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Return to Sport: Post ACL Reconstruction

At the Made 2 Move ACL Performance Lab, a majority of our athletes' first question is- when can I get back to my sport? They are eager to get back on the field or court and will do whatever it takes to get there as quickly as possible. This is what makes them some of our best patients- they are highly motivated and always do their rehab homework!

But oftentimes they are discouraged when we recommend at least 9-12 months before they return to sport. “But I feel better, my knee is strong, I’m READY to play!”- “ *insert professional athlete here*- started playing again at 6 months after his/her ACL surgery! Why can’t I?” is often the response we hear.

So why are we recommending 9-12 months of recovery after ACL surgery vs. the previously thought 6 month recovery time? It’s not because we want to keep you around longer- we want to see you play just as much as you want to be back out there scoring goals and cutting up your opponents! The primary reason for the 9-12 month return to sport time frame is the risk for reinjury when returning too soon.

A recent study showed that “During the first 9 months after surgery, a later RTS was significantly associated with a lower reinjury rate. For every 1 month delay in RTS, the reinjury rate was reduced by 51%. Patients who participated in level I sports earlier than 9 months after surgery sustained 39.5% reinjuries (15 of 38), compared with 19.4% knee reinjuries (7 of 36) in those who returned to level I sports later than 9 months after surgery” (Grindem et. al 2016).

Additionally, the fear of reinjury is an aspect of ACL rehab that often gets pushed to the wayside. The psychological and mental hurdle of returning to sport is an under addressed aspect in the rehab required for return to sport that athletes often don’t recognize or choose to ignore. Delaying return to play in our Made 2 Move athletes allows us time to build confidence in your knee that will translate to sport.

So how do our Made 2 Move ACL specialists address these deficits and get our athletes ready to get back on the field? The obvious aspects of rehab are the strengthening and range of motion exercises we put our athletes through. Another big component of return to sport rehab involves neuromuscular training.

What is Neuromuscular Training and how can it help me recover from my ACL injury?

Neuromuscular control is defined as “afferent sensory recognition of joint position and motion and the following efferent response to that awareness” (Lee et. al 2019). This simply means: our awareness of where our bodies are in space and how we react to this.

In the context of sport, the concept of neuromuscular control becomes clearer. If you are going up for a header in soccer and you collide with your opponent mid-air, neuromuscular control is what allows you to land with proper biomechanics vs. just flopping on your face when you hit the ground (though sometimes that happens too).

Ligamentous injuries tend to disrupt our neuromuscular control- likely due to time the joint was immobilized and the proprioceptive role ligaments play in the body. Following ACL injury, “Impaired neuromuscular function around the knee is considered to be responsible for persisting functional deficits such as decreased maximal strength, limited postural control, or prolonged muscle reaction time” (Lee et. al 2019).

This does not mean that your neuromuscular control in the injured knee is completely shot post ACL reconstruction. Regaining this neuromuscular control simply requires time, and the more time you give it, the less likely it is that you will reinjure your knee. Following an intensive few months of neuromuscular training, strengthening, mobility, and proprioceptive training, our ACL specialists will have you transition to more sport specific training.

Sport Specific Training

Dr. Kevin Vandi, DPT, OCS, CSCS of Competitive Edge PT touches on the sport specific movement requirements required for return to sport post ACL reconstruction, “The unpredictable nature of throwing, catching, jumping, changing direction, and reacting to perturbation is what trains your knee to be comfortable and confident during game speed situations.” Here at Made 2 Move, we incorporate game specific exercises and drills that address these game specific situations- like the cutting, running, acceleration/deceleration and jumping/landing that mimic what you will see in your sport.

If you’re a wide receiver, our Made 2 Move therapists are going to have you jumping in the air to catch a ball while we apply some push in the air to test your landing and reaction mechanics. If you’re a basketball player, you can bet you’re going to practice cutting, dribbling, and shooting under pressure before you ever step back out on the court. Soccer player? You’re going to have your ball in the clinic dribbling, juggling, passing, and jumping to mimic your sport.

Our Made 2 Move ACL Performance Lab is going to give you rehab tasks that will challenge you mentally and physically, as well as require cognitive awareness and intense neuromuscular control, much like what you will experience on the field. This will help prepare you both psychologically (a major hurdle to many athletes returning to sport is fear of reinjury), and physically as your knee adapts to the new demands being placed on it.

During her time on the sidelines as an athletic trainer, Our Made 2 Move ACL Specialist, Laura Sapper, ATC, OTC, CSMS has seen every knee injury in the books. Laura sees players from the moment the injury happens to the moment they step back on the field or court for the first time, so she has a solid understanding of the best time frame for return to sport based on her years of experience working with different athletes. Interested in learning more about our ACL Rehab Program in Charleston? Schedule a free consultation with Laura or reach out to today to set up your initial consultation with one of our specialists!


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