Considerations for Returning to Soccer after ACL Surgery

By Dan Czajkowski, PT, DPT, ATC, CSCS for Athletico Physical TherapyConsiderations for returning to soccer after ACL surgery

You’re almost there. The initial ACL injury you sustained months ago seems so distant. You’ve endured all the time healing from the surgery, the rehab, and now you are pushing ahead to get better, stronger and faster. You can almost taste the grass, outperforming your opponents, and scoring a goal in the final minutes of the game.

But wait. Despite finishing rehab and being cleared to progress to sports specific activities, you haven’t even run on grass yet. You haven’t tried cutting at full speed. You haven’t practiced your best moves or even shot at a goal, let alone scored against anyone. You can see the finish line of your recovery, but you don’t really know exactly what you need to do in order to get there.

Many soccer players coming back from an ACL surgery don’t always know the best way to get themselves back on the field safely. However, the secret is simple – start small, stay consistent and progress slowly. Here are a few things to take into consideration as you work toward getting back onto the field:

1. Start by getting fit.

Soccer is a unique game that includes sprinting, changing direction and endurance. You need to train all these factors to be successful, especially when coming back from an injury where you haven’t trained in months. You will need to train yourself in a variety of ways. A few examples are listed below:

  • Interval sprinting and jogging progressions (i.e. jogging for three minutes, sprinting for two minute and repeating for 30 minutes total)
  • Deceleration and Acceleration (i.e. sprint 5 yards and back to endline, sprint 10 yards and back to endline, etc)
  • Endurance running (i.e. 2-4 miles long run)
  • Agility (i.e. sprinting in Box Shape, agility ladder, 5 or 10 yard zig-zag sprints with cones)

2. Start small with your ball skills and progress very slowly

Even though this is usually the most fun aspect of training for soccer, your knee will need time and practice to get used to manipulating the ball. Start by doing simple moves (i.e. turning, using in/out of foot, tic tocs, roll-overs, etc). Gradually increase your speed of the movement as well as sprinting a few steps after finishing your move.

The same progression goes with passing, crossing and shooting. Start out with kicking the ball in place or using a wall to perform short one and two touch passing. Gradually increase your distance as you get more comfortable, and then start passing while you jog, followed by passing while you sprint.

3. Always work on and perfect your cutting/jumping mechanics.

Just because you are training on your own does not mean that you neglect your responsibility to progress, which can help to prevent future injury. As you get stronger, you will need to learn to control your body and keep your knee stable. ACL Injury prevention programs that focus on improving landing and cutting strategies as well as neuromuscular control have been shown to reduce the risk of injury. The trick with these drills is to land with a soft-landing and maintain a half squat position (i.e. slight forward lean, knee bent and knee aligned over ankles). Practice performing two-leg and one-leg jumping in a variety of directions, including forward, sideways, diagonally and over hurdles. Doing 5-10 reps in each direction can help improve your performance and decrease the risk of injury.

4. Perform SAFE strength training under fatigue.

Soccer is a demanding sport. You will be in situations when your body is tired and fatigued, but you don’t want to let your knee become unstable due to this. Performing strength training after you run or perform a workout that fatigues your body can help improve your knee stability. You can perform a 5-10 minute high intensity sprinting workout and then perform body weight or light weight exercises. Some useful exercises include single leg squat, Bulgarian split squats, side walking with a theraband, or single leg balance on an unstable surface. It is import to make sure you have excellent form (keeping trunk stable, knee aligned forward and behind your toes, etc) when performing these exercises. Keep in mind that strengthening routines can also be performed prior to fatigue and have still been shown to reduce re-injuries as well.

Getting Back on the Field

The journey to returning to sport is long, tiring mentally and physically, and takes a lot of hard work. However, many athletes are successful in this journey and you can be too!

Make sure to consult your physical therapist if you have any questions about your recovery process or how to effectively return to sport during your journey. For information about Athletico’s ACL 3P  Program, which can help athletes minimize the risk of ACL injury as well as help those who have experienced an ACL injury progress after surgery, please email ACL@athletico.com.

US expect the world will eventually catch up with heading ban

Uefa said it would consider implementation which would apply to all under-10s

The US has already taken proactive action with a heading ban in place since 2015. Photograph: Getty Images

A top football executive believes the rest of the world will eventually catch up with the United States’ pioneering ban on heading in youth football.

