A journey is defined as an act of traveling from one place to another (according to the dictionary). An ACL reconstruction and the rehab process after can be considered a journey. From the words “you have torn your ACL,” to pre-hab, to the surgery, to the days following surgery, until that final return to play status is achieved, the ACL journey is long and can take its toll. At Innovative Training Solutions (ITS) I can work with athletes at all stages of their ACL journey. The athlete will succeed in the post ACL rehab protocol and become a physically and mentally stronger athlete than their previous self.
The Post ACL Rehab program at ITS is unique. I have taken the basics of rehab and combined them with the basic principles of strength training. The athlete will start out with body weight exercise and use bands, yoga balls, med balls etc. However, the athlete will be advanced to squatting on a bar as soon as they are ready too. I do not force anyone into these advanced stages. I believe in overloading the joint progressively and allowing the body to adapt to that overload. This allows the body to build strength up. When the joint is increasing strength, it is also increasing blood flow to the area allowing for a greater healing environment. All ACL athletes are progressively overloaded according to their body’s allowance. This will allow the joint to adapt to jogging, sprinting, jumping and cutting without any excess pressures being placed on the joint.
Athletes will be placed on a program according to the stage they are in when they first start at ITS. Pre-hab stage (before surgery) is where athletes will focus on regaining full range of motion and then working on their strength. The stronger the athlete is going into surgery the easier their recovery. Muscle memory will help the athlete regain quad control. Range of motion will be easier to attain because the joint was fluid and fully functional before surgery.
Post ACL rehab program design will depend on what stage the athlete starts at ITS. A general focus on single leg work and core work is established first. Then we move into core work with squat and deadlift. I reinforce hinging, pushing and pulling with athletes and make sure their bodies are moving efficiently with those movements. Squat form is highly scrutinized because it is the basis for all athletic movement. And if athletes are unable to even squat then they are setting themselves up for future injury. I follow the guidelines of the orthopedics I work with and most of them go with jogging at three months, jumping at four months and cutting at five or six months. Again, this is not set in stone for every athlete and will depend on how strong and stable the athlete’s joint is before they progress to athletic movements.
The real struggle for ACL athletes is the mental part of the return. It begins from the initial start of the journey when they find out they tore their ACL. Often the athlete will go through the "why me" phase. It's hard to comprehend sometimes that they tore their ACL, especially if it was a non contact ACL tear. Why a non contact tear? Think about this...you are on the soccer field. You make a quick change of direction to get away from your defender as you take the ball up the field and something weird happens in your knee...it buckles. You don't understand why because you were doing something you had done time and time before. But here you are, in pain and realizing that the worse may have happened to your knee.
Next you have to go to surgery and then the long rehab process. A wave of emotions will run through the athlete throughout this process. For example, right after surgery, athletes have to bend their knee and get it straight. Their focus and determination are tested from the start. If they don't constantly keep working at their range of motion, then their knee will continue to stiffen up and give them problems while advancing to the next steps.
Athletes need to learn to trust their knee again. They need to learn how to be an athlete again. They may have to work hard, which for some is something they never had to do before. Sure, they were athletes before the injury. But some ACL athletes were natural, raw athletes. They never had to work at their God-given skill set. An ACL journey will push ALL ACL athletes to their limits.
At ITS I can reach athletes and help them through the mental return. How do I do this? There is no special technique or hidden book on how I do it. There is no way to explain this honestly… it’s just a thing I am able to do. I am able to push athletes and help them become the best part of themselves...even better than they were before surgery. The same promise is given to every athlete from day one; If you meet me half way, then once this journey is over you will be physically and mentally stronger than you were before your injury. And this is something I pride myself on at Innovative Training Solutions.
Physical therapy has its benefits. I know because I worked in the clinical setting for 17 years. But what everyone doesn't realize is that physical therapy can only do so much. They are guided by insurance guidelines. This means there are standards the physical therapists and staff have to meet to get reimbursement from the insurance companies. Generally knee patients need to be able to walk up and down stairs reciprocally (one after another not one at a time), get in and out of cars without pain, sleep through the night, functional range of motion and walk at least 300 yards pain free. That is all. Anything outside of that and the insurance industry feels it is something the patient can do on their own and therefore they will not pay out. Now there is some bend in the rules depending on where you go to physical therapy (hospital affiliated vs independent facility).
How does this apply to ACL athletes? There are major differences between what Innovative Training Solutions (ITS) can do for ACL athletes compared to PT clinics. PT clinics will advance the athlete to jogging, teach them how to jump and land properly, and go over cutting. ITS is able to do that as well. PT clinics will work on developing strength and stabilization of the joint as it is necessary. However, they are limited on the amount of strength they can help the athlete develop due to lack of equipment. ITS is a functional gym with weights, bars, and functional training tools to help the athlete develop every aspect of their athletic ability needed to return to the sport they love. Some clinicians will argue that this is unnecessary for post ACL rehab. I agree...for the first few stages of rehab it is. However, once the joint becomes stronger and more stable, you can add it in. You are doing no damage to the joint. All movements at the knee/hip do not go past 90 degrees (ie. squat and deadlift). The athlete is not lifting heavy weights. Instead, they are progressively and slowly overloading the joint with light weight allowing their joints to rebuild and become stronger. ITS can and will guide the athlete through this process.
Some will question why that type of training is necessary. And the answer is simple: in order to produce power, your muscles have to be strong enough to generate it. Body weight exercises do not allow the muscles to create this force. Sports place big demands on an athlete's body. To be able to tolerate this stress, the athlete's muscles and joints need to be able to absorb, protect, stabilize, and create power to respond. It's necessary to develop this to help the athlete return to play successfully with no incidences of further injury. The stronger the muscles are, the more stable the joints are. The more stable the joints are, the more capable they are to tolerate the forces experienced during cutting and jumping. The more fluid the ankle, knee and hip work together, the less risk of injury exists. The more balance there is in strength between the quads, hamstrings, gluts and core, the more stable the joints are and the less risk for injury exists. There is no risk involved when the athlete is carefully guided through this process. I have created a specific training protocol to help athletes through this. Athletes will begin with single leg work first where I check for hip/trunk mobility and look for muscle imbalances. Pushing, pulling, and hinging become normal routine movements for the athletes during the single leg work stage. Athletes will then be progressed to core lifts and rehab exercises together. Applying the concepts of both the physical therapy world and strength training world, I have been able to help athletes return to their sport healthy, productive, and often times achieving goals they never thought were achievable. ITS is the answer for any stage of post ACL rehab.
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