I did lots of strength work in the gym and running for my ACL rehab. That should be enough, shouldn’t it?
ACL rehab is a long process that involves many different facets, gaining strength is only one aspect to focus on. There are many other aspects that need to be addressed if you want a successful return to sport. A lot of clients believe that once they are running with no pain, they are finished with rehab. However, the end stages of rehab are perhaps the most important, to help reduce the chance of re-injury, increase the chance of a successful return to sport and possibly reduce the likelihood of osteoarthritis later in life.
In this article I will outline four areas of ACL rehab that are used in conjunction with strength training to get you back to where you want to be.
4) Sport Specific Activities
Proprioceptive training is important to help activate other structures in the knee joint that will produce compensatory muscle activation and ultimately assist with joint stability. It has been shown that proprioceptive deficits can be present up to a year post ACLR, showing that this type training needs to continue well after a return to sport to help prevent re-injury. Proprioception involves balance exercises to help teach your body where it is in space and hence give better stability and strength during unexpected or quick movements.
Below is an example of high level proprioceptive training, where the athlete is balancing on one leg on a bosu ball for added dynamic movement, whilst throwing a ball. This detracts the focus from the knee whilst still creating a challenging environment.
Agility drills are another important aspect of ACL rehab. It allows you to start to adjust to sports specific activities by breaking them down into bite size chunks. For example changing direction, acceleration, deceleration, quick stops and take offs. Training this is important as there are few sports that simply involve running in a straight line continuously.
In the picture below this soccer player is using a ladder for quick feet drills. They use a grapevine movement to increase the twisting and turning motion at the knee joint. Focus here is on speed and accuracy.
Plyometrics works to improve neuromuscular control, which can become a learned skills that transfers to return to competitive play. Research has shown us that when plyometric training is combined with strength training, there is less re-occurrence of injury and a greater percentage of players that return to the same level sport prior to injury.
Plyometrics activities involve explosive movements where muscles exert maximum force in short intervals of time, with the goal of increasing power (speed-strength). Below is an example where the athlete does an explosive single hop for distance. Focus here is not only on distance but also the control of taking off and landing.
4)SPORTS SPECIFIC ACTIVITIES
Working closely with your physio is very important for a successful return to your sport. Your physio can work with you to develop a program that specifically relates to your sport, being it AFL, netball, soccer, gymnastics or crossfit. Your ACL works dynamically, to assist in stabilising the knee joint when you perform any twisting, turning or cutting motions. Therefore, it is important to train, when the time is right, in a manner that will mimic your sport’s functional demands.
In these later stages of rehab, your physio will be closely monitoring how your ACLR side is going compared to your other side. Tests such as the hop for distance, as shown above for the plyometric training, are important to help us gauge when you are ready to return to sport. Studies tell us that your ACLR knee needs to be within 10% of your other knee to achieve a successful return to sport. Once this is achieved, an integrated plan can be developed to help increase your sport fitness, getting you ready to start your season at the peak of your training.
If you want to get back on track with your ACL rehab and get back to doing what you love sooner, please contact us and book an appointment with our specialised physios.
Danielle Tape, myPhysioSA Associate Physiotherapist