tissue, decrease pain and inflammation, increase scar mobility, prevent muscular atrophy Exercises: y!my6gvF-~g,8\'N&p[t|x0 u0vNzSKjZ*C(hZ}szu9`3_?=/ hbbd```b`` "gA$d^ q 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . PDF Rehabilitation Protocol: Thumb Ucl/Rcl Repair Sam Fuller, M.d. 14 Days Postoperative Do NOT remove the surgical bandage. 79 0 obj <> endobj 0 Thumb Ulnar Collateral Ligament Repair with Suture Tape - PubMed There was gross instability of the ulnar collateral . endobj ]rav?4V&%n\(blvdf)TUL"Q+zaH$!EWq,0S4o~!dAf36J5/JqR^)jUx}2}`4vT.5l;c6gA>< MVSxwkHW *LLGrj iBy+9,[Ld~!VpQ[/zT-k.x #M'Ismi>uw a8G PeT{qo| R7RP2rAK(; 0 endobj <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Read court documents, court records online and search Trellis.law comprehensive legal database for any state court documents. The Effect of Ulnar Collateral Ligament Repair With Internal Brace <> Thumb UCL Repair and Reconstruction With Internal Brace Ligament Augmentation Repair Ulnar collateral ligament (UCL) tears of the thumb are common injuries. ,.l(\r @48 dJ^ %$HU 44HK[Y.D;2d8A1 d9\Imog|G|L8p,b}- BT"/q[[%p4)dl0( TOO#]x~0zKGeyk7-Zb!Z]#_@As r1'B04Lq0tS>Yf0lUQ0z.?9M7eCe[4^orMi|yF`8j_z\p=-g:I}^\RVDw*w Brace: Elbow ROM 30-100 Cryotherapy: Continue ice to elbow joint and graft site . Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation - Daniel B. Gibbs, Steven S. Shin, 2020 The new procedure involves repairing the damaged ligament and reinforcing it with a collagen-coated fiber tape in contrast with the traditional UCL reconstruction that involves drilling tunnels in the bone and using a graft from a tendon in your arm or leg. %PDF-1.3 Rehabilitation Following UCL Repair with Internal Brace - Lupine Publishers K`d:V0!QGXCor&J;#Z?='lH3cy?_pOk0qWR_heBU] u)dh5Q :e16&\H11}8 1AE Qf>`?SLXSu {q?u,:g@l2;1FhCSTV9}WKH}[agS~?P3{47*c:lg3l#`vLx}{*_Q]}O)D5*wX[PB{A8k1GtM{@onC 0Ggtz=CiZM.sVLCbi`JC3T)q7]tZ4c^l&XkC~?G.9J7 ]sO0h5_K]@GB[q[Vg"$(MjTy al., a radial-based thumb MCP orthosis designed to leave the thumb IP and CMC joints free limited thumb abduction which reduced the strain on the thumb UCL when loads were applied. Jsx cx=[wOGvu UV]QEMtejL11eO2\5~B*q>vvcu9]dtUbqjNU{ DOI: 10.32474/OSMOAJ.2019.03.000151. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries thumb ucl repair with internal brace protocolbest mossberg 500 heat shield Fine Art LLC thumb ucl repair with internal brace protocol . 1-3 Candidates for repair are most commonly young er (pre-professional) and present POST-OPERATIVE WEEK 2. Dressing changed at 7-10 days after surgery Week 2 Steven Shin, MD, treats elite athletes in his clinic, but you don't have to play for a professional team to benefit from his groundbreaking technique for treating thumb ulnar collateral ligament (UCL) injuries.. For injuries that need more than a cast, internal brace augmentation gives better and much faster results than conventional surgery, according to Shin, executive vice chair of Cedars . 