Revolutionizing ACL Rehabilitation: Moving Away from the Failures of Traditional Physical Therapy

When it comes to recovering from an ACL injury, the traditional physical therapy system has fallen extremely short in providing effective rehabilitation. The outdated practices of relying on manual muscle tests for strength evaluation, limited understanding of return-to-sport movements, unrealistic time frames for returning to activities, and arbitrary protocols have contributed to suboptimal outcomes for ACL patients. In this blog, we will shed light on these shortcomings and present a compelling alternative approach to physical therapy that needs to be adopted across the country.

Strength Evaluation: Beyond Manual Muscle Tests

One of the key issues with traditional physical therapy is the overreliance on subjective measures, such as manual muscle tests, to assess strength. These tests often provide inconsistent and imprecise results, lacking objective data to guide rehabilitation. I believe that providers should be incorporating advanced technologies like isokinetic dynamometers and force plates to provide accurate and quantitative measurements of strength and functional abilities. When this is not possible due to high costs utilizing a battery of tests such as leg extension, leg curl, or leg press 5 RM testing, single leg squat analysis, jump testing, etc, can be coupled to provide a more well-rounded picture of the athlete.

Lack of Understanding Around Leg Extensions

Leg extension exercises have been the boogy man in ACL rehab for years. Many orthopedic surgeons and physical therapists still shy away from introducing them during ACL rehab due to potential for stressing the ACL graft. Unfortunately this shows a lack of education on newer research which has highlighted the safety of using leg extensions in a rehab plan. Of course, like all exercises the leg extension needs to be dosed in at the appropriate time and progressively built up, but it can be an excellent exercise to isolate the quadriceps of an ACL patient. Isolating the quadriceps is crucial throughout the process of ACL rehab due to the propensity for it to remain deficient in strength months after surgery potentially contributing to re-tear rates. Having providers and doctors fear an exercise that can be so beneficial for ACL patients highlights the gap between research and practice.

Understanding Return-to-Sport Movements

Another significant shortcoming of the traditional physical therapy system is the limited understanding of the complex movements involved in returning to sports activities after an ACL injury. Deceleration, plyometrics, and change of direction are essential components of sports performance, yet they are often overlooked or insufficiently addressed during rehabilitation. These movements should be programmed in a progressive way moving from a controlled to uncontrolled, random environment prior to clearance for return to sport, similar to any strength interventions. Little understanding of these types of activities is rooted in lack of continuing education in ACL rehabilitation coupled with insufficient education on these topics in the physical therapy school entry level curriculum. It should be the obligation of the provider to refer a client moving into the return to sport phase out to a clinic or provider that understands these topics.

Unrealistic Time Frames for Return to Sport

The rush to return athletes to their respective sports within arbitrary time frames is a prevalent flaw in traditional physical therapy protocols. Recovery from an ACL injury is a complex process that demands patience, proper healing, and adequate rehabilitation. Establishing a good foundation is critical to setting the outcome for the entire rehab process. Unfortunately, many protocols fail to recognize individual variations in readiness, leading to premature return and increased risk of re-injury. Protocols are typically provided with return to activities - such as running or jumping - strictly based on elapsed time from their surgical procedure with no other considerations. While healing time frames are important when deciding about returning to a specific activity they are only one of several factors that should be used.

The Rationale for Change: Statistics and Expert Perspectives

The statistics surrounding ACL retears following surgery and return to sport are alarming. Studies indicate that up to 30% of individuals experience a subsequent ACL injury, with a substantial proportion occurring during return-to-sport activities. These numbers highlight the urgency for a paradigm shift in ACL rehabilitation. The above reasoning and statistics only highlight some of the many failures of the traditional physical therapy approach to rehabbing ACL cases. As experts in our field, we understand the need for a different approach, one that prioritizes individualized care, objective measurements, and comprehensive training to mitigate the risk of re-injury and optimize long-term outcomes.

Apex Performance & Physical Therapy: Revolutionizing ACL Rehabilitation

At Apex Performance & Physical Therapy, we are committed to challenging the status quo of traditional physical therapy by offering a new, evidence-based approach. Our focus on objective data, understanding of sport-specific movements, individualized readiness assessments, and realistic time frames sets us apart from the outdated methods that have hindered ACL patients' recovery for far too long.