Monday, August 24, 2020

Good vs. Evil Free Essays

Decisions: Good versus Detestable There are numerous ideas that are resolved entirely subjective. Individuals have various ethics; someone’s ethics could be viewed as debasement to another person. We will compose a custom exposition test on Great versus Detestable or then again any comparable point just for you Request Now What somebody thinks about excellent, another should seriously mull over horrifying. A person’s meaning of equity could be somebody else’s meaning of unlawful. There are numerous components with respect to why we as a whole have various standards, for example, the manner in which we were raised, our past encounters, our way of life, or our confidence. Thusly, we as a whole appointed authority in like manner to our own points of view. In East of Eden, John Steinbeck expresses that one can be accepted acceptable or malice once the individual has kicked the bucket. With our various standards, we would have alternate points of view on great and insidiousness. Consequently, we don't have a clue about the right meaning of good or malevolence, so it would not be directly for us to pass judgment on somebody at all previously or after their demise. All that we see is point of view, yet how are we so sure it is reality? Take for instance, a blossom. To a human, it is sufficiently little to grasp; to a creepy crawly, it is sufficiently large to be a home. The human and the creepy crawly are taking a gander at a similar bloom, however see it in an unexpected way. Is the subterranean insect basically smaller than normal, or is the human just too large? It can't be regarded on the grounds that there are various ideal models that control our judgment. There are additionally progressively genuine cases this applies to. On July 5, 2011, Casey Anthony was seen not as liable for killing her young girl Caylee. Eyewitnesses were paralyzed and shocked by the jury’s decision. Legal hearers guaranteed that it couldn't be demonstrated that Casey Anthony was blameworthy in light of the fact that there was insufficient proof. There were just realities that hinted at the end that Casey could be the killer, yet there were no crude and established truths that obviously demonstrated that Casey was answerable for the demise of her little girl. Capital punishment gauged a ton on the thought of the legal hearers. They had a real existence in their grasp; decisions and inductions were insufficient to see her as blameworthy. The jury could be regarded useful for adhering to the law and complying with their pledge, or they could be considered malevolence for letting a potential killer pull off a wrongdoing. There are numerous situations on this decision dependent on our perspectives, however we don't really know reality. There are such huge numbers of points of view known to man, we can never be so certain which is the right one. Without knowing reality, our decisions aren’t supported. They state there is a story behind everything. Stories for the most part have different sides to them, possibly more. As a rule, we need to accept that we know the full story. As people, we like conclusion and we don't care for unanswered inquiries. In any case, would it be advisable for it to frequently happen to somebody that there might be numerous obscure sides to a story? Marilyn Monroe was discovered dead in her room from an overdose on August 5, 1962. Monroe’s passing stays a secret and has gotten one of the most discussed paranoid notions ever. A few people accept that her passing was a murder, and a few people trusted it was a self destruction. There could be numerous obscure clarifications to Monroe’s demise, and we may never discover. Without information on how she kicked the bucket, our decisions are not think. There are continually going to be unanswered inquiries and equivocal endings. As people, what we accept is temperate ordinarily drives back to our perspectives and comprehension of life. Everybody has their life organized a specific route as indicated by their convictions. Our convictions hugy affect our attitude and activities whether we put stock in God, Buddha, Atheism, Karma, or anything by any means. With separating religion and convictions, there is no legitimacy to our decisions. Without the information on reality, we can't judge honestly; we would be accepting indiscriminately. It is a human sense to pass judgment. We judge to cause laws so society to can work in a deliberate way, we judge to shield ourselves from hurt by recognizing what is by all accounts perilous or unsafe, and we additionally judge to settle on choices to profit ourselves, for example, picking the school to our longing. Despite the fact that these are objective reasons regarding why we should pass judgment, they likewise lead to war, psychological oppressor assaults, generalizations, and partiality. Our suspicions and decisions spin around our viewpoint. Our ideal models outline our decisions, and this regularly results to various positions and perspectives. The idea of good and wickedness are according to the onlooker. The genuine meaning of good and underhandedness may never be uncovered in the course of our life. Thus, we can't regard somebody great or malevolence previously or after their passing since we don't have the comprehension of these thoughts in any case. Works Cited â€Å"Death of Caylee Anthony. † Wikipedia. Wikimedia Foundation, 11 Dec. 2012. Web. 07 Nov. 2012. http://en. wikipedia. organization/wiki/Death_of_Caylee_Anthony. Step by step instructions to refer to Good versus Detestable, Papers

Saturday, August 22, 2020

Health Issues of a Developed Country (The US) Free Essays

string(167) government proposed some essential auxiliary and utilitarian changes to the NHS that are recorded in the white paper ‘Equity and Excellence: Liberating the NHS’. Dynamic Since 1948 the NHS has experienced critical changes in its structure and method of activity. There is an unmistakable move as seen by a change from the completely open model of care conveyance towards expanding private investment in the NHS framework. The expanding human services utilization and cost pressures have, to a degree, settled on the first 1948 statement of absolutely free social insurance access to all. We will compose a custom paper test on Medical problems of a Developed Country (The US) or on the other hand any comparative theme just for you Request Now While the rebuilding of the NHS recorded in the white paper ‘Equity and Excellence: Liberating the NHS’ is in light of evolving requests, care ought to be taken through having enough execution observing and quality checkpoints that guarantee that private cooperation doesn't disintegrate a portion of the crucial qualities and characteristics of the NHS, the most essential of which is to empower value of access to quality human services. Presentation The NHS was propelled on July fifth 1948 by the then wellbeing secretary Mr. Aneurin Bevan so as to give medicinal services to all dependent on citizenship and need and not founded on the capacity to pay. It was completely financed by tax collection. The NHS in this way turned into the focal umbrella association that gave all clinical and related administrations free at the purpose of access to all UK residents (NHS, 2011). Since its beginning the NHS has changed fundamentally and today it has become the world’s biggest openly supported medicinal services framework (NHS, 2013). The NHS utilizes more than 1.5 million individuals (White, 2010, pg 3). In spite of the fact that the first pronouncement of the NHS was to give quality clinical consideration to every one of those in need regardless of their capacity to pay, the NHS has experienced a progression of changes and changes in the course of the most recent a very long while. The maturing society, expanding medicinal services requests, and the monetary weights it makes on the human services framework have in actuality required some noteworthy changes in the manner in which the NHS works. This paper will talk about these adjustments in structure and utilitarian parts of the NHS as featured in the white paper ‘Equity and Excellence: Liberating the NHS’ (DH, 2010) and some key changes in setting of the death of the Health and social consideration bill 2011. In the initial 25 years from 1948 there was an unmistakable qualification in that network wellbeing administrations were overseen independently by the nearby specialists while medical clinics were overseen by the NHS. Some auxiliary changes in the NHS were purchased about in 1974 and from that point forward both network wellbeing administrations and clinics have together gone under the domain of the NHS (Webb, 2002, pg 4). Under the first 1948 statement cost was not a factor and specialists were encouraged to give the best consideration to the patient with no cost contemplations (Leathard, 2000). Developing hospital expenses and budgetary shortfalls have obliged the legislature in completely executing their essential declaration of giving free treatment at the purpose of access, and bit by bit since 1951 charges were presented for false teeth and displays (Leathard, 2000, pg 34). Additionally since 1952, solution costs were presented. Throughout the years solution charges have seen a steady increment and as of April 2012 remedy charges are at 7.65 (Politics .co.uk, 2012). Far reaching challenges the solution charges have added to a few special cases in the physician endorsed medicate charges including for youngsters under 16, pregnant ladies, old individuals over 60, and so on. All the more as of late individuals with constant conditions, for example, malignancy have been incorporated into those under the absolved class. While in Wales and Northern Ireland solution charges have been totally abrogated, the English government has, in any case, showed that no further free remedy projects would be presented yet that the new arrangements would concentrate on tenderizing more decency into the solution charging framework (Politics.co.uk, 2012). Change to a Market System Constant underfunding and holes in administrations and the weights to improve the general working productivity have slowly prompted the NHS from being an all out open possession element towards a market based framework. Truth be told this move towards a market based framework could be followed path back to the Thatcher organization that presented the arrangements of ‘general management’ and ‘outsourcing’ which purchased about a central move. Senior supervisors were individuals who were worked in medical clinic the executives and gave a slick layer of interfacing between the wellbeing approach creators and the specialists and attendants who actualize the arrangements. Re-appropriating of non clinical administrations, for example, emergency clinic cleaning, providing food saw just because the passage of the private area into the NHS framework (DH, 2005). From that point forward private division support in the NHS has improved altogether. By the late 1990â€⠄¢s, for example, long haul care by NHS was at that point taken over to an enormous degree and oversaw by private revenue driven specialist organizations. Long haul older consideration is not, at this point liberated from cost. Expanding private investment could be surmised from the insights that from more than 137,200 private consideration homes in 1985 the numbers had dropped to 64,100 by 1998 (BBC, 1999). Old consideration in these settings isn't free and is absolutely implies based with those procuring more than ?16,000 for each annum bearing the whole costs while the state gives most extreme help to those under ?10,000 classes. NHS Spendings survey calls attention to that somewhere in the range of 1998 and 2010 there was a normal 5.75% expansion in wellbeing use while the NHS is scheduled to get .4% genuine terms development somewhere in the range of 2010 and 2014. This shows the level of monetary weight under which the NHS is working. As (Appleby et al, 2009) calls attention to, the weight on NHS will keep on expanding with developing difficulties because of a blend of variables including a maturing demography, significant expense weight of new clinical advances, and the desire for more excellent gauges. It is assessed that the NHS needs to make impressive cost cuttings by method of improved operational effectiveness to the tune of ?15 to ?20 billion with the goal for it to have the option to keep giving impartial access to human services administrations to all the citizens(Nicholson, 2009). It is under these desperate conditions that the UK government proposed some central auxiliary and useful changes to the NHS that are recorded in the white paper ‘Equity and Excellence: Liberating the NHS’. You read Medical problems of a Developed Country (The US) in classification Paper models One of the major changes to the association of the NHS as rattled off in the White paper is the devolution of the ‘Primary care Trusts’ (PCTs) (Nuffield Trust, 2010). The PCTs which were established in 2002 to direct essential consideration arrangement is not, at this point a substantial element. Its capacity has been taken over by Clinical charging gatherings (CCG) containing fundamentally of nearby GPs. The thought behind such a change is to build neighborhood strengthening. Moreover the PCTs were in the past battling with visit rebuilding. One of the fundamental thought processes behind such a change is to put more noteworthy obligation with the nearby GPs as they are legitimately associated with administration referrals. Likewise since GPs are legitimately engaged with both dispatching and care arrangement they are better situated to make powerful evaluations and to forestall superfluous hospitalization and different administrations. At the end of the day, the founda tion of the GP consortia which is one of the features of the ‘Equity and Excellence: Liberating the NHS’ white paper, is relied upon to build the combination between the GP’s , pros and other specialist organizations clearing route for an incorporated consideration conveyance system that is both practical and proficient. Moreover, the white paper additionally alludes to the development of a NHS authorizing board that administers the general fair access to NHS administrations, appointing, and the correct designation of assets. This would guarantee that micromanagement isn't an issue at the NHS. The new strategy system likewise breaks up a few quangos along these lines bringing about more noteworthy operational reserve funds. By these methods the new changes are scheduled to set aside to 20 billion as far as proficiency of tasks by 2014. Projections show that up to 45% reserve funds could be acknowledged as the board related cost investment funds (DH, 2010, pg 5). One of the particular variables of the present NHS changes contrasted with the first NHS strategies is the move from a simply open framework towards a more market driven social insurance framework. The emphasis on expanding the investment of the patient and giving them the decision with regards to their specialist organizations and the treatment that they need are especially noticeable parts of the new human services bill. . The incorporation of the ‘choice of any willing provider’ in the ‘Health and Social Care Bill’ lays weight on the expanded opportunity for the wellbeing shopper (DH, 2010, pg 17). It additionally underlines the expanding rivalry among contracted wellbeing specialist co-ops which is eventually useful for improving the general nature of human services conveyance. Decrease in bureaucratic control and strengthening of the consideration suppliers suggest that the essential consideration providers’ could work freely and successfully to address the issues of the patients. Powerful observing is the way in to any utilitarian framework. For a colossal association, for example, the NHS observing the working of the different offices and frameworks is extremely fundamental for accomplishing smoothing out of activities, process proficiency and accomplishing high qual

