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.

The Healing Process of an Ankle Fracture

By Steven Sapoznik for Athletico Physical Therapy

As all NBA fans know, the first major injury of the 2017-2018 season occurred to star The Healing Process of an Ankle Fractureguard of the Boston Celtics, Gordon Hayward. Gordon suffered an ankle fracture 5 minutes and 15 seconds into the start of the season.

Gordon successfully underwent surgical stabilization of his fractured tibia and dislocated ankle and is on the road to recovery that will include many hours of physical therapy in hopes of resuming his professional basketball career. With ankle fractures catching the medical headlines over the last week, Athletico would like to shed some light on the subject.

Fracture vs. Break

Over the years as a physical therapist I’ve often gotten the question, “’What is a fracture and what is a break?’” Most are surprised to hear that they are one and the same. While both are acceptable, ‘fracture’ is the medical term to describe a break of the bone whereas ‘break’ is considered the layman’s term.

Types of Fractures

The ankle joint is made up of the tibia, fibula and talus. Ligaments, tendons and muscles surround these bones to add stability and function to the lower leg. Not all fractures of the ankle are the same. The classification of the fracture depends on the severity and bones involved in the injury. Examples include medial malleolar and bimalleolar fractures. A medial malleolar fracture involves the bony prominence on the inside of the ankle whereas a bimalleolar fracture involves both the inside and outside bony prominence’s of your ankle.

Surgery vs. Conservative Care

The determining factor for managing a fracture with surgical or conservative interventions depends on the extent and severity of the injury. If a fracture is stable and does not involve other structures surrounding the joint, a period of immobilization with modified weight bearing status may be all that is necessary before beginning physical therapy. Conversely, an unstable or compound fracture of the ankle will most likely require surgical stabilization before initiating physical therapy.

Physical Therapy Following Ankle Fractures

Physical therapy is initiated at the time that a fracture is deemed healed, regardless of surgical status. After a fracture and period of immobilization, muscle atrophy, loss of range of motion and difficulty walking on uneven surfaces typically occur.1

Timelines will vary based on individual patients, however standard physical therapy of an ankle fracture typically begins with gentle range of motion exercises, gait training, and strengthening.2 Once ready, balance and proprioceptive exercises are initiated at 4-6 weeks.2 Gradual return to normal activities usually begins around the 6-8 week mark and full return to activities is typically allowed in the 3-6 month range.2

Making a Comeback

While Gordon Hayward may be out for the rest of the season, he will be in a great position to make a comeback with physical therapy treatment in the coming months. The best part about physical therapy is that you don’t have to be the next NBA star to benefit from it. Physical therapists specialize in rehabilitation of conditions of the musculoskeletal system. If you have an injury or unusual aches and pains, schedule an appointment at a nearby Athletico clinic so we can help you feel better and make your comeback. 

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Stronger than Yesterday: The Squat

By Athletico Physical Therapy

Beginning a new strength training routine can seem overwhelming, especially when deciding what movements to incorporate.

Confidence is tested when someone is unsure what to do or if they worry whether they are completing an exercise correctly. Both are common concerns for many, and if you have ever felt this way, you are surely not alone. This blog addresses one of the most fundamental elements in strength training: the squat. Executing this properly will aid in injury prevention and provide a solid base for developing strength to reach the goals you have set. First, it is important to learn the benefits of this movement.

Benefits of squatting:

The squat develops the hamstring, quadricep, glute and adductor muscles. These muscles are associated with movements like running, walking, pushing, jumping and pulling. As the muscles develop, so too can the overall quality of movement. Squatting will allow the body to work more efficiently as strength develops. Squatting increases:

  • Metabolic functioning as it requires the use of multiple muscles, increasing energy expenditure and insulin sensitivity at the tissues
  • Balance and coordination that can reduce the risk of falling
  • Bone density that also decreases the risk of osteoporosis
  • Overall movement abilities1

If you are in the process of building a strength training routine, the squat is an excellent exercise to incorporate. Its versatility means it can be practiced as a body weight exercise or paired with equipment for a greater challenge. This is an ideal movement for people of all ages, skills and limitations.