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. endstream endobj startxref Hand and Wrist endstream endobj 111 0 obj <>/Metadata 5 0 R/Outlines 9 0 R/PageLayout/OneColumn/Pages 108 0 R/StructTreeRoot 16 0 R/Type/Catalog>> endobj 112 0 obj <>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 113 0 obj <>stream PDF Dr. Allen Thumb UCL Reconstruction Rehabilitation Protocol hb```) $- `>bPO,VLW0ba6d.fb>4mfBs2hef`t| Thumb strengthening: Pick up small objects, such as paper clips, pencils, and coins, using your thumb and each of your other fingers, one at a time. Edema control is initiated with a light compression dressing. % stream !-twF)rm16:M.J r]Sc]Oi~ 132 0 obj <>/Filter/FlateDecode/ID[<74EC21535A719E4081B6460A7EF86336>]/Index[110 39]/Info 109 0 R/Length 107/Prev 88703/Root 111 0 R/Size 149/Type/XRef/W[1 3 1]>>stream When the tear results in pain and instability, surgical repair offers a predictably successful outcome. The UCL provides up to 50% of the frontal plane stabilization of the Abbreviations UCL, ulnar collateral ligament; US, elbow against a valgus load.5 During the clinical evaluation, the ultrasound patient's elbow is placed under a valgus load with the elbow in vary- ing amounts of exion. The InternalBrace Thumb UCL may be repaired with Internal Brace Ligament Augmentation. UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina 2 0 obj endobj V8FW At 4 to 6 weeks, removable thumb spica splint, and protected range-of-motion exercises. ~Y$'h9N`haq8"% {s D)gZ2J =ky~ pP],DQgUh6*DM6`vlK ,R /"0q^p3S;LrV?-VS(6E?VAQJ@p EQQKiqLf[~vA]"`qW `!a`05I**ThsrAD8WH6SXb^h:R.?Q(oeR~R^N The UCL is the main ligament, located on the inner aspect at the base of the thumb, which stabilizes the metacarpophalangeal (MCP) joint. It was grossly incompetent and irreparable. Diagnosis relies upon thumb MCP radial-ulnar stress exam and MRI studies. endobj 213 Figure 1: The UCL repair with the internal brace inserted within the ligament. At 10 to 12 weeks, return to . h!DWl{$A4L61)H}hJftyrI%kSQLc]5sbGP U_8v}9|(O(( qsMfGiICYL|*'VL+b% rt$mZE%'l6gIM*9;J1HIo1Z5F`$y-J+"kI.h&pjIhcLS[Ks9Ol|2:}Uu>i4~]t5sY=Bpnjb.-q M=q]9B!EOc6,Oq%4M 5eZ?DwEH 6h3)N1gzSVuQFoaxsARd. Practice this exercise for about 5 minutes. Postoperative protocol. *XM qD#qHU vr@^zo+Uwe#-`0XLij1 /&E-{BpR`buqyxw{y1E2vzy!`reY,$OcvCnbv_]pyu_//~0]8~t2Vj-/U endstream endobj startxref thumb collateral ligament | Medical Billing and Coding Forum - AAPC 8g14IRxEm`YH#V b6 be1Gv=*K:.;>'!y^vf%lX")z^-vr3[\)U8RnOG8+5[Y#l'^aAWgI>i];%*8jpht4%< pKV[t/ 8]oQ5JF*+zWQ61Hu^DDJT.0H>? Non-weight bearing to operative extremity. The anti edema management will continue for several weeks. EXHIBIT(S) - D (Motion #1) EXHIBIT D - Verified Bill of Particulas and Mrtl7"l\Q`?v`d: % Epub 2019 Mar 12. x[[o~70/5+/@`dk4],`hHp}9C9\YBKP.e?}|S-~K3KbEpSXy~ldpL"$.XHf>_~}d?Te5Zs$Rpdt ?3U,a_~`XRUWcQT2r?B73pgry.v3}w/2\Fz?6-SHK PXUU9:!$\@j)b;}r% /5 V5uz @ TY}]7KX75F1"3#TZLY|A/+{gc_?olhfGmHwiiB%"=CH$ai-`75 gdkZ_ 2 0 obj To date, no literat. stream stream It's pretty neat to see how it has taken on a whole world of uses, including in the knee and ankle. PDF Rehabilitation Following UCL Repair with Internal Brace - Lupine Publishers Rehabilitation following UCL repair with internal brace is accelerated by comparison to Tommy John Surgery. stream hb``g``Zs01G83023>"`*`+MKx.00e)zz oIB`F2Af*LoApKX@D l^" We describe the surgical technique of suture tape augmentation for thumb UCL repair. Key Timeframes: (Dr Meister/TMI Protocol) Plyometric Phase: 12-14 weeks.
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