Recovering from an ACL injury? Here’s why late-stage rehab is essential in getting you back in the game.
Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries in the active population. There are both surgical and non-surgical management options following ACL injury with a rehabilitation period recommended with both management pathways. The rehabilitation process is designed to run in phases over 9-12 months and begins early after injury. Throughout rehabilitation, there is a gradual increase in activity and function as you progress from one phase to the next. Each phase has specific goals, with consistent completion of the rehabilitation program being key to a successful recovery.
Do I need to complete late-stage rehab?
Not all of those who suffer an ACL injury return to sport, with only 65% returning to their pre-injury level of activity. Persistent symptoms, repeated ACL injuries and impaired quality of life are also reported during long term follow up. Inadequate rehabilitation has been proposed as a factor in reduced activity levels in those with who have experienced an ACL injury. To ensure a return to full function and activity with the best possible outcome, it is highly beneficial to complete all stages of rehabilitation following ACL injury.
It can be easy to fall off the ‘rehab bandwagon’ for several reasons: loss of motivation, juggling competing commitments, pain free daily activities and return of adequate function. Tracking your progress is a great way to keep motivated, by setting ‘mini challenges’ for yourself throughout what can seem a lengthy rehabilitation process. Each phase has milestones or benchmarks that need to be achieved, to allow you to progress to the next level. Your physiotherapist will use a combination of clinical tests and equipment to assess a selection of criteria, including range of motion and muscle strength. This is valuable information and can determine:
- Your current capacity and status of your rehabilitation
- How your knee compares to your non-injured knee
- How you compare to standard values
- If you have met the current phase milestones and are ready to progress to the next phase of your rehabilitation
What does late-stage rehabilitation involve?
Late-stage rehabilitation is the term given to the rehabilitation phase from 6 months, until return to sport. This is the fun stage of rehabilitation in which your physiotherapist will tailor your program to you and the sport you love. Consultations with your physiotherapist will include discussions about your goals for rehabilitation, specifically what activity or sport you intend to return to. For example, this may be participating in Parkrun each week, cycling on weekends with the family, social tennis with friends, or academy level soccer. Plyometrics are explosive jumping-type exercises and are only introduced in late-stage rehabilitation once the strength foundations have been achieved earlier in the rehabilitation period. One of the main aims of late-stage rehabilitation is prevention of another ACL injury. Rehabilitation and injury prevention programs that include plyometric exercises have been shown to significantly decrease the risk of subsequent ACL injuries by up to 60%.
Late-stage rehabilitation typically involves a specific strength, plyometric and endurance-based program along with running and integration back into your sport or activity. This phase of rehab can be based around your usual sport schedule and in familiar environments. For example, if you are aiming to return to soccer, late-stage rehab could incorporate the following aspects prescribed by your physiotherapist:
- A gym or home-based program targeting lower limb strength and endurance
- Plyometric, jump and landing drills such as box jumps
- Field based conditioning, sprint, and agility drills at your usual soccer fields
- Noncontact ball drills with the team at the regular scheduled training sessions
- Specific warmups incorporating Football Australia’s Injury Prevention Perform+ Program
When can I return to play sport?
The decision and clearance to return to play pivoting and cutting sport, such as soccer or netball, is made in conjunction with your physiotherapist and orthopaedic surgeon. Return to play decisions are made 12-months following surgery at the end of late-stage rehabilitation. Part of this final process includes additional benchmarks and a structured return to play testing protocol performed by your physiotherapist. The return to play testing involves a series of physical knee focused tests, neuromuscular control and landing drills, power measurements and mental readiness questionaries. Those who complete a battery of functional tests prior to a return to sport have a reduced risk of re-injury. Upon return to sport, your physiotherapist will discuss and tailor an ongoing injury prevention program for you. There are a range of sport specific programs, such as the FIFA 11+ and Football Australia Perform+ for soccer and the KNEE program for netball, that have been shown to reduce the risk of injuries when completed two to three times a week.
Completing ACL rehabilitation?
If you are currently completing ACL rehabilitation and would like to track your progress, have lost motivation, or are unsure about whether you are ready to return to sport, book an appointment with your physiotherapist to help you get back in the game with a successful recovery.
Author:
Jessica Norton
Senior Physiotherapist
Physiologic (Allsports Robina)
References
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