Five important considerations for ACL Rehab
ACL ruptures are one of the most grueling injuries to recover from and the most unfortunate thing about ACL tears is that not a lot of athletes get back to their prior level of performance AFTER the surgery. [1-3]
Toole et al. tested 115 athletes that were cleared for sport after having ACL surgery and ONLY 14% of them passed all of the return to sport criteria. [1]
This is mainly because most physical therapy clinics and rehab facilities do not have the knowledge or the equipment needed to be able to clear athletes for sport.
We see this often in our clinic when people come in with chronic knee pain after unsuccessfully rehabbing their ACL tears.
It is not uncommon that you might experience:
Knee pain on the opposite limb since it starts to do more work. [2]
Hip pain on the same side since the knee with the ACL reconstruction isn’t quite as effective at accepting the load. [3, 4]
And more!
There are important things to consider when navigating how to return to sport and ideally come back stronger than you were before:
Most athletes that were told to return to sport by their healthcare providers actually failed return to sport tests. There are very specific key metrics that let you know what you are capable of functionally. These have to be met or you’ll have an INCREASE rate of re-tears or a tear of the opposite leg. [1-3]
There needs to be objective data being collected throughout the process and the old way of testing your ability to produce force is not cutting which is kicking your leg out against someone’s hand. Advances in sports science technology have made it VERY EASY to collect data but this is NOT something that is readily available in clinics that are not equipped to work with high-level athletes. (5,6) Equipment such as force plates, and isolated dynamometry tell us exactly what you’re capable of doing along with the asymmetries that still exist side to side. [5,6]
Using the opposite limb as the norm will not give you an accurate depiction of what your prior level of function is. The main reason for that is that you tend to be less active after the injury, and you are even more inactive after the surgery. [7] If your physical activity levels come down and you don’t take a baseline measure of what the non-surgical leg is able to do. [7] It might be 3 months of being deconditioned and using that as a baseline is NOT going to be accurate.
Standards exist in the industry on what you should be able to do after an ACL tear including strength testing, jump testing, and more. [1, 3-5] Despite the fact that these standards are readily cited in the research, there is still a huge gap in physical therapy clinics that are utilizing these return-to-sport protocols.
There are key muscle groups that need to be trained and the importance of each will change depending on the graft. Our general order of importance is quadriceps, hamstrings, and then a mix of calf/groin/glute muscles. All these key muscle groups provide protection to the ACL, they lost function when you are physically inactive, and they play a big role in your ability to perform functional tasks like cutting. [8-10]
The ACL rehab process is a journey, but we believe that there is a silver lining to injury especially when you use this process to learn more about your body, become stronger than before, adopt better habits like sleep, and utilize this opportunity to grow.
Our team is well equipped with state-of-the-art technology in SoHo and Long Island City to be able to provide the highest quality of care when it comes to athletes with ACL injuries. We have enough weights to challenge, turf to perform agility drills, equipment to keep you conditioned, and more!
If you’re frustrated with your current rehab process where you’re being seen alongside 2-3 other people on the hour and NOT getting the care that you need.
Schedule a free discovery session here and see how ACL rehab can be done differently
Citations:
1.) Toole AR, Ithurburn MP, Rauh MJ, et al. Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs? J Orthop Sports Phys Ther. 2017 Nov;47(11):825-833. doi: 10.2519/jospt.2017.7227. Epub 2017 Oct 7.