Monday, July 20, 2020

Contrarian Investing When Theres Blood in the Streets

Contrarian Investing When Theres Blood in the Streets “The Time to Buy is When There’s Blood in the Streets”As Baron Rothschild rightly said in the 18th century itself, has become the motto for contrarian investors around the world.The quote by Rothschild originally was believed to be, “Buy when there’s blood in the streets, even if the blood is your own”, which he implemented himself by buying in the most serious time after the battle of Waterloo during the panic.The belief that when things seem worse in the market is the best time to make a move and profit is considered to be the soul of contrarian investing.If you are new to the world of investing, we would suggest you to take it slow.Let’s see what the contrarian investing strategy is and how it is similar to value investing.WHO IS A CONTRATARIAN?Think about a contrarian as an investor who tries to earn a profit by deviating from the herd and investing when the market seems to go down and sell when others are buying.The crowd, in such cases, tends to overreact to the m arket’s condition without analyzing it carefully which leads to a maximized increment or decrement of the prices allowing the contrarians to profit more than the general investors.Read on to find out more about this type of investing that suggests you buy or sell in extreme conditions and why.CONTRARIAN INVESTINGIn simple terms a contrarian is someone who buys when others are selling and sell when others are hoarding up to avoid subsequent losses, it sounds simple, but is it really?Let’s find out.Now that you know who a contrarian is, it will be easier to understand the process of Contrarian Investing.Contrarian Investing is nothing but a strategy that is characterized by buying and selling goods in opposition to the prevailing market situations.With this strategy, a contrarian dives into the market and buys a stock at times other investors are getting rid of their stocks at a significantly lower price and vice versa.Sometimes the stock price is exploited so much that it exagger ates a company’s risk and belittles its prospects of rising back to its value.Identifying and selling such stocks can lead to extremely heightened profits when the company gains back its popularity, conversely when the price of a stock is skyrocketing it is common that there will soon be a drop leading to loss, at such times the contrarians get rid of such shares when stockholders are accumulating them to avoid future costs.However, contrarian investing is not simply about undervaluing or overvaluing the conventional stock market but about grabbing the opportunity when it presents itself without any fear.Such opportunities may occur when the market is greatly falling or rising.More candidates are identified when a market fluctuates greatly (fluctuation can be positive or negative).The mutual mindset of contrarians is that the worse things seem in the market, the more opportunities appear to profit.The result for such investment is, for example, a contrarian frequently buys cheap s ecurity that others think is a dog and sells a security that everyone else is demanding for.You must have heard the term value investing?It is often used synonymously with contrarian investing but is it the same? Find out!Contrary to popular belief, both, contrary investing and value investing have their differences, but a common similarity is that contrarians often value invest.Wondering how the graph of a contrarian investor would look like? Here is an example. Source: INOWHAT THEN, IS VALUE INVESTING?It is when investors try to find stocks trading at values lower than their intrinsic costs and jump at such opportunities to make huge profits later on when the stock price hits the ceiling.For this, the investors must be patient, and it may mean that they’ll be holding the stock for a while.However, the higher profit makes it worth the wait.The idea is buying a mispriced stock and waiting until eventually, the stock price moves closer to the intrinsic value or above that, at such times the value investors sell the stocks that they got at the cost of stones at the price of gold.FINDING THE RIGHT VALUE OF THINGSValue investors are always looking for bargain deals which may result in earning more than their initial investment; they buy companies when their stocks are priced below their original value allowing themselves the best chance of profiting from their investment.It may seem unnatural, getting more by paying less but that’s what value investors do, in simpler words, value investors exchange a 5-dollar bill for 20 dollars as you’re buying something that is worth more than the company is charging.Benjamin Graham, the father of value investing, advocated an approach he liked to call ‘the cigar-butt approach’ to investing where he bought potential companies that couldn’t meet their intrinsic values and invest in them until they reaped profits.He compared this approach to a cigar-butt he picked up from the street that had one last good puff left in it, taking a drag from it and then throwing it away, this way both the company which other investors would often overlook would get an investor and Benjamin would get one last drag (of their profit).DONT MESS WITH A CONTRARIAN INVESTORContrarian investors, on the other hand, are like that annoying friend, who does the exact opposite of what is advised.Contrarians bet against stocks that are priced more than their cost and also stocks that are suitable for value inv esting (obviously).Value investors are often contrarians, and they know what time is best to buy stocks at bargain prices when most investors are fearful and act oppositely by selling stocks at cheaper values.Contrarian investing is more of a strategy or an approach to investing in extreme conditions whereas value investing is a kind of investing.Now that we know about the father of Value investing, let’s learn about the Wizard or as they call him ‘Oracle of Omaha’, and largest shareholder of Berkshire Hathaway, Warren Buffett, and his investing strategy.Buffett meddled with the traditional concept of value investing in making it his own, and rightly so as he is now one the richest people in the world.He says in an interview, “It is far better to buy a wonderful company at a fair price than a fair company at a wonderful price”, which makes it clear that Buffett is a value investor on the contrarian side that loves to hold stocks until the maximum period before getting the best price.When everybody thinks alike, contrarians see the full picture and invest in the opposite possibility.Where value is investing can be identified by using financial metrics, such as the price to earnings ratio, contrarian investing also identifies the sentiments regarding the stock among other investors such as trading volume and earnings forecast of a company and its business prospects.Here is a look at what some contrarian investors have to say. Now, let’s get back to contrarian investing as a whole and discuss the factors and rules contrarians abide by to make successful investments.THE TOP ASPECTS TO CONSIDER TO INVEST RIGHTHere are some factors that every contrarian must consider before making investments and why.1.  Popular Sites and Magazines are a No-NoMaterial and information that everyone else is using to invest are completely useless for contrarians. They are in fact ‘contrarians’, they must go contrary to the popular flow and make a profit in the process.P opular websites, magazines, newspapers, and TV stations should be treated as irrelevant while investing and must be considered only if you plan to go against what is said in such sources.If most people are buying in you must not buy in, consider it like that, if you’re on a bandwagon that is overloaded and about to buckle under the load, it would be wise to get off that bandwagon.These sources must be used as a guideline to avoid mainstream investments.2. Don’t Fit InContrarians always stand out, they go against the herd and make the most out of it, by critically analyzing different possibilities first.Being a loner helps in contrarian investing while taking a position.Getting approval from others would be impractical if what you wish to do is stand out, and if the crowd automatically approves what you are doing then you must reanalyze your strategy from scratch.3. Leave Warren Buffett AloneLet’s be honest. All those mantras from Warren Buffett are great, but you’re not him (not yet of course).Buffett invests using money from different sources and not his own, holding on to shares for a long time is not advisable as your funds will be blocked during the time.Let’s face it, Buffett has tons of money which he can put on hold without affecting him, but you as a beginner cannot do that.His ideas are all great but not suitable for beginners and people with limited funds.So, all those ‘Warren Buffett’ ideas you penned down while researching on the internet, hold on to them and not your shares.Agility is key, buy stocks hold on for a while and then sell without wasting any time so you can invest in a new position.4. Don’t Hold On (forever)Don’t invest in something and get attached to the position that is counterproductive in any type of investment.Think of it as a piece of paper that you must eventually get rid of in order to increase your productivity in the share market.It’s just an investment, close positions quickly and moves on where the gras s is greener only then can you dare to be different than the masses.5. Look at the Turnaround TimeThe market changes almost rapidly and with fierce aggression, wait for such opportunities and don’t let them affect your investments by financing companies that are doing good and improving at a decent pace.There are several such companies out there which investors often overlook or undervalue based on misjudgments and general hatred among masses; contrarians work hard to find exactly such companies which are being undervalued for all the wrong reasons.Don’t mistake these factors for the rules that you must follow, they are binding, but the rules are definite.There are some similarities between these aspects and the rules contrarians follow, but the factors are not all that you must consider.Let’s look at what else contrarians do to make the most out of their fearsome investments.KEY RULES TO INVEST RIGHTHere is a beginners’ guide to investing you might want to check out. We wil l also talk about some of the other investing tips below.Nothing Popular Helps Directly.Flush out all the popular sources and trends out of your options.Going against the flow is essential for contrarians to win big at the end and following the herd is not the way to go.These magazines and newspapers are like toilet paper for investors, they serve a purpose but that’s it, they’re not the contrarian’s bible.The only thing their information is good for is that it helps contrarians to counter what is trending.Be TechnicalAnalyzing the technicalities is important for any investment, take some time to study the basic tenets of the investment field and sectors.Focus more on the less popular principles, the efficiency of these tenets is surprising after you understand how different tenets, like business and value tenets, operate.Trading InsightsUnderstanding the market is another crucial aspect of contrarian investing know as much as you can about the field and sectors you are playin g in.The market changes at an abrupt pace and being quick on your feet is very important to make smart investments.Be Smart: Follow a PlanBe practical and create a blueprint before you dive into the market because once you invest, there’s no turning back.Don’t enter the market blindfolded; chances are instead of hitting the jackpot you will likely lose everything.The plan must include an individual entry and exit plan in case things don’t go as you intended them to, which is mostly the case with investments.Know When and HowDon’t jump in without thinking and then repent, understand when the time is right to buy and when you must get rid of the stock you’ve been accumulating.Do not use all of your funds in trading shares as chances are; you’ll lose everything, do, it is better to hold on to most of the funds and invest in shares which you are sure (or almost sure) about after researching about the trends.Now that you know all the what and ifs of contrarian investing let†™s find out more about the phenomenon, its importance and how contrarian investing (which seems so simple) can be dangerous.WHY IS IT IMPORTANT?As popularly said by contrarians, “Be fearful when others are greedy and greedy only when others are fearful”, contrarians do exactly that, they buy when other investors are selling and sell when others are buying, it sounds simple, but now you know that it really isn’t.Buying and selling shares during a crisis is very beneficial as it leads to either the price going as low as it gets or completely hyped up which is the point of investing in the share market if you think about it.   Such investors (contrarians) are ready to go against the crowd and put everything online to win big in the long run.When traditional investors are panic-selling, contrarians are taking advantage of this drop in the price to buy more shares, and as they say after every night a new day dawns, the dropped prices after a while, when the company’s worth is rea lized, rise up resulting in substantial growth.Contrarian investment can be looked at as a long-term investment strategy with benefits higher than general and short-term investments.Contrarians never bet for the present; they bet for the future and in a dangerous market where others are generally doing the opposite of what the contrarians intend to do.Traditional investors do not agree with the strategy of contrarian investing, but that is something that contrarians see as a sign that they’re on the right track.RISKY ENDEAVOR â€" UNDERSTANDING THE INHERENT RISKSAs simple as it sounds, there are certain risks associated with going against the flow with contrarian investing, let’s discuss some of them in this section.1. Overpowered by the HerdAs discussed earlier, the concept behind contrarian investing is waiting for the prices to get too high or too low, which sooner or later they will.Like contrarian investing there is another concept of ‘Momentum Investing’ which is the op posite of it.In momentum investing, investors go with the herd and invest where most people are investing; this may create problems and long waiting period for contrarians.When investors start leaning towards the crowd, it means trouble for contrarian investors as the momentum investors are inclined towards the forces that the contrarian went against.A similar situation arose in 1996, when the stock prices reached to dangerously high levels, making many contrarians sell before they had intended to and when this occurs, it generally continues for years as a trend.2. It Gets LonelyLet’s face it, contrarian investing means you’ll be winning when others are not satisfied.It is human nature to want to do what others are doing, contrarians must go to great extents to resist that urge and stay put on their original decision.If you give up your contrarian shares before the intended rise in stocks, then chances are (more than less) you will be in huge debts.There will be times when you w ish to banish your initial plan and begin following force (other investors), but this may result in disastrous situations for you.3. The Crowd is Not Always WrongIt is common practice for contrarians to believe that the stocks where the majority of people are investing are always overpriced.This may not be the case at all times, not everyone is stupid, if many investors are following the same pattern then the odds are generally in their favor and just a single per cent leaning towards you, and honestly, those are not really good odds.The crowd can be right at times, but it is also wrong, it is up to you whether you’re willing to take a risk.4. Overestimation of One’s AbilityNo doubt contrarian investors are smart but perhaps too smart, and this is what gets in their way.They try to rationalize every big fluctuation the market faces and make mistakes as not every big trend means an opportunity; you must know when to buy and sell.You cannot always tell where the market will take y ou; it is only a matter of time that all your dreams are crushed with a curveball the market throws at you.Contrarian Investing requires a mixture of precise judgments and just the right amount of smartness if you think you can hack it then give it a shot and see just how difficult it can be.CONCLUSIONContrarians take risks when they buy or sell shares opposing the natural flow of investors, but with proper planning and implementation (and of course, patience!) they are the ones making the maximum profit.The quote “Buy when there’s blood in the streets, even if the blood is your own” describes this investment strategy rightly, as that is true when the time is right to buy and hit a home run.This trading approach requires a lot of discipline and is not advised to individuals who are impatient as it requires them to wait for a long time.Contrarian investing has its downsides, like any other investing strategy; however, with the high return rate, it is highly advised to become a contrarian if you have the capital.Go against the flow and test your skills and luck at the stock market.

