Updated: Apr 13
Anterior cruciate ligament (ACL) REHAB PROGRAM
Resistance Sports Science coaches are experts in return to sport rehabilitation. For years our coaches have followed a strict procedure on ACL Rehabilitation to ensure our athletes are back playing the sport they love with minimal risk of re-injury. Our programming is extensive and specific to the particular surgery our athletes were involved in. To get you back playing your sport, you will be guided by our sports physiotherapists and Exercise/ Sports Science department. The process we follow and more information on ACL injuries is below:
What is the ACL and how do I know if it is torn?
ACL stands for Anterior Cruciate Ligament. It resists rotational knee forces and anterior tibial translation. Put simply, it prevents forward shift of the tibia bone from the knee itself. A physiotherapist or Doctor can diagnose a ruptured ACL by a positive Lachman's test. A large forward shift of the tibia in comparison from the injured leg to the uninjured leg can give evidence to suggest that an ACL may be ruptured. Our physiotherapy team will ask questions like how it happened, did the athlete hear any noises like a loud pop, did the pain go away after a few minutes and does the knee feel unstable. If the athlete answered yes to the last three questions, it looks more and more likely that the ACL may be ruptured. Our Sports Physiotherapy team will refer you to a bulk billed MRI to finalise the diagnosis.
https://www.youtube.com/watch?v=RTV5Yo3E7VQ&t=5s Video for reference.
What are the potential causes and factors leading to an ACL Injury?
Rapid change of directions with deceleration loads creating excessive torsion through the knee
Muscular imbalances causing greater medial force on the knee
Gender. Females are at least two times more likely to rupture an ACL.
Lower Limb Strength Deficiencies
Previous ACL injury History
Ligament laxity otherwise known as hypermobility
Training age within a certain sport. The less time you have had to develop specific skills and movement techniques, the greater the chance of ACL rupture
What's the process ?
ACL Rupture on field (pre surgery)
Day 0 - 7
You may in your first few days post an ACL rupture be able to walk with a limp or sometimes almost normally. It is important to note that for many athletes this doesn’t correlate to a misdiagnosis. Many athletes believe that because they can walk again that their ACL isn’t ruptured. Unfortunately in many cases it is indeed ruptured, your body just doesn’t require your ACL for walking! After the first few days of recovery our physiotherapy team will get the injured athlete to begin moving through its current range of motion. We use Compex, an electro stimulation machine which fires muscle fibers which can not be activated by just tensing. This gives the athlete a greater chance of retaining their maximal available muscle fibers which will aid in improving their recovery time post surgery. Our sports physios will use a range of manual therapy techniques including massage and dry needling to release spasm and wound up muscles with the aim to take pressure off the knee.
Week 1-6 Pre ACL Surgery in the Rehab Hub
Surgeons typically like to see six weeks of rehab before an athlete undergoes ACL surgery. In the next 5-6 weeks of your ACL rehab our Exercise Physiologists will work to ensure your muscle mass grows in size. In most cases the greater the muscle we can build in these 6 weeks, the lesser the atrophy experienced by the athlete and the greater the chance of a successful ACL rehab return.
Surgery - Week 2 Post Operation
The Resistance Rehab team will consult your hospital physios and surgeon to ensure a successful procedure. Within the first 12-16 weeks of your ACL rehabilitation, our sports physiotherapy team will lead the rehab and ensure you are consistent with your exercises, stretching and general homework. You will be prescribed rest for at least the first week as the procedure may be quite painful or it may leave the athlete feeling quite sick for numerous days. In this time, electro stimulation and gentle muscle tensing will be enough to keep the knee activating without hurting it or causing excessive pain. With any procedure there will be a small level of pain our practitioners will need to work with to ensure we can adapt to greater stimuli there-after.
Week 2 - 6 in the Rehab Hub.
In these weeks of your ACL Rehabilitation program you join our Rehab Hub. Our athletes will see our physios up to 5x per week if they do require. They are entitled to 1x physio session weekly and 4-5 small group rehab sessions. The goal here is to increase range of motion of the knee joint, decrease stiffness and swelling and improve lower limb muscle activation. Your nominated sports physio will guide you through the whole process acting as your rehab mentor throughout. You will be encouraged to exercise daily and work within pain free range. Every week you will experience large improvements in these areas and you will notice that muscle mass will start to re-shape and grow.
Your homework exercises will be updated weekly to fortnightly and the level of intensity of most exercises will improve considerably.
Week 7 -12 in the Rehab Hub
From Week 7 you will start to see a gradual increase in intensity, complexity and general volume in your ACL rehabilitation. The likes of squatting and gentle lunges will now become much easier as your range of motion through the knee joint improves. Our aim here is to increase muscle mass as much as possible and decrease “tightness” through the ITB, Glutes and general hip area. If you have been in crutches or in a moonboot, you are of a high percentage to suffer from lower back pain as a result. In weeks 7-12 we not only focus on your ACL rehabilitation but your body as an entirety.
You will gradually increase the amount of landing load though single and double legs and by the latter weeks of this block you will begin light assisted jumping.
Somewhere within this timeframe you should be expecting to to attempt your first run! Our ACL program starts with very light 50m jogging efforts with walk back recovery. The focus in the gym will be more tailored to rotational forces and heavier loads. Expect rep ranges of around 6-10 with many pilates based accessories at the end of your sessions. It is important that throughout the ACL process that the athlete doesn’t get too fixed on just quad strength. We want your body to work as an efficient machine which can handle whatever life throws at it. In this block you will see light plyometrics, single leg strength and heavier compound lifting.
This is two separate strength and power blocks. The focus strays towards reactive movement, longer distance and more intense runs plus strength loading. Every week we want to see improvements in strength within this phase. Whilst your main lifts may be strength focused your accessories will focus on hypertrophy. We are still ensuring throughout the entire process that muscle mass continues to grow which minimises the risk of re-injury when you return to sport. In this block of training you will commence your first true performance test to analyse what deficiencies require more attention. Expect the likes of depth jumps, single leg hopping, reactive landing, heavy squats & deadlifts and rotational exercises throughout the entirety of this block.
This is your explosive plyometric phase of training. We are preparing for your return to training! We need our athletes to be able to confidently land, change direction, pivot, accelerate, sprint, skip, jump and load heavy. Your body will adjust to this high intensity plyometric load which is required for returning to training/sport. This block is about confidence. We need you to be confident in every movement, there is no room for hesitation. Hesitation leads to injury! Expect skipping, single leg hurdles, lateral jumping, barbell squat jumps, bulgarian jumps, heavy single leg loads and much more.
Return to Training Week Week 37-45
Depending on how successful your rehab has been, upon approval of your Surgeon, Physiotherapist and S&C coach, you may be given clearance to participate in light training. This looks like gentle skills, straight line running and no contact. Your Strength regime will be heavily focused on the specific skills required to train. This may look like tackling or bumping drills, game based scenarios, reactive single leg jump and lands, explosive sprints, repeat efforts and much more. Injury prevention is still on the forefront of this program. Your RSS Coach will assist in managing your load and will program around your sport and work balance.
Return to Sport Week 46+
Congratulations, you have successfully Rehabbed your ACL. You have shown no hesitation in any skill drills, you are confident to take contact, you are lifting adequate strength numbers and overall you are just as fit if not fitter than before the injury. It is recommended that you gradually increase your game and contact time and with clearance from the Surgeon, Physiotherapist and Strength Coach. You are ready to return!