4 Tips for Returning to Play After an ACL Reconstruction

By Anne Bierman, PT, DPT, SCS for Athletico Physical Therapy

The ACL is a major ligament that helps to stabilize the knee joint. Athletes and recreational enthusiasts of all ages can experience an ACL tear, especially those who participate in high demand sports like soccer, football, volleyball and basketball.4 Tips for Returning to Play After an ACL Reconstruction After surgery, athletes tend to be very anxious to get back to the sport they love. To help them get back to their sport safely with minimal risk of re-injury, Athletico developed an ACL 3P Program. The three “P’s” stand for prevention, progression and performance. The performance aspect of the program emphasizes limb symmetry, proper landing/cutting mechanics and match fitness to minimize the athlete’s risk for re-tear. Learn more about the program by reading Athletico’s “Can ACL Tears Be Prevented?” blog.

Evidence suggests that an athlete may be 30 percent likely to re-tear an ACL, 20 percent on contralateral leg and 10 percent on same leg2. Athletico’s program aims to lower that risk by making sure an athlete has good landing and cutting mechanics when fatigued. Here are the top four things to consider before returning to play after an ACL-Reconstruction.

1)  Timing isn’t everything

A decade ago, most patients were discharged from physical therapy around the three month mark, then released by their physician to return to play at the six month mark. Instead of a time-based criteria, evidence suggests more objective criteria. Athletico’s ACL 3P program includes a cluster of tests – Y balance testing, hop testing, and video analysis of cutting and landing tasks to determine an athlete’s readiness to return to play. Educating patients from the first day of post-op about criteria-based return to play instead of returning right at the six month post-op mark will help them have realistic expectations.

2) Hop testing alone is NOT sufficient

A recent article came out suggesting that hop testing by itself is insufficient to allow an athlete to return to play. If hop testing is the only criteria for return to play, the athlete has been done a disservice. Other objective, sport-specific criteria should also be used.

Similarly, power is one of the last items to come back. Athletico includes single leg, triple hop testing in the “prevention” screen so that we have a baseline on athletes. If that athlete ever has an injury, Athletico clinicians can make sure that athlete not only returns to their baseline, but exceeds it.  Athletes often demonstrate symmetry by the 6six month post-op mark. However, their power often doesn’t return until the 7-8 month post-op mark.  By having a baseline, Athletico clinicians can ensure athletes are not only symmetrical but re-gain power as well.

3) Fatigue

Athletico’s final RTP phase includes a five minute fatigue protocol. Because athletes are most likely to get injured when they are tired, Athletico ACL 3P clinicians want to ensure that landing and cutting mechanics are flawless when fatigued. This is a key differentiator of Athletico’s program.

4) Athletes should not expect to play in a tournament their first weekend back in contact

Patients are often allowed to return to non-contact practice participation before the six month mark, or before they pass all return to play criteria under fatigue. This allows the athlete to start getting some sport-specific muscle memory and fitness. Many parents and athletes think that “getting released” means they can go back to playing a 90-minute soccer match (or even worse – an entire tournament) the first week back.

To ensure safe progression, when “released,” athletes should participate in several weeks of full contact practices before trying just a few minutes in each half of a match.  Physical therapists work hard to mimic sport-specific movements in physical therapy, but reactive decision-making is difficult and best replicated during practice and games. This can fatigue athletes quickly. Educating patients about appropriate progression is key to minimizing their risk for re-injury!

Returning To Play!

If you are interested in Athletico’s ACL 3P Return to Play testing, please email ACL@athletico.com.

These 3 Surprising Workouts Are the Best For Your Health, Says Harvard

There’s nothing like a multitasking sweat session to help us burn calories, banish stress, and clear our minds. But as Business Insider reports, not all fitness routines are created equal. A new health report released by Harvard Medical School titled “Starting to Exercise” outlined the most effective workouts that not only aid in weight loss, but also help strengthen your brain, bones, and heart.

“Research shows that just a half-hour of moderately intense exercise a day can improve your health and extend your life,” the report says. I-Min Lee, a Harvard professor and author of the study, notes that activities like long-distance running can have negative effects on your digestive system and joints. In addition to explaining the best ways to avoid injuries and use the proper breathing techniques, the research also reveals some of the most beneficial workouts for your health—and a few of them may surprise you. Read on below for three routines that help you live longer and only require 30 minutes of your time.

Walking. This activity may seem like a no-brainer, but as Business Insider reports, some studies have found that walking for at least 30 minutes at a leisurely pace can help boost your memory and reduce depression. For those who don’t exercise regularly, Harvard suggests starting off with 10- to 15-minute strolls and building up to 30- to 60-minute walks.

Tai chi. A Chinese martial and meditative art that involves a series of gentle and flowing movements, this ancient practice emphasizes deep focus and paying attention to breathing. Lee writes that tai chi is “particularly good for older people because balance is an important component of fitness, and balance is something we lose” as we age.

Swimming. Harvard’s Healthbeat newsletter calls swimming “the perfect workout,” all thanks to its ability to work almost every muscle in your body. From protecting your brain from signs of aging to raising your heart rate, this aerobic workout also reduces potential injuries “because it’s less weight bearing,” Lee writes in a recent issue of the newsletter.