The Professional Footballers’ Association has advocated the move, which would apply to all under-10s, and in January European football’s governing body Uefa said it would consider implementation if its own study provided sufficient evidence.

A major study into the long-term effects of heading and potential links to dementia and brain damage commissioned by the English Football Association and English PFA began two months ago but initial findings are not expected for at least three years.

However, the US has already taken proactive action with a ban in place since 2015.

Kevin Payne, the chief executive of US Club Soccer, national association member of the United States Soccer Federation principally involved in youth football, was involved in the discussions which led to restrictions being brought in.

“While there is not a lot of direct evidence or research which draws a straight-line correlation between heading a ball at young ages and potential issues later in life we think it is a logical assumption as younger children’s technique will not be as good and their brains are not as fully developed,” he said.

“Until such time as that research has been completed and there are conclusions to be drawn we thought it was much safer to err on the side of caution.

“When you are talking about someone’s brain it is a big deal and we need to be almost overly-protective in this area.

“Part of the issue is that no one really knows what are the consequences of heading a ball at this young age.

“Until we do know the answer the only responsible course of action is to do everything possible to minimize the chance of it creating problems.

A top football executive believes the rest of the world will eventually catch up with the United States’ pioneering ban on heading in youth football.

The Professional Footballers’ Association has advocated the move, which would apply to all under-10s, and in January European football’s governing body Uefa said it would consider implementation if its own study provided sufficient evidence.

A major study into the long-term effects of heading and potential links to dementia and brain damage commissioned by the English Football Association and English PFA began two months ago but initial findings are not expected for at least three years.

However, the US has already taken proactive action with a ban in place since 2015.

Kevin Payne, the chief executive of US Club Soccer, national association member of the United States Soccer Federation principally involved in youth football, was involved in the discussions which led to restrictions being brought in.

“While there is not a lot of direct evidence or research which draws a straight-line correlation between heading a ball at young ages and potential issues later in life we think it is a logical assumption as younger children’s technique will not be as good and their brains are not as fully developed,” he said.

“Until such time as that research has been completed and there are conclusions to be drawn we thought it was much safer to err on the side of caution.

“When you are talking about someone’s brain it is a big deal and we need to be almost overly-protective in this area.

“Part of the issue is that no one really knows what are the consequences of heading a ball at this young age.

“Until we do know the answer the only responsible course of action is to do everything possible to minimise the chance of it creating problems.

“There were some individuals who were not happy about it and I am sure there are still, the old guard who think it is silly not to allow heading.

“But we think we are ahead of the curve on this. We think it is very possible that other countries will end up having a little bit of the same thing.”

The regulations have a huge support structure behind them which helps coaches and parents diagnose and monitor injuries with any head trauma flagged up with a warning to seek medical attention.

Dev Mishra, an orthopaedic surgeon at Stanford University, founded Sideline Sports Doc which offers an online course to help injury recognition which has amassed 50,000 coaches and staff members in just over 18 months.

“If we could find a way for these coaches to have some of this basic recognition maybe we could reduce the severity of injuries, especially concussion,” said Mishra.

“How do you figure out this kid has had a concussion and how do you remove them from play so they don’t have another?

“It is a very simple four-step algorithm which attempts to mimic for a coach what we as trained physicians do on the field of play.”

Online tool Player’s Health tracks athletes’ injuries and has 150 organisations from universities and high schools to clubs signed up for a wide range of sports.

“When your athlete is displaying more than one head injury in six months there is going to be a notification that the parent/guardian should be mindful and we can inform them of specialist facilities near them,” said Tyrre Burks, founder and chief executive.

“The whole system is around alerting everyone. The parent is notified and their kid is not allowed to come back and play until they have that medical clearance uploaded into the system.”

The Irish Times 3/20/2018

TISSUE RECIPIENT COMPETES IN IRONMAN TRIATHLON

Rachel was a typical college athlete: focused, intense, and determined. When a knee injury threatened her ability to complete in her final soccer season, she simply played through the pain.

It wasn’t long before Rachel discovered she could no longer “grin and bear” her meniscus injury. She had to have the injured tissue replaced with an allograft – sidelining her for months from any physical activity.


“It was a difficult decision,” recalls Rachel. “But movement is everything to me. I knew I had to have the procedure.”


