ACL ruptures are a significant injury associated with a lengthy return to sport. For those that do return to sport, many do not return to the same level of competition or may experience re-rupture. Irrespective of whether an individual decides to manage their injury surgically or conservatively, a well guided rehabilitation plan and testing battery prior to return to sport greatly mitigates risk of re-injury and improves participation rates in their pre-injury level of sport.
Due to a large number of variables around each ACL injury and the desired end goal of rehabilitation, there is no set standard of exercises that all patients recovering from an ACL injury can go through. Instead, rehabilitation needs to be catered towards an individual based on factors such as the timeframe post injury, pain, swelling, deficits and functional demands of their chosen sport or activity.
From the moment of injury, each individual will experience a different rehabilitation journey, which ideally results in returning to their chosen sport or activity. Given this, progression through rehabilitation stages and return to sport should not be based on arbitrary time frames, rather a goal oriented approach should be taken to make informed decisions as to when an athlete is ready to progress.
One such example of this type of rehabilitation process would be the Melbourne ACL Guide 2.0 (Cooper & Hughes, 2018), whereby key phases of rehabilitation and goals are outlined, instead of prescription of a standard set of rehabilitation exercises. Whilst our clinicians at The Injury Clinic take a more nuanced approach to ACL rehabilitation, utilising modern technology and emerging scientific evidence, it provides a reasonable framework for the rehabilitation process.
This blog aims to discuss the key stages and milestones from injury through to return to sport in those who have sustained an ACL injury and subsequently undertaken surgical management.
For information regarding whether conservative management may or may not be for you, read our blog on surgery vs non-operative management here
Stage 1: Prehab
A comprehensive exercise regime post injury should be commenced prior to undergoing surgery. Improving swelling, restoring range of motion and improving strength of the lower limb has been shown to improve postoperative outcomes.
Stage 2: Improve swelling, range of motion and quadriceps activation
A period of protected weightbearing, use of compression and elevating the affected limb may help to settle the limb post surgery. Exercise prescription during this stage primarily focuses on restoring knee flexion and extension, and restoring quadriceps activation.
Stage 3: Strength & neuromuscular control
Once the knee has settled, a period of robust strengthening and control exercises should take place. The aim of this phase is to restore symmetry in strength between the lower limbs, improve control and balance. Light introduction to exercises which target rate of force production may occur during this phase provided the knee is coping well.
Stage 4: Plyometrics, returning to run and agility
Continuation of routine gym work should continue in this phase alongside the addition of running, jumping, landing and change of direction drills. This phase of rehabilitation needs to gradually expose an individual to the demands of their chosen activity or sport, with graded progressions of drills targeting the aforementioned physical attributes. A slow re-introduction to regular training should occur during this phase to assist in preparing an athlete for sport specific demands.
Stage 5: Return to Sport
A return to sport testing battery should be conducted to ensure that the athlete is both physically and mentally prepared. As a part of our testing battery, clinicians at the Injury Clinic utilise VALD Force Decks which provide objective data on power, strength and limb symmetry for a range of movement patterns.
Stage 6: Prevention of Re-injury
Ongoing strength training, conditioning, use of an appropriate warm-up routine and recovery strategies should be implemented once an athlete has returned to sport to mitigate the risk of re-injury.
Cooper & Hughes (2018). The Melbourne ACL Guide 2.0.
https://www.melbourneaclguide.com/docs/ACL_Guide.pdf
