ACL Injury Rehab: Here is What You are Missing
The anterior cruciate ligament (ACL) is a key stabilizer of the knee joint. ACL injuries are one of the most common injuries seen among athletes. These injuries are often devastating, season-ending injuries for athletes of all sports. The recovery from an ACL injury is anywhere from 6-12 months and even then, most people still show a significant deficit in strength from leg to leg.
The Missing Link in ACL Injury Rehab
The missing link in most ACL injury rehab programs is performing true strength training. Three sets of 10 squats with a medicine ball are not going to get your quad strength to where it needs to be. Most athletes do not get back true strength after ACL injury because of a lack of good programming. Most physical therapists do an excellent job of progressing patients through an ACL rehabilitation program. It’s one thing to help patients get back to the basics; walking, squatting, stairs, running, jumping, etc. However, many clinicians are releasing athletes back to sport before they are actually ready to return safely, which is leading to a high rate of re-injury. There are many different published guidelines on return to sport criteria after an ACL injury. These guidelines certainly provide some very useful objective data that can help clinicians determine if the athlete is ready to handle the demands of their individual sport. However, none of these specific tests have proven to be very good at predicting if the athlete is truly ready to return without risking re-injury. There is inherent injury risk with all sports. However, returning to sports after an ACL injury without full strength significantly increases that risk.
Why Are Athletes Not Getting Strong Enough During Their ACL Injury Rehab Programs?
There are several reasons why athletes are not getting strong enough during their ACL injury rehab programs.
- Lack Of Equipment
- When was the last time you stepped foot in a physical therapy clinic that had true strength equipment? I’m talking about barbells with weights, heavy kettlebells, squat racks, etc. Many outpatient orthopedic clinics lack the equipment necessary to build true strength. These clinics can certainly get by helping the average patient return to full function, but higher-level athletes need a different training stimulus to succeed.
To build true strength, you NEED to lift heavy. To build power, you need to train with a velocity component. Fortunately, there are starting to be more and more outpatient clinics that are integrating strength and conditioning into their business. Here at PhysioStrength, we take our patients and athletes through the entire rehab process from the acute phase into the return to sport phase. Our clinicians have a strong strength and conditioning background and we have the equipment and space necessary to replicate the intense demands of sport.
- When was the last time you stepped foot in a physical therapy clinic that had true strength equipment? I’m talking about barbells with weights, heavy kettlebells, squat racks, etc. Many outpatient orthopedic clinics lack the equipment necessary to build true strength. These clinics can certainly get by helping the average patient return to full function, but higher-level athletes need a different training stimulus to succeed.
- Lack of Strength & Conditioning Knowledge of the Clinician
- Physical therapists are great at helping patients restore function. It’s what we do. However, when working with athletes, it is also important to have a solid understanding of the foundational principles of strength and conditioning program design. Not all outpatient orthopedic physical therapists are competent in program design and there is a lack of emphasis on intentional training. As mentioned earlier, 3 sets of 10 repetitions is not a one size fits all approach to training. It’s important to understand the demands of each individual sport and develop a training plan that helps replicate those demands. At PhysioStrength Physical Therapy, we bridge the gap between rehabilitation and fitness. When our athletes have progressed through their “traditional rehab program,” we develop an individualized strength and conditioning program to help them build back aerobic fitness, anaerobic conditioning, strength, power, and whatever they need
- Insurance Companies
- Unfortunately, your insurance company doesn’t care if you can play football, soccer, volleyball, or any sport. Insurance companies do not pay for full rehabilitation programs. The insurance company just wants to see that you can walk and get through the day without a significant limitation. Insurance companies will stop paying for services once you can do your daily activities without pain or limitation. This forces many clinicians to release patients from care before they are ready. This creates a gap in the rehabilitation program that often leads patients on their own.
Here is What Needs to Change
In the final stages of an ACL injury rehab program, one of the criteria many clinicians look for as a measure of determining an athlete’s readiness to return to sport is that the involved leg strength is 90% that of the uninvolved leg. The biggest issue with this measure is that the uninvolved or “good” leg has likely experienced significant atrophy and strength loss during the rehabilitation process. The athlete’s strength prior to the injury is the ultimate baseline. Unfortunately, unless you are a professional athlete, you probably don’t know what your true leg strength was prior to the injury.
There are plenty of different ways to test and assess an athlete’s readiness for sport. The important thing is that you cluster different tests and clinical assessments instead of relying on just one. Making assessments similar to the actual demands of the sport is the most important thing.
Want to Work With Us?
If you or someone you know has experienced an ACL injury or any other type of musculoskeletal or orthopedic injury, we are here to help. We are accepting new patients. Please schedule an evaluation online or feel free to give us a call at 253-336-2040. We are proud to be the best sports and orthopedic clinic in the south sound and look forward to helping you and your family.