Thursday, May 21, 2020

Although Humankind Has Always Practiced A Spectrum Of...

Although humankind has always practiced a spectrum of diversified cultures and rituals throughout history, people will remain constant. They will hang on to their ancient learnings creating a transparent, barbaric-based environment. Shirley Jackson’s famous short story â€Å"The Lottery† has created controversy among her audience with regard to its purpose. The story describes a small New England village which practices an annual ritual known as â€Å"The Lottery†. In the beginning of â€Å"The Lottery†, townspeople gather in the village’s town square, where everyone waits for the ritual to commence. One of the main characters, Mr. Summers, hosts the lottery and chooses a â€Å"lucky† winner from a black, broken-down box. After selecting a name from the box,†¦show more content†¦The description of the rituals show that someone influences the people to chant and praise. This illustrates an otherworldly identification of the leader. Ja ckson further describes the victim of the lottery as someone who stood before the crowd resembling a divine being. Words such as â€Å"duly† and â€Å"supposed† provides knowledge that the village practiced and followed the same procedure every year with no other alternatives or any other unrequired arrangements. Similarly, Old Man Warner, when talking about the dangers of discontinuing the lottery, continues, â€Å"Used to be a saying about ‘Lottery in June, corn be heavy soon’† (Jackson 4). Old Man Warner’s words imply the worship of a higher being, who willingly. sacrifice their own people to a divine individual with the hope that the rest of the year will be successful. This proves that the villagers don’t necessarily understand the real reason for the lottery; they subside because they believe in a higher being who will reward them with a good year. Although Jackson does tie â€Å"The Lottery† to a Biblical theme, there lie s a greater reason for the twisted ending of her short story. â€Å"The Lottery† uses details to illustrate the traditional customs of patriarchy. The abundance of evidence in the text that suggests that males dominate this society. â€Å"The lottery was conducted--as were the square dances, the teen club, the Halloween program--by Mr. Summers† (Jackson 1).Show MoreRelatedAll About Peace Education13195 Words   |  53 PagesRights Peace education is an elusive concept. Although peace always has been and continues to be the object of an unceasing quest in almost all communities and groups, the training of each new generation centers on divisive issues of in-group/out-group differentiations, intergroup conflict and ongoing preparation for defense and war against real and perceived enemies. The universal presence of conflict and war in human history has always necessitated that priority be given to education forRead MoreDeveloping Management Skills404131 Words   |  1617 Pagestextbooks for introducing students to the leading theories about management while ignoring what is known about effective management practice. Sympathetic to Mintzberg’s critique, we set out to identify the defining competencies of effective managers. Although no two management positions are exactly the same, the research summarized in the Introduction highlights ten personal, interpersonal, and group skills that form the cor e of effective management practice. Each chapter addresses one of these skills

