“Torn ACL”. Two of the most feared words in an athlete’s vocabulary. The rehabilitation process back from a torn ACL is a very complex and multifactorial game. With the goals of return to competition, we as clinicians must dive into the intricacies of proper rehabilitation post-op ACL reconstruction. Unfortunately, current research shows that one-fifth of the total population that return to sport after ACL reconstruction sustain a second ACL injury (Wiggins et al., 2016). 20%. Why is this? A research team lead by Matthew Buckthorpe decided to dive deeper into this issue.
Within their study, the group proposed a new framework coined the “return to sport (RTS) continuum”. The RTS continuum places more focus on “performance” rather than just “prevention”. The progressive framework of the RTS continuum consists of four stages starting from on the field return (OFR), to return to training (RTT), to return to competition (RTC), and return to performance (RTP) (Buckthorpe et al., 2019a). The biggest downfall with current rehabilitation does not lie primarily in the return to sport portion of rehabilitation. Rather, what does the athlete do after they return to sport? A recent study found decreased scores on hop tests in clients 5 years after ACL reconstruction, compared to their performance during rehabilitation (Patterson et al., 2020). Decreased hop performance leads to increased opportunities for a recurrent ACL injury.
What can we deduct from this? Rehabilitation should not end after simply returning an athlete to their sport. The RTS continuum highlights this with the final stage of “return to performance”. While the athlete may be “safe” to return to competition, deficits can still be present. Baseline cannot be the standard. The sad reality is there is a reason these athletes sustained their first ACL injury. Their bodies “baseline” ability could not protect them from sustaining this injury. So, instead of returning an athlete to their baseline, we need to focus on surpassing that to a “performance” level. The objectives and goals can no longer focus on “getting the athlete back to where they were before”. Instead, let’s get the athlete better than they have ever been. No more operating at 85% of ability. To learn how we can get you back to 100% and performing better than you ever have, reach out to us! Our team of performance physical therapist are here to return you to 100% to prevent any recurrent ACL injuries.
Sources
- Buckthorpe, M., Villa, F. Della, Villa, S. Della, & Roi, G. S. (2019a). On-field rehabilitation Part 1: 4 pillars of high-quality on-field rehabilitation are restoring movement quality, physical conditioning, restoring sport-specific skills, and progressively developing chronic training load. Journal of Orthopaedic & Sports Physical Therapy, 49(8), 565–569. https://doi.org/10.2519/JOSPT.2019.8954
- Patterson, B. E., Crossley, K. M., Perraton, L. G., Kumar, A. S., King, M. G., Heerey, J. J., Barton, C. J., & Culvenor, A. G. (2020). Limb symmetry index on a functional test battery improves between one and five years after anterior cruciate ligament reconstruction, primarily due to worsening contralateral limb function. Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, 44, 67–74. https://doi.org/10.1016/J.PTSP.2020.04.031
- Wiggins, A. J., Grandhi, R. K., Schneider, D. K., Stanfield, D., Webster, K. E., & Myer, G. D. (2016). Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. The American Journal of Sports Medicine, 44(7), 1861–1876. https://doi.org/10.1177/ 0363546515621554
