ACL Rehabilitation - Focus on Athletic Development ASAP

In a previous blog I discussed that overall I see and feel we are not pushing athletes who have had ACL reconstruction hard enough through rehab. This may be due to many factors: lack of equipment, lack of time (the individual's life schedule or clinicians too busy in the clinic), and perhaps even lack of knowledge of how to push people. Many times people are not pushed to their limit when they providers are not comfortable with the higher level activities.

Here I want to discuss some key components to rehab and when they can or should be started - although I may discuss ACL reconstructions in particular - these thoughts apply to any rehabilitation process

Overall Conditioning - building overall capacity of the body. This can be start relatively early - once the immediate post-operative effects (fatigue, pain, etc) are lessening - usually I start about 2 weeks out, but this could be earlier or later depending on the individual. I define “overall conditioning” as getting the entire body moving - thus things such as bench press, arms, arm biking, swimming, etc. , on top of the “rehab” needs - quadriceps strengthening, squatting, stepping. Heel raises, etc. etc. The earlier we can start to build capacity throughout the body, the more we are prepping the individual for jogging, return to sport. Think about it -if the first time your heart rate gets elevated is the first time you return to jogging - you have to deal with both the cardiovascular fatigue and the musculoskeletal fatigue.

Note: The World Health Organization (WHO) recommends 30 minutes a day of “huff and puff” exercise and 2 days of resistance training thus these should always be in the forefront of our mind when training ANYBODY.

Progressively increase load - strength training 101 here. Start with low weight and as someone shows you they are able to handle the weight increase it. Many times clinicians become fearful of using weight “ because it is not time yet”. While I am not blind to healing times, I am also well educated in managing load. So when someone asks me - when should I add weight to “x” - my answer is always “when you have earned it” or “when you are ready:. There is not a specific timeframe for increasing weight - it is criteria based (e.g. for weight bearing after a broken bone - the determining factors are how does it feel and how the healing of the X-ray looks - if you LOOK stable and feel good, in some cases a repeat X-ray may not even be done - for adding weight to squats - if they are easy and look good we add weight, if they are hard, we may. not). This being said - if you are getting back to jogging or heavier daily activities (outdoor chores, carrying laundry, etc) and you have not yet had weight in your hands when squatting, lunging, etc you are likely going to be underprepared for these activities and thus may experience pain or difficulty.

I am a strong believer that when rehabilitating the athlete we should be focusing on deadlifting (progressively increasing load), squatting (with weight), sled pushes / pulls, carries, push ups, pull ups, etc. All the movements that build the basics primal movements and build them well will help you succeed on building athleticism.

Variability- Training in all various movements, various forms of the primal movements, challenging the environment is vital in performance training - our bodies respond best to periodization (Periodization is the systematic planning of athletic or physical training. The aim is to reach the best possible performance in the most important competition of the year. It involves progressive cycling of various aspects of a training program during a specific period - wikipedia). If you are finding you are always do the same EXACT thing in rehab - especially during the later phases (3 months +) you are likely not reaching your highest potential.

Get back into normal routine ASAP - This is where having a solid team is crucial. When PTs, Personal trainers and physicians communicate - the results are amazing. If you already had a workout routine (going to the gym, group classes, etc) - the goal should be to get you back involved as soon as possible. There will need to be modifications - but the more you can get back got feeling like you, the better your recovery will be. There is nothing better than telling someone that you want them to “get back in the gym” - usually their reaction is ..”already?” - but when professionals communicate with each other - PTs can focus on certain aspects, personal trainers focus on other aspects - the combination is dynamite.

“Rehabilitation is training in the presence of injury”. If we can get through fear of moving early, respect the phases of healing, and get people to respectively not feel fragile early on in rehabilitation - we are setting them up for a more powerful, confident return to their activities, sports and life.