Wednesday, May 6, 2020

Essay about Coming Of Age In Mississippi - 1377 Words

Coming of Age in Mississippi is an eye-opening testimony to the racism that exemplified what it was like to be an African American living in the south before and after the civil rights movements in the 50s and 60s. African Americans had been given voting and citizen rights, but did not and to a certain degree, still can not enjoy these rights. The southern economy that Anne Moody was born into in the 40s was one that was governed and ruled by a bunch of whites, many of which who very prejudice. This caused for a very hard up bringing for a young African American girl. Coming of Age in Mississippi broadened horizon of what it was like for African Americans to live during the 40s, 50, and 60s. There are many traces of†¦show more content†¦Also, I think that since she was busy with everything else in her life that she could not really hang out with friends, church was a place for her to make some friends. Religion was not just a factor for Anne, but for many of the slaves during the Civil War. The slaves would use religion as a way to get away from the harsh realities of their lives. Also they viewed Jesus and Moses as heroes who lead their people to freedom. Their religion was aimed toward the real world rather than being in heaven when they died. Basically, their singing or praying was about being delivered from slavery. They also used hymns as special codes for meeting points while trying to escape. To me the song Swanee River has a different meaning to the song on page 129. To me Swanne River was talking about being at home and a child, being around the familiar faces; your family and friends. Also, I think that home refers to being back on the plantation where they know they have security. Not in the sense of being safe, but being where they know and somewhat have fun. The song on page 129 about gods hebben means to me that black and white people are the same, minus the color of their skin. It is saying that every one is the same in God s eyes, and when we get to heaven we are all going to look the same. To me the Swanee River song tells me that the black people miss being at home and as much as they hated being owned by whites they miss being on theShow MoreRelatedComing of Age in Mississippi2022 Words   |  9 PagesComing of Age in Mississippi Anne Moody Questions: 1. What did the murder of Samuel O’Quinn do to Anne Moody? 2. What were the causes of Anne Moody’s relationship with her mother changing when she went to college at Tougaloo? 3. During the movement, why was organizing in Canton, Mississippi so much more difficult than in Jackson, Mississippi? Introduction Coming of Age in Mississippi is an autobiographical book written by Anne Moody. The book entails the struggles throughout an AfricanRead MoreThe Monograph Coming of age in Mississippi1286 Words   |  6 Pagesï » ¿ MONOGRAPH PAPER COMING OF AGE IN MISSISSIPPI Coming of Age in Mississippi by Anne Moody was published on 1968. This autobiography is memoires of Anne Moody about growing up poor and black in the rural Mississippi. The book was divided into four parts from childhood until her late 20s that described the experiences of Anne Moody in the Civil Rights Movement and her struggles against  racism. Anne Moody was born in the 1940s which was the time after World War IIRead MoreComing of Age in Mississippi Essay806 Words   |  4 Pages As if growing up wasnt turbulent enough, Anne Moody grew up during a crucial time in American History. It was during this time that race and civil rights took center stage in her home state of Mississippi. Young women face many physical and emotional changes during their teenage years, regardless of when and where they grew up. However, for Anne Moody, and other young black women, there was the instability in race relations to deal with as well. During her younger childhood years, Anne wasRead MoreComing Of Age Throughout Mississippi1342 Words   |  6 PagesDeandra Green Professor Joshua Jeffers United States History II 3 November 2015 Coming of Age in Mississippi The book Coming of Age in Mississippi goes into detail about a very prominent time in United States history. The book takes us back to a time where the issue of civil rights began to rise eventually reaching its peak marking this an unforgettable time in history for that generation and for generations to come. During this time the south in general was already a tough place to be in, butRead MoreComing of Age in Mississippi and Segregation Essay1304 Words   |  6 PagesComing of Age in Mississippi is an autobiography of the famous Anne Moody. Moody grew up in mist of a Civil Rights Movement as a poor African American woman in rural Mississippi. Her story comprises of her trials and tribulations from life in the South during the rise of the Civil Rights movement. Life during this time embraced segregation, which made life for African Americans rough. As an African American woman growing up during the Civil Rights movement, Moody has a unique story on themes likeRead MoreAnne Moody Coming Of Age In Mississippi1626 Words   |  7 PagesAnne Moody’s autobiography, Coming of Age in Mississippi, depicts the various stages of her life from childhood, to high school, then to college, and ends with her involvement in the Civil Rights Movement. In the novel, Anne tells the reader her story through events, conversations, and emotional struggles. The reader can interpret various elements of cultural knowledge that Anne Moody learned from her family and community as a child. Her understanding of the culture and race relations of the timeRead More Coming of Age in Mississippi Essay example639 Words   |  3 Pagesactivist and NAACP member tried to organize a meeting, the Principle Willis, who is an Uncle Tom, tattled on him. Samuel was shot by a mob of white men. The first experience of a civil rights movement was when she was attending Natchez College in Mississippi. The lunch lady served food with maggots in it. The cook, Miss Harris, knew that the food was s poiled but didn’t care. Anne organized a protest and it was successful. This was a hint of what was yet to come from Anne. nbsp;nbsp;nbsp;nbsp;nbsp;BlacksRead MoreAnne Moodys Coming of Age in the Mississippi1268 Words   |  6 Pageswas with her white skinned â€Å"black† relatives. â€Å"If it wasn’t the straight hair and the white skin that made you white, then what was it?†3 The racial hierarchy was not only comprised of blacks and whites, which Essie-Mae Moody discovered at a young age. In between white and black were all shades of people, some almost flaunted their white qualities and lighter skin, and even acted superior to those of darker shades even among relatives. However, Essie didn’t understand why â€Å"†¦ they hated Mama andRead MoreComing of Age in Mississippi- Anne Moody797 Words   |  4 Pagesbegins with Anne as a four-year-old child watching her parents work everyday for Mr. Carter, a white plantation owner. She witnessed several black farmers living in rotten, two-room wooden shacks. It was most likely evident to her, even at that early age, that Whites were the affluent, upper-class. She elucidates her recognition of the difference in living conditions in the following statements: It seemed as though we were always moving. Every time it was a house on some white man s place andRead MoreComing of Age in Mississippi vs. The Jungle Paper1039 Words   |  5 PagesComing of Age in Mississippi vs. The Jungle Paper There is an argument that states that Anne Moodys tale in Coming of Age in Mississippi is a more optimistic tale then that of Jurgis Rutkis in The Jungle and vice versa. This is not the case. When you take the time to analyze both story, you come to find that both have the same pessimistic core. The only difference is the character Jurgis was optimist throughout most of the beginning despite his circumstances yet in the end he loses all hope

Irony a Common Theme Free Essays

Although they have very different plots with vastly different different characters, a common theme is cleverly intertwined by the authors of the following stories. â€Å"The Interlopers,† by Saki narrates a duel between two neighbors, torn apart by their forefather’s grudge. â€Å"Gimpel the Fool,† by Isaac Bashevis Singer, is told by a man thought of as a fool, and forgives all those who mistreat and abuse him. We will write a custom essay sample on Irony a Common Theme or any similar topic only for you Order Now The play â€Å"Pygmalion,† by Bernard Shaw shows the story of a normal flower girl becoming an upper class lady, and all the woes that come with it. The Interlopers,† â€Å"Gimpel the Fool,† and â€Å"Pygmalion† all share the common theme of irony. Even in such different contexts, irony is seen in these tales. â€Å"The Interlopers† has an ironic ending that shocks the reader. Saki starts the short story with Ulrich von Gradwitz seeking his nemisis, Georg Znaeym in a vast forest he calls his own. The reason for such hate would be many generations before dispute over land and game, which was still existed. When they both face each other, they are both prepared to kill one another, until a tree falls on them. After endless bickering under the tree, Gradwitz tells Znaeym, â€Å"Neighbor, if you will help me to bury the old quarrel I- I will ask you to be my friend,† (4) who then agrees. After this, â€Å"The Interlopers† abruptly ends with the two men ironically being eaten alive by a pack of wolves. In â€Å"Gimpel the Fool,† the main character, Gimpel, is treated as a fool all his life in a village, and doesn’t let it bother him, which further convinces the townspeople of his ignorance. This is ironic since Gimpel is actually the smartest of the bunch by thinking to himself, â€Å"let it pass† (1) even though he is labeled throughout the story as a fool. Till the end, the village makes a fool out of Gimpel, through forcing him to marry an outwardly unfaithful woman to acting to his face as if they don’t know that all children born from her have different fathers. Finally, after his wife’s death, Gimpel leaves his sad little hometown. He then travels around the world, telling tales to many audiences, and enjoying pleasureful company. Indeed, Gimpel was not a fool. In â€Å"Pygmalion,† a phonetics professor, Mr. Higgins, takes the responsibility of training a lower class flower girl, to becoming an upper class woman, which has an ironic outcome due to the fact that her new lifestyle would seem be more comfortable, but in reality is not. Mr. Higgins is forced to teach Eliza the whole English language to her once again due to her own version containing words/sounds such as â€Å"Ah-ah-ah-ow-ow-ow-oo! † (1749) Eliza already being beautiful, it only takes washing up to look like a lady. Resulting from becoming a proper lady, ironically Eliza has to sell herself in order to find a husband, while when she was a flower girl she just had to sell flowers. Keeping up with the superficial world of appearances with everyone watching her every move proves to be too stressful, and Eliza eventually breaks. She then leaves Mr. Higgins to marry someone he considered a fool, Freddy, who was smitten with her. In all these stories,different types of irony is expressed. The Interlopers† has situational irony since the result of the truce of the two men did not result in their freedom, but contrary, their death. In â€Å"Gimpel the Fool,† there is verbal irony since Gimpel is purposely labeled as a fool by the author though the truth is the opposite. â€Å"Pygmalion† has dramatic irony since Eliza believes her life will be better as an upper class woman, though we know that will not be the case, as she herself also finds out the next day. Using irony not only adds twists to these stories, but also contributes to character development and increases suspense. How to cite Irony a Common Theme, Papers