How to perform the squat:

The squat is a movement that recruits many of the body’s muscles, making it a prime exercise for strength and growth. It is also a daily movement most do without thinking about it (getting in and out of a chair). In fact, a chair can be a great place to start practicing this exercise. Consider the following cues when squatting and check out the infographic below for a visual guide on how to perform:

  • Step your feet roughly shoulder width apart
  • Turn the toes out about 30 degrees, allowing the knees to follow the direction of the toes
  • With the chest lifted and the core tight, begin to unlock the knees and the hips
  • Allow the hips to travel backwards until you reach the bottom of your squat keeping the weight over the center of the foot
  • Squat depth will depend on factors such as injury, age, mobility and anatomy
  • Keeping these cues in mind, it is important to aim for a depth that reaches parallel or slightly below parallel (if possible)
  • The depth achieved in a full squat allows for greater use of muscle tissue to build strength, prevent injury and create a larger overall adaptation to the movement
  • As this exercise becomes progressively easier a variety of equipment can be added to create multiple varieties of the same movement2
    • Editor’s note: Adding resistance in the form of barbells, dumbbells, ropes or bands to any movement allows the body to build greater strength. Before adding resistance to the movement, however, it is recommended practicing the squat as a bodyweight exercise to ensure it is executed correctly.

Examples of the squat include:

  • Barbell back squat
  • Barbell front squat
  • Goblet squat
  • Dumbbell squat

If you would like to learn more about strength training from an Athletico Physical Therapist near you, click here to request an appointment!

Improve Your Swing, Right From The Start

By Steven Marsh for Athletico Physical Therapy

Golf is a difficult game, but what if you could take strokes off your round while reducing your risk of injury at the same time?

One of the low-hanging fruits to improve your golf game starts with your position at address. Your posture at address can fall into one of three categories: Neutral spine (ideal), C-Spine or S-Spine. Here is an easy assessment to find out which posture you start out in:

  • Set up your phone so it can take a picture or video. Start recording.
  • Give yourself enough distance from the phone, and assume a normal position as if you were swinging your 5-iron.
  • Come back to the camera and assess!

Once you have identified which posture you naturally set up into, here are a few tips to see if you can bring yourself closer to neutral position at address.


If you have S-Posture:

The main dysfunction of this posture is too much arching of the low back. To help reverse excessive arching through the low back, focus on stretching your hip flexors and strengthening your glutes. For starters, try the Half Kneeling Hip Flexor Stretch and Glute Bridge exercise that are outlined below.

Half Kneeling Hip Flexor Stretch

  • Begin in a half kneeling position with one knee bent in front of your body.
  • Tighten your core and squeeze your glutes (which will tilt your pelvis backward). Gently push your hips forward. You should feel a stretch in the front of your hip.
  • Make sure to keep your hips facing forward and back straight during the exercise.
  • Hold each stretch for 30 seconds, and repeat 3-4 times per leg.

Glute Bridge

  • Begin lying on your back with your arms resting at your sides, your legs bent at the knees and your feet flat on the ground.
  • Tighten your core muscles, squeeze your glutes and slowly lift your hips off the floor.
  • Perform 2-3 sets of 8-12 repetitions.

 


If you have C-Posture:

This posture features slouching of the shoulders and back. Exercises, such as stretches that focus on the chest and strengthening around your shoulder blades, can help correct this posture, like the Pec Corner stretch and Wall Slide with Lift-Off exercise.

Pec Corner Stretch

  • Stand facing a corner. Place your forearms flat on the wall on each side of the corner with your elbows at shoulder height.
  • Slowly lean forward, taking a small step if needed until you feel a gentle stretch in the front of your chest and shoulders.
  • Hold for 30 seconds and repeat for 3-4 repetitions.

 


Wall Slide with Lift-Off

  • Begin in a standing upright position facing a wall.
  • Rest both hands on the wall with your palms facing inward, then slide them up the wall.
  • When your arms are straight, raise your hands a few inches from the wall.
  • Bring your arms back down and repeat.
  • Perform 2-3 sets of 10 repetitions.

Ready to Start

Hopefully these quick stretches and exercises help to get you into a better starting position. This can lead to better ball-striking, improved power and less injuries!

If you would like to learn more from an Athletico physical therapist, please use the button below to request an appointment!

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