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
Al Attar, W. S. A., Bakhsh, J. M., Khaledi, E. H., Ghulam, H., & Sanders, R. H. (2022). Injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament injury: a systematic review of cluster randomised trials. Journal of physiotherapy, 68(4), 255–261. https://doi.org/10.1016/j.jphys.2022.09.001
Andrade, R., Pereira, R., van Cingel, R., Staal, J. B., & Espregueira-Mendes, J. (2020). How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II). British journal of sports medicine, 54(9), 512–519. https://doi.org/10.1136/bjsports-2018-100310
Arundale, A. J. H., Bizzini, M., Dix, C., Giordano, A., Kelly, R., Logerstedt, D. S., Mandelbaum, B., Scalzitti, D. A., Silvers-Granelli, H., & Snyder-Mackler, L. (2023). Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention. The Journal of orthopaedic and sports physical therapy, 53(1), CPG1–CPG34. https://doi.org/10.2519/jospt.2023.0301
Brinlee, A. W., Dickenson, S. B., Hunter-Giordano, A., & Snyder-Mackler, L. (2022). ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports health, 14(5), 770–779. https://doi.org/10.1177/19417381211056873
Culvenor, A. G., Girdwood, M. A., Juhl, C. B., Patterson, B. E., Haberfield, M. J., Holm, P. M., Bricca, A., Whittaker, J. L., Roos, E. M., & Crossley, K. M. (2022). Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus. British journal of sports medicine, 56(24), 1445–1453. https://doi.org/10.1136/bjsports-2022-105495
Whittaker, J. L., Culvenor, A. G., Juhl, C. B., Berg, B., Bricca, A., Filbay, S. R., Holm, P., Macri, E., Urhausen, A. P., Ardern, C. L., Bruder, A. M., Bullock, G. S., Ezzat, A. M., Girdwood, M., Haberfield, M., Hughes, M., Ingelsrud, L. H., Khan, K. M., Le, C. Y., Losciale, J. M., … Crossley, K. M. (2022). OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis. British journal of sports medicine, 56(24), 1393–1405. https://doi.org/10.1136/bjsports-2022-106299
One in five Australians now live with persistent pain. Pain can impact you physically, mentally, emotionally and socially.
Very similar to our general health, the health of the structures in our bodies is maintained through regular movement, keeping strong, exercising regularly, maintaining a healthy body weight, caring for our mental health, regularly sleeping well, remaining social, and not smoking or drinking too much alcohol. So, when these things go wrong, our nervous systems can become sensitised and pain may persist.
Our Musculoskeletal Physiotherapist, Hayley, has a special interest in managing persistent pain. She can help you to understand why you have pain, and get you back moving, active and living again. Call our friendly staff for assistance today.
As all of the football codes are wrapping up for the year, attention turns to off-season planning. Here are some recommendations for athletes to optimise their time off:
1. REST AND RECOVER
Week 0-4
· Make sure you utilise this initial phase to let your muscles, tendons etc recover from the intensity of the season.
· Alternative light intensity activities are good options such as swimming, walking, bike riding.
· Enjoy time with friends and family, try new hobbies and activities.
· Reflect on the season and set some goals for the next year.
2. STRENGTH DRILLS
Week 5+
· The off-season is a great opportunity to get in the gym and work on improving strength, power and movement quality for enhanced performance next season.
· This strength program can be sport-specific and based around your goals. For example, if you wish to improve your speed off the mark then including exercises that focus on glut strength and power will be useful. Senior Physiotherapist, Jess Norton, can help you design and implement a program based on your available equipment and resources (at home or the gym).
· Take the opportunity to prevent any injuries or ensure a full recovery from any this season. For example, if you experienced lower back soreness or a stress fracture this season, it will be important to be working on improving the strength and mobility around the area and any contributing factors to ensure your risk is lower in the coming year.
3. CONDITIONING WORK
Week 8+
· Preseason can be tough, so make sure to start building your aerobic capacity with some running, swimming or higher intensity gym work so you are ready. Spikes in load can increase your injury risk so make sure you gradually build and transition back into field-based training.
· Load management is a complex topic, particularly when athletes are juggling multiple team and training commitments. If you would like advice on load management to maximise your performance but minimise your injury risk, Senior Physiotherapist Jess Norton can work with you and provide recommendations on how to structure your training schedule (field/gym/other) plus other important factors.