Sunday, April 26, 2020

Why Are We So Concerned With Our Image Essay Example Essay Example

Why Are We So Concerned With Our Image Essay Example Paper Why Are We So Concerned With Our Image Essay Introduction We are subsequently concerned with our image and the manner others, around us perceive us. We strive, everyday to shine within a multitude of stars and to be fully appreciated by our friends, family and associates. We put on a show, each day according to the way we aspire others to view us, as individual people, who stand out and deserve an encore on our own, personal stages.Our world is a stage, our life is a drama, perfectly played out in our roles, and we are the actors, performing. Each and every one of us, share similar aspirations in life and yearn for each one of our presentations to be ideal in order to achieve our goals. Our personal stage must be precisely set and the audiences’ reaction or perception of our acting abilities will be demonstrated through their feedback.During one’s lifetime, a presentation on stage is not always what we anticipate, an event in which Erving Goffman referred to as a â€Å"dramaturgical analysis†.Our social life allows for more than one role to played, for example, being a student, daughter, or lover, requires different presentations. As Goffman mentions in his book â€Å"The Presentation of Self in Everyday life: Selections.† In our show, we offer an impression to the audience through verbal and body language, and the interaction we communicate to others, relays how we perceive ourselves. Goffman views the world as micro sociology; social interactions, and according to Henslin, it is face to face interaction demonstrating how people react and behave when they come together and demonstrates how they get along and survive.First impressions are incredibly important since they may affect how others regard us as individuals, while they build our confidence and heighten our reputation as award winning. According to Henslin, â€Å"When you first meet someone, you cannot help but notice certain features, especially the person’s sex, race, age and clothing†. We develop other impressions t hrough vision and by listening to the character. You may possibly hear someone’s name or all about their story before you actually meet them and perhaps you have already developed a pre-developed image of that person.When you are first introduced to a person, important factors furnish us with a cause to imagine and possess assumptions regarding that individual, therefore, regardless of their true character or personality, your assumptions have already shaped your first impression. This is an important explanation of why people are so concern in relation to their image, since all factors have persuasive influence on a person’s social life.The scene displayed when Mary Harron first met with Andy Warhol, is one demonstration of a first impression of an individual. (Harron, 1980) In the article â€Å"Pop Art/ Art Pop: The Warhol Connection,† before Harron actually met with Andy Warhol, she had previously heard numerous stories in relation to Warhol, and she had alre ady develop a vivid impression of Warhol, consequently, there was little shock about his overall appearance and personality and she was only surprised about Warhol‘s age.Pop art was a subject that came to mind when one imagined Warhol, so his age was never a consideration.Henslin mentions in his book titled â€Å"Essential of Sociology†, (Henslin, 2004) that â€Å"We possess ideas on how we want others to judge us, and we use our character roles in everyday life to communicate these ideas. Goffman referred to these efforts which manage the impressions that others receive from us, as â€Å"impression management†. Goffman also considered impression management as a way to control our performance as we perform in a certain manner; one that an audience expects from us so they may be guided against an unexpected and unfamiliar scene.I play the role of a daughter, for my parents and my attitude is always respectful and polite since this is how I want to present myself to them.According to lecture notes on micro sociology, Professor Steve discusses the Goffman’s Theory where he explains that â€Å"We are all trying to present an idealized vision of ourselves while trying to hide our very real problems or shortcomings†. We consistently want to offer a good impression by acting out what we think others want, so we continually perform our roles according to what the audience wants to see, and the advantage is that we will gain an excellent reputation if we do meet their expectations but if we fail to meet those expectations, we fail while performing that role.Goffman looks at our daily life as a performance played out on a big stage and as actors performing for our audience; we must remember that what we perform will be our major â€Å"appearance.† Goffman also articulates that â€Å"It is an appearance on the front stage,† which also implies that there is an aspect of our personalities that yet remains on the back stage b ut front stage is what Goffman is concerned with thus our performance for others will be routinely acknowledged by society. As Speakers in our school clubs and dinners, we are considered actors in a front stage performance.According to an article â€Å"The Presentation of Self in Everyday Life: Selections† by Goffman, he refers to our performances as â€Å"All the activity of an individual which occurs during a period, marked by continuous presence before a particular set of observers and has some influence on our observers.† He also mentions that there are various elements in our appearances. The stage setting includes our physical layout while the background supports our stage. The setting will allow the audience to follow our performance, while the appearance and our method basically describes our social status and the role we play will demonstrate to the audience the level of our educational background and enlighten them whether we are involved in social activities or if we are aggressive actors, displaying us as great leaders in our performance.In â€Å"The Presentation of Self in Everyday Life: Selection†, Goffman divided the front stage into two parts; we â€Å"give† and â€Å"give off†. The give involves verbal symbols which he utilized to convey the information in helping the performer and audience to engage in the performance, while the â€Å"give off† includes a wide range of action performances in which the audience may consider feeling sympathy for the actor.Since there is a front stage, there must also be a back stage, where we relax and showcase our full identities without being concerned with how others perceive us.According to the lecture notes by Professor Steve, most of our time is spent performing on front stage, which means wearing costumes and dressing up, however, our back stage performance is a place where we hide our true problems, since everyone does have a secret about themselves. A person ma y have a drinking problem, gambling or some illegal activity that they wish to keep private. They may try to hide pieces of their life and during their performance, they may give a different impression to others about who they really are. Goffman offers that we have to conceal the process in order to make our stage performance. If Goffman is correct in his theory, then we all are exceptional actors who deserve to win Oscars!As Goffman pointed out in his article (Goffman, 1959) â€Å"The Presentation of Self in Everyday Life: Selection†, â€Å"In order to get the setting right for the performance, manner calculating is also important,† which means that good designs should be a big part of the setting and like Mary Harron, Goffman shares her ideas of first impressions, as in her online article â€Å"Pop Art/ Art Pop†, she mentions that one of the reasons that Andy Warhol became a famous pop artist was due to the fact that he respectfully, knew how to calculate and manipulate the media.Warhol has displayed a man who had respect for money, fame and power. He is a famous artist, who within his social connections is incredibly large, therefore, Harron made the connection that it is not only Warhol who became famous but the people around him; his friends and coworkers became famous, as well. All famous people have one thing in common; they have more stages to perform on than an average individual, while one stage is for the media and the public, the other stages are held out for their friends and family.â€Å"Movies, radio and TV have changed the nature of fame†, Mary Harron explains that Andy Warhol used this type of communication to build the idea of Pop Art and today, in our society because Andy Warhol is a symbol of pop, and plays the achievement role in his performances and Pop Art is a standard that people and society determine on their own.Warhol built up an idealization of society as he heightened their expectations by expressing h is wealth and power. Goffman also agrees that material possessions are expressed as one of the most important parts of social class as a status symbol.According to our lecture notes, Goffman believes that each of us possess secrets and display our freakiness in some fashion and if we behave in an anticipated manner or perform differently than what others expect, they may feel that we are behaving irrationally, so there is the chance that you could be considered less desirable as a human being.The movie â€Å"Boy’s Don’t Cry† was inspired by a true story by Brandon Teena who has a sexual identity crisis, since she was born with a female’s body but thinks like a male. She cut her hair and taped down her breasts which made her look like a man; her way of setting her stage for her own performance; one that began when she arrived in Nebraska. The new audience had no idea that she was a female. When Brandon Teena falls in love with Lana and becomes one of Lanaà ¢â‚¬â„¢s friends, performing as a young male, she offered a grand performance. Garfinkel offered that she â€Å"Engaged in activities that made her appear to be something she wasn‘t.† The movie is not only about Brandon’s performance but about the environment that supports her status. Garfinkel also believes that we have to manage our own identities through hard work, achievement and accomplishment.There was nothing wrong with Brandon Teena as a person but she was not accepted and marginalized by the society, so she failed in her performance and end up murdered by Lana’s friendsI do believe that our society is changing because bisexuals are becoming more common and people tend to treat bisexuality as normal and in the movie â€Å"Boy’s Don’t Cry,† (Peirce, 1999) we understand how important and effective a front stage and back stage performance can be as we all want to find a spot in society where we can belong.In a personal experience of my own, I was studying aboard in England. When I first arrived at the school, I behaved as a quiet and shy stranger because I didn’t know anything about the people, in England. I didn’t want to offer a performance, until I know more about them. When I was approached for conversation, I changed my performance by offering an outgoing person, who did want to talk and be socially interactive, in order to make friends.Sometimes, I am nice to people that I don’t like and I play that role. Goffman refers to this behavior as playing different roles, while others call it being two-faced, but the more I think about it, I understand that everyone might have more than two faces on their stage in life.There are many instances during my life performances, where I will be forced to make alterations but I will continue performing, offering an award winning performance! Why Are We So Concerned With Our Image Essay Thank you for reading this Sample!

