Welcome to the ACL Rehabilitation: Part 4 blog!
Our last ACL rehabilitation blog post was focused on regaining strength and neuromuscular control. As we move into ACL rehabilitation:
Part 4 we see the rehabilitation become more dynamic as it moves towards a
return to sport specific activities.
In this phase, the most important ACL Rehabilitation goals are as follows:
Hopping Performance
Once the limb has developed adequate strength and control, we progress to
dynamic hopping and jumping, which begins to bridge the gap back towards sports
performance. This may start with double legged hops, and progressed through to
box jumps, drop jumps, single leg hops with perturbations. Good technique, hop
distance, and endurance are key things to look for.
Completion of a thorough, progressive agility program
This element of rehab will see a return to running, it may start with as
little as 20 second intervals on a treadmill, and gradually progressed. Once straight-line
running has been built up and tolerated, agility drills are progressed, beginning
with simple offline running drills. Agility drills can be progressed all the
way up to modified game play.
Regain full strength and balance.
In the previous phase, strength and balance were key focuses. It is very important
that these qualities are continued to be worked on to achieve the resolution of
FULL strength, and FULL balance.
Before testing at the end of this phase of rehab takes place
it is advised that the following criteria are met:
Full range of movement
No swelling
Good technique of a single leg squat
No side-to-side difference for the following:
§ Bridge (single leg)
§ Calf raises (signle leg
§ Side bridge endurance test
When considering progression to begin to return to sport, we
need to meet the following criteria:
1. Single Leg Hop Test: 95% when compared with non-injured side
2. Triple Hop: 95% when compared with non-injured side
3. Triple Cross Over Hop Test: 95% when compared with non-injured side
4. Side Hop Test: 95% when compared with non-injured side
5. Single Leg Squat: Greater than 22 with both limbs
6. Star Excursion Balance Test: This test assesses dynamic balance involving reaching one limb out to various points. Tests should be 95% when compared with non-injured side
7. Vestibular Balance Test: This test involves standing on one leg and performing side to side turns of the head, followed by up and down movements. It is passed if it can be performed without taking hands of the waist.
Supplementary goals would be:
– Single Leg Press 1 rep max at 1.8x bodyweight
– Squat 1 rep max at 1.8x bodyweight
Next Steps..
Following a successful progression through ACL Rehabilitation: Part 4, the athlete would be ready to start the process of reintegrating with their sport. The journey is still far from complete! Keep your eyes peeled for the next in the series, as we look deeper into the process or returning to sport. Many thanks as always to the great work of the Melbourne ACL Guide.