Jess Norton | B.Phty, B.ExSc
Senior Physiotherapist | Physiologic
Plantar fasciitis which we know refer to as Plantar Heel Pain is a common condition that can cause pain at the bottom of the foot and heel. It Is typically caused due to the irritation of the plantar fascia which is a long and thin ligament which lies directly underneath the skin at the bottom of the foot.Plantar heel pain can be debilitating due to the increased amount of discomfort when going for walks or going up and down stairs.
Fortunately physiotherapy can help alleviate the symptoms that are associated with plantar heel pain and this can be done by either therapeutic taping, footwear advice, strengthening exercises and physical activity management advice.
A common question that we get hear at the clinic is should I see a podiatrist or should I see a physiotherapist for this?
The answer is either or both.
Physiotherapists are well equipped to provide you with some basic pain management and physical activity management advice as well as provide the best exercises to assist you during your recovery.Podiatrists on the other hand are fantastic at providing footwear advice suitable to your problem and potentially arranging some orthotics depending on your requirements.
If you or anyone that you know suffers from Plantar Heel Pain please feel free to contact us here at Physiologic and we will be more than happy to help you out.
Chris Pearson
Physiotherapist.
Low back pain is a common condition experienced by 80% of people at least once in their lifetime. For up to 30% of people, their pain may become persistent (lasting for longer than 12 weeks) and interfere with many aspects of their life. This can look like having trouble doing usual day to day activities, exercise, work and difficulty being involved in social activities and hobbies which you enjoy.
Very similar to our general health, the health of the structures of our lower back is maintained through regular movement, keeping the back, trunk and legs strong, exercising regularly, maintaining a healthy body weight, caring for our mental health, regularly sleeping well, and not smoking or drinking too much alcohol.
It’s very important to understand that back pain usually improves with the right treatment even if you have had it for many years. Our Musculoskeletal Physiotherapist, Hayley, has a special interest in managing low back pain. She can help you to understand why you have pain, and get you back moving, active and living again. Call our friendly team for assistance today.
References
Hartvigsen, J., M. Hancock, A. Kongsted, et al., What low back pain is and why we need to pay attention. The Lancet, 2018.
O’Sullivan, P.B., J. Caneiro, K. O’Sullivan, et al., Back to basics: 10 facts every person should know about back pain. 2020, BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine.
Hayley Thomson | B.Ex Sci, M Phty, M Msk Phty, M Med Res
APA Musculoskeletal Physiotherapist | Physiologic
As this current wave of COVID spreads through the eastern states of Australia we know that in the vast majority of cases people recover well after the initial onset of respiratory symptoms. However, since early on in the pandemic some patient reported experiencing secondary symptoms that were lasting weeks or months after initial infection. This has been termed ‘Long-COVID’ and it affects our body in many ways.
Once patients are out of hospital or the initial COVID recovery phase, physiotherapists can play a significant role to play in the management of Long COVID. Some of the main symptoms experienced include shortness of breath, significant fatigue, altered sleep and reduced cognitive function. These symptoms have a big impact of being able to carry out normal daily living.
Returning to daily living and/or exercise needs to be closely monitored in patients with long covid, as symptoms can worsen with excessive physical, cognitive or emotional activity similar to those with chronic fatigue syndrome. Physiotherapists can advise on how to pace your daily activities and more specific testing can be done to determine at what heart rate intensities you should be working at throughout the day or when exercising. Here at Physiologic we are one of only a few practices in South East QLD with the ability to accurately test your metabolic function via a Metabolic Efficiency testing and we have experience in assisting those with chronic fatigue syndrome set suitable training programs in order to optimize their function.
Many patients are reporting significant difficulties in controlling their breath long after the initial infection. Breathing is usually something that comes naturally to us. However, many patients with Long COVID are reporting “it feels like I have forgotten how to breath correctly”. Physiotherapists can assist with relearning correct breathing patterns and ensuring the correct muscles are being used.
If you or someone you know if struggling with Long-COVID your primary contact should be your GP. Contact us here at Physiologic to discuss how we can help you return to your optimal level of function, in a shorter time frame than just a wait and see approach.
Adam Shaw
Titled Musculoskeletal Physiotherapist
