ACL Rehab Reminders: Athletic Trainers Focusing on a Few Specific Areas

The road to recovery following ACL reconstruction can be long and hard. Athletic trainers can make it a little easier by focusing rehab on a few specific areas.

Athletic trainers know returning to sport after ACL reconstruction can be a lengthy process for the athlete. Along the way, there are several important areas to focus on, says John Nyland, EdD, ATC, PT, Associate Professor of Orthopedic Surgery at the University of Louisville.

In a recent presentation at the International Sports Medicine Congress, Dr. Nyland urged athletic trainers to work to correct athlete’s deficiencies during rehab. According to an article from Healio Orthopedics Today, Dr. Nyland suggests one way to do this is to take a proactive approach.

“Someone needs to talk to the patient, and I would suggest it is the physiotherapist and athletic trainer’s responsibility, at least, to do that,” Dr. Nyland said.

Along with tackling the biomechanics and biology that affect return to sport, Dr. Nyland explains it’s important to keep in mind behavioral and psychological factors such as resilience and self-efficacy. For instance, he says athletic trainers should emphasize the importance of quality over quantity in exercise movement.

Athletes will also need to build their flexion and neuromuscular control and re-establish non-impaired active knee extension in order to get through rehab.

“This is a big missing piece of a lot of traditional physical therapy approaches because the first time [athletes] go back, they have to go in this position of extended hip, high knee flexion and they are going to tear something or they are going to cause patellar tendonitis,” Dr. Nyland said.

Another focus during physical therapy from ACL reconstruction should be basic strength training, according to Dr. Nyland. This is especially important as athletes work to build strength in the lower extremity and hip and restore quad and high knee flexion functions.

“You have a healthy hip, a supple strong hip, you are not going to have back problems. You are not going to have knee problems,” Dr. Nyland said.

In terms of agility training, the progression that Dr. Nyland recommends is to go from exploratory movements to sport-specific movements. This allows athletes to focus on the position they play or their particular sport.

“Too often we see motion constraints after surgery,” Dr. Nyland said. “[Athletes] get so used to going from fun and playing and recklessly moving to being constrained in uniplanar motions. We see this all the time post-reconstructive surgery of the knee. It is important to get them to move again.”

Once athletes return to activity, their recovery is not over. Maintaining the ACL after reconstruction will take continual care. So along with strength training, Dr. Nyland says athletic trainers will want to emphasize the importance of maintenance training.

“In my opinion, the ACL injury is a permanent injury,” he explains. “As long as you are going to be an athlete, you have maintenance requirements particularly at the hip, not just the quads.”

What determines ACL outcomes? Don’t miss our article on the topic, “Predicting ACL Outcomes: Biomechanics.”

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