Thursday, March 19, 2020

Treatment Rehabilitation of Grade II Medial Collateral Ligament (MCL) Injury The WritePass Journal

Treatment Rehabilitation of Grade II Medial Collateral Ligament (MCL) Injury Introduction Treatment Rehabilitation of Grade II Medial Collateral Ligament (MCL) Injury IntroductionGeneral Knee AnatomySpecific   Medial Collateral Ligament AnatomyBiomechanicsMechanism of InjuryPhysical Examination/Clinical AssessmentRadiographClassification of InjuryTreatment and Rehabilitation ObjectivesInflammatory Phase (up to 72 hours post injury)Proliferation Phase (3-21 days post injury)Increased range of motion was also enhanced by using a stationary bicycle (Wilk et al., 1996).A.  Ã‚  Ã‚  Ã‚  Ã‚   Basic ExercisesProprioceptionConclusion/SummaryReferencesRelated Introduction The superficial medial collateral ligament (MCL), and other medial knee stabilisers (most notably the deep medial collateral ligament and the posterior oblique ligament) are the most commonly injured ligamentous structures of the knee (Grood, et al., 1981; Hughston, 1981; Phisitkul, et al., 2006; van der Esch, et al., 2006). The majority of MCL tears are isolated and predominantly occur in young people participating in sports activities. Typically, the mechanism of injury involves valgus knee loading, external rotation or a combined force vector- particularly prevalent in sports such as football and skiing which involve these type of forces and repetitive knee flexion (Peterson, et al., 2000). In the United States, occurence of these types of injuries to the knee has been reported to be 0.24 per 1000 during any given 12 month cycle and to be twice as high in males 0.36 compared with 0.18 in females (Daniel, et al., 2003). In actual fact, the incidence of these types of injury is probably much higher than reported as many minor MCL injuries are never even assessed or treated by medical personnel. In terms of treatment, the approach to medial knee injuries has changed dramatically over recent years. As the understanding of the anatomy, biomechanics, and causes of medial knee injuries has evolved, as has the treatment.   Whilst in the 1970’s and 1980’s surgical treatment for MCL injuries was common place, today most MCL injuries are treated conservatively with early rehabilitation (Phisitkul, et al., 2006). In general, all isolated Grade I and II tears and even the majority of Grade III tears can be treated non-operatively with a supervised, functional, rehabilitation program. Excellent results can be expected with return to full pre-injury activity level being the norm (Bradley, et al., 2006). This paper will research and interpret some of the relevant literature that is available to us, with the aim of developing and implementing a functional rehabilitation plan (in keeping with the principles of soft tissue healing) that is suitable for the treatment of a Grade II MCL injury of a 33-year-old, male, semi-professional footballer (the patient). General Knee Anatomy The knee joint, is the largest and most complex synovial joint of the human body (Bradley, et al., 2006). Figure 1: Anterior view of the patellofemoral joint. Hawkins (2009) The patella, patella ligament and femur combine to form the patellofemoral joint (Saladin, 2001). The patella itself is a triangular-shaped sesamoid bone that is attached to the quadriceps tendon. This tendon inserts into the trochlear groove on the femur and primarily acts to increase the ‘mechanical advantage’ of the quadriceps muscle group (Hamill Knutzen, 1995). The lateral and posterior aspects of the knee joint are encapsulated by a joint capsule whilst the anterior section of the knee is protected by the patella ligament (and its retinacula). The quadriceps and the hamstrings are the prime movers of the knee joint knee ‘extensors’ and ‘flexors’ respectively. The quadricep group of muscles are located on the anterior part of the thigh and comprise of the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. They converge on the patella tendon, travel over the patella and insert onto the tibial tuberosity. In addition to knee extension, the quadriceps group of muscles (in combination with the iliopsoas) are also responsible for flexion of the hip (Saladin, 2001). The hamstring muscles are found on the posterior section of the thigh and comprise of the biceps femoris, semimembranosus, and semitendinosus. They are responsible for the flexion of the knee joint and (together with the gluteus maximus) the extension of the hip joint (Saladin, 2001). The main stabilisers of the knee are the quadriceps tendon (to front of the thigh) and the semimembranosus tendon (at the back of the thigh) (Saladin, 2001). The medial and lateral collateral ligaments are primarily responsible for preventing the knee from rotating during extension (Saladin, 2001). The anterior cruciate ligament and the posterior cruciate ligament stop anterior and posterior translation of the tibia relative to the femur (Saladin, 2001). Specific   Medial Collateral Ligament Anatomy Medial knee stability is provided, for the most part, by its ‘medial static’ and its ‘dynamic’ stabilisers. The medial static stabilisers, which work as an integrated unit, are the superficial MCL, the posterior oblique ligament and the middle third of the deep MCL. The dynamic stabilisers are the per anserinus tendons most notably the semimembranosus tendon (Peterson Renstrom, 2001). The superficial MCL is, on average, 11cm long and 0.5cm wide. It originates from the medial femoral condyle (anterior to the tubercle) and travels, distally, to insert 5-7cm below the joint line on the anteromedial tibia (just below the insertion of pes anserinus tendons). The anterior fibres of the superficial MCL tense during knee flexion whilst its posterior fibres slacken. The superficial MCL is tight during external rotation of the knee (Peterson Renstrom, 2001). The middle third of the deep MCL is a short structure about 2-3cm long and is attached to the meniscus underlying the MCL. This part of the ligament is relatively ‘slack’ to facilitate knee motion whilst short enough to hold the meniscus firmly in position. In terms of injury, the deep MCL can be ruptured both proximally and distally to the meniscal attachment (regardless of the location of the tear of the superficial MCL). The posterior oblique ligament is a thick capsular ligament originating just behind the superficial MCL (at the condyle just below the joint line). The posterior oblique ligament becomes ‘slack’ during knee flexion (Peterson Renstrom, 2001). Biomechanics Biomechanical studies show that the MCL’s main function is to resist valgus (outward side motion of the leg) and external rotation forces of the tibia in relation to the femur . The superficial MCL has been found to be responsible for 57% of medial stability at 5Ëš of knee flexion and up to 78% at 30Ëš knee flexion. The deep MCL accounted for 8% at 5Ëš and 4% at 30Ëš whilst the posterior oblique accounted for 18% and 4% respectively. Mechanism of Injury The player reported to the clinic approximately 24 hours after the injury occurred. The player was able to weight bear. When asked how the injury occurred the player stated that he was running at pace to ‘close down an opposing player’ and then described performing a ‘change of direction’ or ‘cutting’ manoeuvre. He stated that as he planted and pushed off his right leg, he experienced a sudden excruciating localised pain and an immediate lack of stability in his right knee. This caused him to collapse. As stated, the primary mechanism of injury to the MCL is most commonly a valgus stress (Fetto, et al., 1978). However, due to the position of the knee and the force vectors involved, a combined flexion/valgus/external rotation injury is usually the end result (Hayes, et al., 2000). The vast majority of MCL injuries are from a lateral force to the distal femur with the foot being fixed to the ground, although non-contact valgus external rotation injuries are common the latter being particularly prevalent in sports such as football and skiing (Perryman, et al., 2002; Pressman, et al., 2003). Because of the complexities of knee injuries, it is important to perform a complete knee examination in order to rule out other potential problems such as fractures, cruciate ligament tears, menisci ruptures or chondral cartilage damage (Bradley, et al., 2006). Physical Examination/Clinical Assessment The best time for examination of the knee is immediately after the injury before muscle spasm occurs   (Phisitkul, et al., 2006). Unfortunately, as in this case, that is not always feasible. However, a 24 hour period of rest and immobilisation (which the patient undertook) is usually sufficient for muscle spasm to subside and relaxation to occur (Hughston, et al., 1976). This allows an effective examination and assessment of the injury. The injury was examined and assessed through a combination of subjective and objective approaches. Important initial information obtained through speaking with the patient and preliminary observations included the location of pain, the ability to ambulate after the injury, time and onset of swelling, the presence of deformity, and the immediate site of tenderness (Indelicato Linton, 2003). The location of oedema and tenderness can accurately identify the injury site of the superficial collateral ligaments in 64% and 76% of cases respectively (Hughston, et al., 1976). The exact location of injuries of the deep MCL and the posterior oblique ligament are more difficult to palpate because of their deep-seated position, but pain and tenderness in this area can at least indicate the presence of injury to these posteromedial structures (Sims Jacobsen, 2004) On asking the patient to indicate the most painful spot, he pointed to the medial aspect of the right knee joint. The area indicated by the patient suggested injury to the MCL. Contralateral comparison of the knees was carried out in order to identify areas of oedema and/or deformity. Significant swelling and slight discolouration was observed on the medial aspect of the right knee joint. Upon palpation of both knee joints, a noticeable heat differential was felt in the affected area. While keeping the patient relaxed, a valgus stress test   (MCL test) was performed with the knee in 30Ëš of flexion (figure 1), and compared to the contralateral knee as a control. The examination was then repeated with the knee in 0Ëš of flexion to recruit the function of remaining posteromedial structures (figure 2). The valgus stress test proved positive in contralateral comparison in 30Ëš of flexion and negative in 0Ëš of flexion. The absence of laxity in the second test reduced suspicions of any associated injuries to the secondary restraints such as the cruciate ligaments and the posterior capsule. In addition, a number of other tests were carried out to assess whether any injuries, commonly associated with MCL injuries, were prevalent (bone bruises, ACL tears, lateral collateral ligament tears, medial meniscus tears, lateral meniscus tears, and posterior collateral ligament tears). Anteromedial rotatory instability (often present when there is evidence of anterior subluxation of the medial tibial plateau during a valgus stress test with the knee in 30Ëš of flexion) was assessd by performing the anterior drawer test (figure 3) whilst holding the tibia in external rotation. This proved negative and therefore ruled out the possibility of a posterolateral knee injury rather than a medial knee injury. Lachman’s test (figure 4) and the Pivot shift test (figure 5) were also performed to negate the existence of any ACL rupture whilst Murray’s test (figure 6) was carried out to assess the integrity of the Meniscus cartilage. All these tests also proved negative. The results of the assessment supported the initial belief that the patient was suffering a superficial MCL injury with the posterior oblique ligament still intact and no associated damage to either the cruciate ligaments or meniscus cartilage of the knee. Radiograph In accordance