ACL injuries are becoming more and more common, particularly in our younger athletes. Alas, even after all of the research and surgeries performed, we aren’t significantly changing the number of re-injuries that are happening. ACL rehabilitation and optimising the return to sport process through a criteria-based progression and program is currently the best evidenced based practice. At PRP Physio I have developed an ACL rehabilitation program that takes you from initial injury management all the way through to return to sport and is inclusive of an ongoing injury prevention program. I genuinely believe it provides athletes with the best opportunity to maximise both their recovery and their performance on returning to sport.
ACL injuries are commonly seen in many Australian sports but mostly in soccer, AFL, netball, and rugby league and rugby union. The common factor between all of these sports is that they are multi-directional 360-degree games. Preparing an athlete to return to their prior level of performance and reducing their risk of injury takes exposure to sport-specific movements and patterns. I believe in an early loading program that develops early strength improvements and allows for exposure to basic sport-specific movements to develop confidence in the knee.
The program that I have developed is specifically designed for an athlete who desires to not only return to sport but exceed the level of performance they were previously at. My goal is to make each athlete more robust and complete than they were prior to their injury.
The theory of surgical reconstruction is to reinstate the lost passive stability that the ACL provides. Commonly surgeons will utilise a graft from the hamstrings but some surgeons may opt to utilise the patella tendon, ultimately this is surgeon preference in most cases. Most clients respond positively to ACL reconstruction surgery and don’t report any complications but depending upon your surgeon’s protocol you may be placed in a brace for a period of time following surgery.
Returning to running after ACL reconstruction will typically occur within the 12-16 week period and returning to restricted training often occurs around the 4 to the 5-month mark. I often recommend clients aim for a 12-month return to sport. 9 months is certainly possible but requires a significant investment in time into the rehabilitation that some clients with work and family commitments may not be able to make. Returning to sport prior to 9 months isn’t highly recommended due to the significant increase in the risk of re-injury due to graft maturity rates.
In the early stages, it is all about settling down the inflammatory process, maximising the range of motion, and keeping muscles active to minimise strength losses. Hands-on techniques such as massage, dry needling, and joint mobilisations are integral to maximising mobility and maintaining the functional capacity of the knee. At home, the utilisation of ice and compression bandages to minimise the swelling build-up throughout the day is important. With regards to an exercise program the early emphasis is on light but consistent loading for range of motion as well as consistent isometric and isotonic exercises for the muscles focusing on the quadriceps, hamstrings, gluteals, and calves.
As fun as all of the plyometric and change of direction work is we can’t do that work if we don’t have a solid basis of strength. Developing a well-rounded strength and conditioning program not just for the knee but for you as an athlete is the next stage of your progress. I will work with you to develop a complete strength and conditioning program including a gym program and home program so that you are able to maximise your results in the minimum amount of time. This process takes time, we can’t rush strength training as magic can’t happen in 2 weeks. This stage takes commitment and consistency in training to see results. You will get out of it what you put in.
This is where it starts to get a little bit more fun. Prior to fully developing into plyometric work we will have done some introduction work prior to this to develop your movement patterns and ensure that you are nailing them. The key point I will be hammering home during the stage is technique and consistency. An athlete may be able to produce a lot of power, but if they can’t control it they will significantly increase their risk of injury. We will also be working on change of direction and multidirectional drills in this stage as well as we begin to prep you for the workload up to returning to training.
This is often the biggest portion of the rehabilitation process that I feel gets missed by clinicians and it’s integral to a good outcome. Without being able to assess and see how an athlete moves and operates on the field or court it is difficult for practitioners to truly give advice. As a mobile physio, I am at an advantage in that I am able to meet you at your nearest sporting field or court and watch and participate in field-based drills with you and we can discuss your performance right then and there. There’s no need for you to come back and see me in 3 weeks and tell me how you went because you can tell me in real-time and we can optimise and hone in on what you most need to work on to maximise your performance. All of this work is feeding in with returning you to training in a progressive and staged manner. Increasing the complexity of the environment around you by manipulating the number of players involved in a drill or increasing contact are just some of the ways we work with you and your coach to seamlessly work your way in.
The end goal for any athlete is to get out there in a competitive game. Here, we need to put all of the pieces of the puzzle together. Culminating in a return to sport assessment that includes clinical, psychological, and physical testing measures to ensure you are truly ready to return to sport. Our return to sport assessment is based upon the latest evidence and research to ensure we are providing you with the best information possible.
As a physiotherapist, I have managed many ACL clients, whether they undergo surgical reconstruction or non-surgical management. From football players of all codes (union, league, AFL, and soccer), to basketball and netball players I have helped just about any athlete return to sport after their ACL injury.
We pride ourselves on our ACL rehabilitation program which was developed in-house that helps take anyone from day one post-injury all the way through to return to sport should that be their goal. Our program includes everything from home exercises, a gym program, a return to running program, and return to training progressions.
Each stage of the program requires you to pass certain criteria. Recent evidence has identified that criteria-based progression has shown both better results in rehabilitation and lower re-injury rates compared to time-based progressions.
ACL injuries get expensive, once you factor in potential surgical costs, time off of work, doctors’ appointments, and specialist consults, it all adds up. I genuinely believe my ACL rehabilitation package provides the best value for money in physiotherapy rehabilitation for the best results.
As part of our ACL Rehabilitation package, you get everything you will need to go from start to finish. It encompasses everything including the following:
Physiotherapy is a key factor in maximising your recovery, ensuring you return to your maximum performance on your return to sport, and ensuring you maximise your quality of life in the future. As a mobile physiotherapist, we can cover everything for you as I am not bound by the structures of a clinic. If we need to perform field-based rehabilitation we meet at a field, if we need to reassess your gym program, I will meet you at your gym. Wherever we need to be I will be there.
Our rehabilitation program includes a total of 72 physiotherapy sessions throughout the 12-month program. Why so many some may ask? This program was designed for those who want the best outcome possible and is designed to not cut any corners. We will leave no stone unturned through your recovery and be with you every step of the way. The amount of contact we will have throughout the 12 months will change depending upon the stage of recovery that you are at to best suit your needs and goals. We have detailed below the aims of each stage and what changes throughout the program.
ACL rehabilitation can be expensive, particularly if you are opting for surgical management. Once you account for specialist consults, surgical fees, the cost of an anaesthetist, and imaging costs it adds up, and we haven’t yet included any potential time off from work yet. We don’t believe that finances should play a role in an athlete being able to have access to the best rehabilitation possible. If you were to access this program at a regular cost it would set you back $7600, our package costs a total of $6200, a saving of nearly 20%. For the level of access and rehabilitation that you will receive I honestly believe it is fantastic value for money.
Now I understand that given the early costs of managing an ACL injury are quite high which is why payment plans are available. Weekly, fortnightly, or monthly payment options are available depending on what best suits your needs and capacity. I will work with you to find an option for you to access the care you desire and deserve.