Today, Rachel went back to competition. In fact, she completed the Hawaii Ironman 70.3 Triathlon in May 2009, something she only dreamed of prior to her allograft meniscus replacement.

Inspired by her experience, Rachel chose orthopedics as her field of specialty in medical school as an MD candidate at Rush University Medical Center.

TISSUE TRANSPLANT HELPS TEENAGER RECOVER FROM RARE TUMOR CONDITION

MCKENZIE, RECIPIENT OF: JUVENILE CARTILAGE ALLOGRAFT

Mckenzie was an athletic, active child plagued by constant knee pain. After realizing it was more serious than just growing pains, her parents knew they had to see a doctor. When reviewing Mckenzie’s MRI, her doctor noticed a spot on her femur. He diagnosed Mckenzie with a rare tumor condition called Chondroblastoma, which can cause pain and recurring tumors. The condition generally affects long bones and is most common in children and young adults.

The pain forced Mckenzie to end her soccer career, a sport she played and loved since kindergarten. Normal activities like walking and standing became excruciating. “It wasn’t easy being diagnosed with something so serious as a child,” said Mckenzie. “My life came to a complete stop. My family and I knew we needed to do something because it wasn’t a pain I could spend the rest of my life with.” Since her diagnosis, Mckenzie has endured five surgeries to remove tumors and clean up her leg. In each surgery, she received donated tissue.

“I think it is amazing what we can do and how we can help others in need,” she said. “I am so thankful I was able to receive tissue.” Mckenzie received a juvenile cartilage allograft in her most recent surgery. Juvenile cartilage allografts come from donors aged one month to 12-years-old. Though she still faces some limitations, Mckenzie is pain-free and has been able to return to some of her favorite sports. “My life won’t ever be 100% normal because of what the tumor did to my leg, but this has helped me in getting my life back,” she said. “If I hadn’t had this procedure I could have eventually lost my leg.”

Mckenzie is grateful for the tissue donation that helped her heal and hopes sharing her experience will encourage others to register as organ, eye and tissue donors. “The only thing I can be is thankful to still be here, as healthy as I can be, and to make sure to tell my story to help others realize how important it is to be a donor.”

THREE-SPORT ATHLETE GETS BACK IN THE GAME AFTER TISSUE TRANSPLANT

By AlloSource: Doing More with Life

JAKE
RECIPIENT OF: BONE AND CARTILAGE

Jake’s life was never without sport: as one season ended, another began. Soccer became basketball, basketball became track, and he enjoyed the athletic challenge of each sport. However, constant knee pain threatened to put Jake on the bench.

Jake’s knee pain started three years ago and doctors suggested he try stretching and physical therapy to remedy the problem, but the pain persisted. When running or playing soccer, his knee would sometimes give out and it became clear to Jake and his parents that more medical attention was necessary.

“I didn’t feel that I was able to compete to my full potential,” said Jake. “I had an obvious limp when running, but I didn’t know what was causing it.”

After an MRI, Jake’s doctor diagnosed him with Osteochondritis dissecans, a joint condition in which cartilage and bone in the knee become loose. Though he was in the midst of a basketball season and looking forward to track, Jake’s diagnosis forced him to stop playing.

Jake and his family sought a second opinion after his diagnosis and they met Dr. John Polousky of HealthONE Rocky Mountain Hospital for Children in Denver. After weighing his options, Jake and his doctor moved forward with surgery. During the procedure, Dr. Polousky used bone and cartilage allografts to replace the damaged tissue and realigned the weight-bearing line in Jake’s leg.

Jake understood prior to his surgery that a deceased tissue donor made the bone and cartilage allografts possible.

“My immediate reaction was sadness. Today I am very appreciative that the person chose to be a donor and wanted to help someone beyond their own life.”

Part of Jake’s recovery included the use of  an external fixator with metal pins anchored into entry points in his leg. “After the surgery I noticed all of the attention I received from strangers. I don’t think they had ever seen an external fixator, and it did look strange,” he said.

Jake recently had the external fixator removed and has started his exercise regimen again. He rides his bike 12 miles per day and does not have any pain.

Receiving donated tissue affirmed Jake’s belief in donation. He registered as a donor when he got his driver’s license and hopes that others will consider registering too.

“I have felt the impact of what it really means to receive something from someone you don’t know. I would be interested in knowing about my donor’s life because
they are a part of me now. He or she made it possible for me to be healthy, so that I can do the things I like to do.”