with the Ottawa knee rules (Stiell, et al., 1997) it was decided that radiographs were not required for this injury. More recent work has shown the Ottawa knee rules to be very successful in reducing unnecessary radiography, whilst ensuring a high level of recognition fractures (Bachman, 2003). The Ottawa knee rules state that a radiograph is required only in patients who have an acute knee injury with one or more of the following: Age 55 years or older Tenderness at head of fibula Isolated tenderness of patella Inability to flex to 90 ° Inability to bear weight both immediately and in the emergency department Classification of Injury In 1976 (revised in 1994) Hughston standardised MCL injury classification into two related systems the severity system (Grade I, II III) and the laxity system (grade 1+, 2+ 3+). Under this combined classification system, Grade I involves a few damaged fibres resulting in localised tenderness but no instability or laxity. A Grade II injury involves a disruption to substantially more fibres, with more generalised tenderness but still no instability (although it is not uncommon for a degree of laxity with the knee in 30Ëš flexion). A Grade III injury is a complete tear of the ligament with resultant instability and laxity. Grade III injuries are then sub-classified according to the extent of laxity (determined by the amount of absolute joint separation from valgus stress with the knee in 30Ëš of flexion). Grade 1+, 2+, and 3+ laxities indicate 3-5 mm, 6-10 mm, and more than 10 mm of absolute medial separation respectively. Fetto and Marshall (1978) defined Grade I injuries as those without valgus laxity in both 0Ëš and 30Ëš of flexion, Grade II injuries as those with valgus laxity in 30Ëš of flexion but stable in 0Ëš of flexion, and Grade III as those with valgus laxity in both 0Ëš and 30Ëš of flexion. The injury was subsequently classified as an isolated Grade II MCL injury in accordance with Hughston (1976 1994) and Fetto Marshall (1976). Using a full return to sport as an indicator of a successful end point, Ellsasser et al (1974) treated 74 professional football players with incomplete tears of the MCL using a functional rehabilitation program. In this study, a success rate of 98% was found compared with a 74% success rate for a separate group treated surgically. In the non-operative group, return to play occurred between 3 and 8 weeks. Return to play was even quicker in a study by Derscheid and Garrick (1981). They treated football players with Grade I and Grade II injuries with a specific rehabilitation programme. Players with Grade I MCL injuries returned to full play in an average of 10.6 days, whereas those with Grade II MCL injuries returned in an average of just 19.5 days, with neither group showing a propensity for injury reoccurrence. Based on this research, a consensus on the time it would take for the patient to return to full sporting activeity would be 3-8 weeks. Treatment and Rehabilitation Objectives An appropriate treatment and rehabilitation plan is required to restore normal function to the knee joint and the surrounding soft tissues with a view to enabling the patient to return to his sport as early and effectively as possible with no residual symptoms and a minimal risk of injury reoccurrence All soft tissue injuries, regardless of their nature and severity, undergo the same three stages of healing the inflammatory phase, proliferation phase and the remodelling phase. The time required to complete each healing stage is dependent up on the nature and severity of the injury. However, of note, numerous investigations comparing surgical and non-surgical treatment have reported no advantages of surgical intervention over non-surgical intervention (Quarles Hosey, 2004; Phisitkul et al., 2006). The following treatment and rehabilitation plan was designed and implemented to address the needs of the patient. Inflammatory Phase (up to 72 hours post injury) The inflammatory phase is characterised by heat, redness, swelling and pain generally leading to a loss of movement and function. The goals of treatment at this stage were: Protect injury Control oedema Prevent associated muscle atrophy Regain range of motion Increase weight bearing capacity Maintain general fitness/strength P.R.I.C.E (Protection, Rest, Ice, Compression and Elevation) The P.R.I.C.E. regimen is employed following injury with a view to controlling the haemorrhage, decreasing inflammation, reducing tissue metabolism and minimising secondary hypoxic injury, cell debris and oedema.   Research has suggested that the sooner after injury that cold therapy (cryotherapy) is started, then the more beneficial the reduction in metabolism will be (Knight et al., 2000). Elevation has been shown to have a significant effect on reducing effusion (O’Donohue, 1976). The patient reported that he had already applied ice intermittently during the 24 hour period between injury occurrence and assessment approximated to have fulfilled 4 x 20 minute applications of crushed ice at 2 hourly intervals with the knee in an elevated position in line with commonly agreed protocol. He also reprted that he had kept the injured limb elevated for sustained periods. Measurement On inspection the right knee was swollen over the lateral aspect with a small amount of visible bruising. At this time the patient was asked to indicate his level of pain using a visual analogue scale (VAS). Measurement of the girth of the knee was also taken using a tape measure whilst active flexion and was also assessed using a goniometer. These measurements would be continually reassessed throughout the rehabilitation process in order to assess progress and outcomes. Continued active flexion was also encouraged at this time. Simple ‘knee bend and straighten’ exercises, with the patient lying in a supine position on an exercise mat the movement repeated 10-20 times,   3 times a day, with a view to increasing active range of movement (figure 1) . The patient was also instructed in different exercises to maintain cardiovascular fitness and upper body conditioning. The patient also received a massage to the upper and lower leg (particularly the quadriceps group of muscles) in an elevated position using effleurage techniques to aid removal of waste products via the lymphatic system reflexive muscular inhibition of the quadriceps has been thought to be the result of the pain associated with MCL injury (Dixit, et al., 2007). The knee was then strapped. Strapping The knee was strapped to assist healing and reduce the risk of aggravating the injury. The knee was strapped in a position of 30Ëš flexion with the lower leg partially rotated inwards (figure 1). A combination of ‘lower leg and thigh anchors’, ‘medial cross’ and ‘medial straight line’ taping techniques, using   zinc oxide tape and elastic adhesive dressing,   were employed to provide suitable support for the patient and reduce and valgus stress (figure 2). Experience has shown that this type of strapping is preferable to the use of a knee braces in Grade II MCL injuries as the strapping can be re-applied whenever required with the correct level of compression and support required. There is some concern that functional braces may expose athletes to additional risk by imparting a false sense of confidence. It is reported that lower extremity muscle strengthening, flexibility improvements, and technique refinement are more important than functional bracing in treating ligamentous knee injuries (Christenson, 2010). The patient was advised to continue elevating the limb, as much as possible, for the following 24 to 48 hours. Anti-inflammatory medication Non-steroidal anti-inflammatory medication (ibuprofen) was prescribed to the patient, via NHS Direct, two hours after injury. Whilst some studies have shown no early adverse affect of nonsteroidal anti-inflammatory drugs on the strength of healing torn MCL’s (Moorman, et al., 1999), it remains controversial as to whether inhibiting the inflammatory response is uniformly advantageous. Pain and disability following injury are in part due to the inflammatory response and, whist it is suggested that decreasing the inflammation decreases the symptoms (therefore allowing earlier rehabilitation) (Weiler, 1992), it is also important to consider that inflammatory cells are responsible for clearing away cell debris and necrotic fibres and without this phagocytic function regeneration may not be able to begin (Reynolds et al., 1995, Almekinders et al., 1986, Jones 1999). As the patient reported that the pain had subsided over the last 24 hours (measured using a visual analogue scale), he was advised to continue taking the non-steroidal anti-inflammatory medication only when necessary. Proliferation Phase (3-21 days post injury) The proliferation stage involves the repair and regeneration of the injured tissue (development of new blood vessels, fibrous tissue formation, re-epithelialisation and wound contraction) and begins approximately 72 hours after injury. The goals of this rehabilitation phase included: ââ€" Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Decrease effusion ââ€" Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Decrease pain ââ€" Ã‚  Ã‚  Ã‚  Ã‚   Restore full range of motion ââ€" Ã‚  Ã‚  Ã‚  Ã‚   Enhance joint strength ââ€" Ã‚  Ã‚  Ã‚  Ã‚   Introduce proprioceptive exercise ââ€" Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Achieve full pain free weight bearing statu Maintain general fitness and strength levels It has been stated that ligaments heal with a stronger and more organised collagen fibril architecture when early mobilisation and exercise is employed during the healing process (Osborne and Rizzo, 2003). Therefore, in addition to continuing the treatments introduced during the inflammatory phase (ice, intermittent compression, and massage), manual joint mobilisation techniques were also employed at this stage. Comprehensive zinc oxide and elastic adhesive strapping, removed and re-applied by the patient whenever necessary (particularly during active flexion exercises), was also continued. Pain scale assessment, ankle girth measurement and goniometer measurements were continually monitored throughout the proliferation phase. As stated, n the proliferation phase, the goals are to continue re-establishing full range of motion, increase muscular strength/power/endurance, and adding in functional activities. Exercises include isotonic exercises to isolate and strengthen particular muscle groups, such as in the hip and thigh regions (knee extension, leg press, hamstring curls and hip exercises). In order to re-establish the dynamic stability of the knee joint, it is crucial to strengthen the hip and calf musculature, with an emphasis on progressive Closed Kinetic Chain exercises (such as wall squats, step-ups, lateral lunges and stair climbing) that foster proprioception (Wilk et al., 1996). Range of Movement (RoM) Range of movement exercises were significantly progressed from the inflammatory phase. Active and passive movements continued with the addition of manual mobilisation techniques for the knee joint. The following advanced knee stretches were utilised with a view to restoring movement to the joint and improve flexibility of muscles crossing the knee. The patient was advised to carry out each separate muscle group stretch 3 times daily (provided they do not cause or increase pain). i.  Ã‚  Ã‚   Quadriceps Stretch Treatment couch was used for balance. Heel taken towards your bottom, keeping knees together and back straight until patient felt a stretch in the front of their thigh (figure 1). Held for 15 seconds and repeated  4 times at a mild to moderate stretch (pain free). ii. Hamstring Stretch Patient’s foot was placed on chair. With knee and back straight, patient leant forward at hips until he felt a stretch in the back of his thigh/knee (figure 2). Held for 15 seconds and repeated 4 times at a mild to moderate stretch (pain-free). iii.   