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.

If These Walls could Talk-Chicago Bears; The Return of Zach LaVine; Understanding Probiotics

Episode 17.31 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.

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Segment One (01:27):  Former Chicago Bear Otis Wilson talks with Steve and Dr. Cole about how the game has changed from 1985 and about his new book, If These Walls Could Talk: Chicago Bears: Stories from the Chicago Bears Sideline, Locker Room, and Press Box. Led by stars like Walter Payton, Jim McMahon, Mike Singletary, William “Refrigerator” Perry, head coach Mike Ditka, and defensive coordinator Buddy Ryan, the Chicago Bears in the 1980s were an NFL powerhouse.

As anyone who’s seen “The Super Bowl Shuffle” surely knows, they were also an unforgettable group of characters. Otis Wilson, the Bears starting outside linebacker, was right in the center of the action, and in this book, Wilson provides a closer look at the great moments and personalities that made this era legendary. Readers will meet the players, coaches, and management and share in their moments of triumph and defeat. Be a fly on the wall as Wilson recounts stories from those days in Chicago, including the 1985 Super Bowl-winning season. If These Walls Could Talk: Chicago Bears will make fans a part of the team’s storied history.


Segment Two (12:58): Dr. Cole and Steve discuss the return of Zach LaVine and the rehab process after ACL reconstruction. Fred Hoiberg confirmed that the Bulls will be bringing Zach LaVine (knee) along slowly once he’s cleared for contact.Zach LaVine #8 of the Chicago Bulls poses for a portrait during the 2017-18 NBA Media Day on September 25, 2017 at the United Center in Chicago, Illinois.

“We’ll still take things slow,’’ Hoiberg said. “We won’t throw him out for an hour scrimmage the first day he gets cleared for contact. It will be a gradual process. But he’s doing great, doing everything he’s supposed to do.’’
LaVine is on track to be cleared for contact within the next few weeks, but the Bulls will be taking an extremely cautious approach with his return, so it could be a while until he’s fully up to speed working without restrictions.

Segment Three (19:41): Karen Malkin from Karen Malkin Health Counseling decribes probiotics, why and when they should be used.

Probiotics are live bacteria and yeasts that are good for your health, especially your digestive system. We usually think of bacteria as something that causes diseases. But your body is full of bacteria, both good and bad. Probiotics are often called “good” or “helpful” bacteria because they help keep your gut healthy.

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Good bacteria are naturally found in your body. You can find probiotics in some foods and supplements.

It’s only been since about the mid-1990s that people have wanted to know more about probiotics and their health benefits. Doctors often suggest them to help with digestive problems. And because of their newfound fame, you can find them in everything from yogurt to chocolate.

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!

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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