By DANIELLE DIRECTO-MESTON

COLLEGE STUDENT BEATS BONE CANCER

CHARLOTTE: RECIPIENT OF BONE ALLOGRAFT

In 2005, Charlotte was a healthy, active 24-year-old just finishing her Master’s degree at Colorado State University. When she started to experience pain in her arm, Charlotte initially thought it was nothing serious.

She started some chiropractic treatments but the pain did not get better. Next, Charlotte noticed that there was something under her skin that would stick out when she moved her arm. Shortly thereafter an MRI confirmed a tumor and Charlotte was diagnosed with osteosarcoma – bone cancer.

Charlotte went to see Dr. Ross Wilkins at the Denver Center for Extremities at Risk where she learned about the daunting road ahead: they would do everything they could to beat her cancer, but she may be facing amputation.

After a regimen of chemotherapy that shrunk the tumor, Dr. Wilkins and his team were able to remove Charlotte’s bone and replace it with a bone allograft from AlloSource. Charlotte’s arm was saved from amputation and today she is back to some of the physical activity she enjoyed before cancer.

Although Charlotte has limited mobility in her arm, she is working every day to improve it. She embraced her drug regimen and has also explored nutritional and holistic therapies to assist in her recovery. Charlotte now works at Philmont Scout Ranch in New Mexico, one of three high adventure bases owned by the Boy Scouts of America. This summer she will be the staff and events coordinator at the training facility.

While she can’t rock climb anymore, she does pursue the high ropes course, backpacking, hiking and takes hip hop and Zumba classes.

Charlotte cites her faith as a major component of her strength through the cancer battle: explaining that she felt like she was in God’s hands throughout her entire diagnosis and healing process. Now, she’s thrilled to have reclaimed her life and is relishing finding new ways to do old things: a small price for being able to keep her arm.

Featured Body Part: Head

By: Cori Cameron and Katie Varnado, ATC for ATI Physical Therapy

Featured Body Part: Head

The brain is one of the most important and powerful organs in our body. It’s also one that we may often take for granted; forgetting the fact that it’s responsible for everything from our movements to our thoughts. According to the Brain Facts from Medical Daily, 85 billion neurons must complete upwards of five trillion chemical reactions each second, at speeds of over 260 miles per hour to keep us going. That’s crazy impressive! With all of this power and responsibility, comes the fact that we need to be able to protect our head and brain. The more we know about prevention and the cause of injury, the better the chances are of avoiding an injury in the future.

Common Conditions

  • Hematoma – A collection of blood outside the blood vessels. This can cause pressure to build inside your skull, causing loss of consciousness or even permanent brain damage.
  • Hemorrhage – Uncontrolled bleeding can occur in the space around your brain or there can be bleeding within your brain tissue.
  • Concussion – A brain injury that occurs when your brain is jarred or shaken inside the skull. Loss of function is typically temporary, but repeated concussions could lead to permanent damage.
  • Skull Fracture – A break in one or more of the bones in the cranial portion of the skull. When the skull is broken it is unable to absorb the impact of a blow, which makes it more likely that there will be brain damage as well.

Common Causes
Head injuries can be broken into two categories:

  • Blows to the Head – Injuries are typically caused by:
    • Motor vehicle accidents
    • Falls
    • Physical assaults
    • Sports-related accidents
  • Shaking – While this is most common in infants and small children, they can occur any time one experiences violent shaking.

Injury Prevention
Katie Varnado, ATC, Midwest Director of Sports Medicine, gives us some tips to help prevent and rehabilitate head injuries:

  • Appropriate Equipment – Make sure to wear the appropriate protective equipment for your sport.  This could include helmets and mouthguards.  Equally as important as having the correct equipment is making sure it is fitted appropriately (not too loose).
  • Use Proper Technique – Make sure you have learned and practice proper technique for the sport you play. Do not lead with your head and do not use your head as a “weapon.”
  • Neck Strengthening Exercises – Some scholars believe that strengthening the neck musculature allows forces dissipate during a head collision or rapid rotation, thus reducing the force the brain sustains and lowering your risk of concussion.

Rehabilitation
Rehabilitation after a head injury is important and recognition of an injury is key:

  • Know the Signs and Symptoms of a Concussion – Headache, dizziness and nausea are just a few.
  • Discontinue Physical Activity – If you suspect you have sustained a concussion, it is important to immediately remove yourself from further physical activity.
  • Seek Appropriate Medical Evaluation – See an athletic trainer, physical therapist or a physician for a full evaluation.
  • Rest – Physical and cognitive rest are crucial to allowing the brain to heal. Follow physician instructions regarding gradually returning to taxing activities.
  • Vestibular Rehabilitation – If you have symptoms that do not resolve in a relatively short time span, vestibular therapy may help reduce symptoms.

When weighing your treatment options for head injury rehabilitation, consider physical therapy. Physical therapy offers a wide variety of treatment options including strengthening, stretching, and sustainable home exercise programs. Stop in or call any ATI location for a complimentary injury screen or to learn more about how physical therapy can help you overcome your pain.

Get your head in the game with ATI!