Calf Stretch With patient’s hands placed against the wall, his leg was stretched behind him as demonstrated in figure 3. Keeping his heel down, knee straight and feet pointing forwards, the patient gently lunged forwards until he felt a stretch in the back of his calf/knee. Held for 15 seconds and repeated  4 times at a mild to moderate stretch (pain-free). iv. ITB Stretch Patient’s leg was placed behind his other leg and taken as far away from him as was comfortably possible. Patient then pushed his hips to the side of his leg until he felt a stretch in the outer thigh/hip (figure 4). Back was kept straight throughout. Held for 15 seconds and repeated  4 times at a mild to moderate stretch (pain-free). v. Adductor Stretch Standing tall, and with back straight, pateint’s feet were placed approximately twice shoulder width apart. Patient then gently lunged to  one side, keeping his  other knee straight, until he felt a stretch in the groin of his straight leg (figure 5). Held for 15 seconds and repeated  4 times at a mild to moderate stretch (pain-free). Increased range of motion was also enhanced by using a stationary bicycle (Wilk et al., 1996). Strengthening Strengthening work for the lower limb musculature continued in a progressive form (as pain allowed). The following knee strengthening exercises were designed and implemented with a view to improving the strength of the muscles surrounding the patient’s injured knee. The patient began with the basic  knee strengthening exercises, advanced to intermediate  knee strengthening exercises and eventually undertook the advanced knee strengthening exercises. A.  Ã‚  Ã‚  Ã‚  Ã‚   Basic Exercises To begin with, the following basic knee strengthening exercises were performed approximately 10 times each, 3 times a day, during the first week of rehabilitation. As knee strength improved, the exercises were progressed by gradually increasing the repetitions and strength of contraction. i. Static Inner Quadriceps Contraction Patient was instructed to tighten his quadriceps muscle group by pushing his knee down into a rolled towel (figure 1). Placing his fingers on his inner quadriceps (vastus medialis) allowed the patient to feel the muscle tighten during contraction. Held for 5 seconds and repeated 10 times as hard as possible pain free. ii. Quads Over Fulcrum Patient was instructed to lie on his back, with a rolled towel under his knee, and told to relax the knee (figure 2). Patient then slowly straightened his knee as far as possible tightening the front of his thigh (quadriceps). Held for 5 seconds and repeated 10 times as hard as possible pain free. iii. Static Hamstring Contraction Patient began this exercise by sitting with his knee bent to about 45Ëš (figure 3). He then pressed hisr heel into the floor tightening the back of his thigh (hamstrings). Held for 5 seconds and repeated 10 times as hard as possible pain free. B. Intermediate Exercises The following intermediate knee strengthening exercises were generally performed 1-3 times per week (during weeks 2 and 3 of the rehabilitation programme). Ideally they were not performed on consecutive days, to allow muscle recovery. As the knee strength improved, the exercises were progressed by gradually increasing the repetitions, number of sets  and/or resistance of the exercises  provided they did not cause or increase pain. iv. Knee Extension in Sitting vs. Resistance Band Patient sat with with his knee bent and a resistance band was tied around his ankle (figure 4). Keeping his back straight, patient slowly straightened his knee, tightening his quadriceps. He performed 3 sets of 10 repetitions on each occasion. v. Hamstring Curl vs. Resistance Band The patient was instructed to lie on his stomach with a resistance band tied around his ankle as shown (figure 5). He then slowly bent his knee whilst tightening his hamstrings (figure 6). He performed 3 sets of 10 repetitions on each occasion vi. Squat with Swiss Ball Patient stood with his feet shoulder width apart and facing forwards. A Swiss ball was placed between the wall and his lower back to add an element of proprioception (figure 7). Patient then slowly performed a squat, keeping his back straight. His knees were kept in line with his middle toes and did not move forward past his toes. Performed 3 sets of 10 repetitions on each occasion. vii. Lunges Patient stood with his back straight in the position shown (figure 8). He then slowly lowered his body until the front knee was at a right angle (figure 9). His knee was kept in line with his middle toe and his feet facing forward. Performed 3 sets of 10 repetitions on each occasion. viii. Heel Raises Patient used treatment couch for balance (figure 10). Whilst keeping his feet shoulder width apart and facing forwards, patient slowly move up onto his toes raising his heels as far as possible and comfortable without pain. Performed 3 sets of 10 repetitions on each occasion. C.  Ã‚  Ã‚  Ã‚  Ã‚   Advanced Exercises The following advanced knee strengthening exercises were generally performed 1 3 times per week (from week 4 of the rehabilitation programme onwards). Ideally they were not performed on consecutive days, to allow muscle recovery. As the knee strength improved, the exercises were progressed by gradually increasing the repetitions, number of sets  or resistance  of the exercises provided they  did not cause or increase pain. ix. Single Leg Squat with Swiss Ball Patient stood on one leg with his foot facing forwards. A Swiss ball was placed between the wall and his lower back to incorporate a proprioceptive element (figure 11). Patient slowly performed a squat, keeping his back straight. Patient ensured his knee did not bend beyond 90Ëš and was in line with his middle toe. His knee didn’t move forward past his toes. Performed 3 sets of 10 repetitions on each occasion. x. Lunges with Weight Patient stood holding light weights, with his back straight in the position shown (figure 12). He slowly lowered his body until the front knee was at a right angle. Knee was kept in line with his middle toe with feet facing forward. Performed 3 sets of 10 repetitions on each occasion. xi. Single Leg Heel Raises Patient stood on one leg with treatment couch for balance (figure 13). Keeping his foot facing forwards, patient slowly moved up onto his toes, raising his heel as far as possible and comfortable without pain. Performed 3 sets of 10 repetitions on each occasion. xii. Hamstring Curl on Swiss Ball Exercise began with patient lying on his back with a Swiss ball under his legs as demonstrated (figure 14). Keeping his back straight, patient slowly bent his knees and tightened the hamstrings. Performed 3 sets of 10 repetitions on each occasion. Proprioception ‘The awareness of position, movement or balance of the body or any of its parts’ (Prentice, 1994). As observed in the ‘Strengthening’ section of the proliferation phase, early proprioception exercises are started at this point. Many of the more basic strengthening exercises identified were progressed by getting the patient to close his eyes closed and/or changing the surface that he was standing on e.g. mini trampoline, air filled cushion, sponge cushions, wobble and rocker boards. During the proliferation phase all proprioceptive work is undertaken with the injured joint strapped with zinc oxide strapping providing confidence to the patient by its perceived level of support. Other specific proprioception exercises used at this stage included: Balance on swiss ball (figure 1) Balance on trampette (figure 2) Balance during leg press (figure 3) Dips on uneven surface (figure 4) Balance on Bosu ball (figure 5) Balance while throwing ball to alternate hands (figure 5) The exercises were progressed by time and/or by increasing the repetitions. All exercises would be performed bilaterally. Variations for proprioceptive exercise were almost endless a vital element in avoiding patient and therapist boredom. It was also important to this rehabilitation programme that exercises could also be carried out at home (as patient also had a full time job). Cardiovascular fitness and general strengthening was also addressed at this time using circuit training, swimming and cycling. Remodelling Phase (21 days to 12 months post injury) The remodelling phase of healing is a long-term process often taking years to complete (Prentice, 1994). Factors that can impede the rate of healing are varied and include surgical repair, poor vascular supply, infection, disease, wound size, health, age and nutrition In terms of rehabilitation, during this phase more aggressive strengthening and mobilisation was required to ensure optimum tissue realignment and strength. The goals of treatment in the remodelling phase were: ââ€" Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Regain full strength ââ€" Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Ensure full pain free range of motion ââ€" Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Maintain overall conditioning ââ€" Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Prepare for return to full participation Range of Motion (RoM) exercises continued with a greater emphasis being placed on ‘hands on work’ in the form of joint mobilisation to ensure full movement is achieved. The strengthening work that was started in the proliferation phase was continued and progressed (in terms of resistance, speed and repetitions) whilst further emphasis was placed on general fitness at this time introducing more sport specific activities. Running drills were progressed from linear to exercises involving change of direction at high pace with and without a ball. Specifically, when the patient was able to run at 75% of maximum speed, figure 8 drills were used beginning with 20m and then 10m figure 8’s. Advanced cutting drills at 45Ëš and finally 90Ëš were also added. Proprioception exercises will be progressed, with a more sport specific content. This involved hopping onto various unstable surfaces (figure 1), hopping on a mini trampoline whilst side foot volleying a ball (figure 2), hopping forwards, sideways and backwards over hurdles at varying pace (figure 3) and practising the kicking action whilst planting the foot on an unstable surface (figure 4). Throughout this phase and when returning to full function the patient continued to wear zinc oxide and elastic adhesive strapping to minimise the possibility of recurrence of injury. Ice was used predominantly after exercise to guard against recurrent pain and swelling. When an athlete achieves the goals of the remodelling phase, they are close to returning to full participation. As earlier identified, Derscheid and Garrick treated 23 Grade II MCL patients and all were returned to playing football within 19 days (4 to 19 day range, 10.6 day mean). However, many of these athletes did not feel they were 100% for several weeks. For this reason, further rehabilitation including strengthening, dynamic knee stabilisation, plyometrics, SAQ drills and proprioception exercises should be completed until the athlete feels 100% and is able to play without inhibition (Wilk et al., 1996). Maintenance exercises, even after return to sport, that promote continuation of strength, endurance, and function are also vitally important to consider (Wilk et al., 1996). Pre Discharge The pre-discharge stage is vital. It is the time for the therapist and patient to decide whether or not a return to full unrestricted activity can take place. Return to full activity was allowed once the following were achieved: Ligamentous examination is normal Quadriceps strength is 90% or greater than the contralateral limb Sport/activity specific agility testing causes no pain To achieve these requirements, the patient was asked to do everything that is expected of him when returning to their chosen sport, including replicating the conditions in which the injury was caused. In this case the patient was required to run, sprint, jump, tackle, pass the ball over varying distances, change direction at speed and be able to withstand full physical contact. 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