Rehabilitation after ACL reconstruction surgery.
The ACL (Anterior Cruciate Ligament) rehabilitation protocol I use to guide rehabilitation for my patients is a goal based progression. We can move through the ACL protocol at our own pace, and let the criteria govern how quickly we go, rather than a traditional pre-determined timeline. This is really helpful for setting goals and determining the appropriate exercises for each patient at each stage. Rehabilitation after ACL surgery must be individu alised and requires clinical reasoning that the experienced therapists at RHP Physiotherapy can provide.
Image from www.ihealthsphere.com.au
This simple and elegant protocol was designed by Randall Cooper, a specialist sports physiotherapist from Melbourne, and is broken down into 5 phases. There is a list of goals and outcome measures that need to be satisfied at the end of each phase to move onto the next one. The five phases are:
• Phase 1: Recovery from surgery
• Phase 2: Strength & neuromuscular control
• Phase 3: Running, agility, and landings
• Phase 4: Return to sport
• Phase 5: Prevention of re-injury
Interestingly the rate of return to same level sport after ACL reconstruction may not be as high as you would think, and certainly not what we see reported in the media of quick returns to high level sport by high level athletes. A recent Australian study revealed that of 314 participants, less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation. At follow-up, 45% were playing sport at their preinjury level and 29% were playing competitive sport. Ninety-three percent of the study sample had attempted sport at some time after their ACL reconstruction surgery. Long term effects after reconstruction are being investigated by researchers at UQ now with Steph Filbay and her colleagues.
So, taking your time, progressing at your own pace, and being mentally and physically prepared for return to sport could maximise our success of returning to sport.
Here are a few tips on how to progress through an ACL rehab protocol with minimal problems:
* Get the knee straight early (within the first 2-3 weeks), and keep it straight. Flexion (bending) can progress gradually. If you have had meniscus repair, this may happen after you are allowed out of a brace as recommended by your surgeon.
* Use knee pain and knee swelling as a guide. Listen to your knee. If either or both are increasing, the knee isn’t tolerating what you’re doing to it.
* Build high impact forces gradually. The articular structures in the knee joint will take time to adapt to a resumption of running, jumping and landing.
* Complete your ACL rehabilitation. Once people are back running with no knee pain it’s easy to think that it’s all done. But the last 1/3 of the protocol is the most important – to help reduce the chance of re-injury, increase the chance of a successful return to sport, and possibly to reduce the likelihood of osteoarthritis down the track.
* Technique is everything. Compensation patterns develop after an ACL tear, so focusing on correct muscle and movement/ biomechanical patterns is paramount. A copy of the complete ACL Rehabiltation Guide from Randall Cooper can be downloaded from the Thermoskin website.
A copy of the complete ACL Rehabiltation Guide from Randall Cooper can be downloaded from the Thermoskin website.
In the next of my blogs I will explain how we use the Melbourne Return To Sports Score at the end of Phase 4 to determine readiness for return to training and sport.