Are you ready to Return to Sport After ACL Reconstruction?
Are you ready to return to sport after an ACL reconstruction? Here’s how we find out.
As a physical therapist specializing in sports rehabilitation, one of the most rewarding aspects of my work is guiding athletes through the journey of ACL reconstruction (ACLR) recovery. This process demands dedication, a meticulous approach to addressing all the complex factors of their sport, and not least of all patience. When is an athlete truly ready to resume their athletic endeavors post-surgery? It's a question that requires a comprehensive assessment, considering not only physical readiness but also mental and emotional factors.
First and foremost, the timeline for returning to sport after ACL reconstruction varies for each individual. While there are general guidelines, such as the typical six to nine months mark, the decision should be based on objective measures of strength, stability, and range of motion, rather than solely on time elapsed. Even 9 months is aggressive depending on the persons level of function and how they show on testing. Throughout the rehabilitation process, we closely monitor the athlete's progress, gradually reintroducing sport-specific movements and assessing their ability to perform without compromising stability or risking reinjury.
A couple important markers show as a helpful predictor to success with return to sport after ACLR:
90% quad strength compared to other side
90% on the Noyes hop testing (all 4 tests)
22 single leg sit to stands
90% on side hop test
Equally important is addressing the psychological aspect of recovery. ACL injuries can be mentally taxing, and it's essential to ensure that the athlete has regained confidence in their abilities and trust in their repaired knee. Open communication and collaboration between the athlete, physical therapist, and other members of the healthcare team are crucial in this regard. Building resilience and providing support through setbacks or fears of re-injury are integral parts of the rehabilitation journey.
Ultimately, the decision to return to sport after ACL reconstruction should be a shared one, based on objective data, functional assessments, and the athlete's readiness both physically and mentally. Rushing the process can lead to setbacks or even further injury, while a thorough and systematic approach increases the likelihood of a successful return to competitive play. By focusing on comprehensive rehabilitation, we not only help athletes return to sport but also empower them to thrive and excel in their athletic pursuits once again.
What is Patellofemoral Pain Syndrome. How do we fix it?
How to fix patellofemoral pain syndrome (PFPS)?
Patellofemoral Pain Syndrome (PFPS) is a common condition characterized by pain around or behind the kneecap, typically aggravated by activities that involve bending the knee, such as running, squatting, or climbing stairs. It is a very common diagnosis, and the good news is this tends to be a diagnosis of exclusion, meaning that they’re aren’t any disrupted ligaments/muscles/meniscus/etc in the knee.. Understanding the underlying factors contributing to PFPS is crucial for effective treatment. One primary cause is improper tracking of the kneecap due to muscular imbalances, weak hip stability, stiff/weak ankles, or poor biomechanics during movement.
Addressing PFPS involves a multifaceted approach tailored to the individual. Firstly, as with all injury recovery, it depends on the person’s function and what their goals. No two people’s rehab should look the same. Secondly, a lot of attention has recently been given about strengthening the quadriceps however what the research shows is although that is important what is equally if not more important is strengthening your hip abductors/known as your glutes. We will target the glutes specially if the symptoms are really aggressive and quad stregthening is too much. Additionally, strengthening is the only thing. Techniques such as foam rolling and stretching specially tight quadriceps can help reduce pains and improve flexibility. Finally, educating patients on proper body mechanics during daily activities and sports is essential for long-term management and prevention of PFPS recurrence.
In conclusion, Patellofemoral Pain Syndrome can significantly impact one's quality of life, but with the right guidance and treatment, it is manageable. As a physical therapist, my goal is to empower individuals with the knowledge and tools to address PFPS effectively, allowing them to return to their desired activities pain-free. By addressing muscular imbalances, improving biomechanics, and promoting overall joint health not only will you recover from PFPS but may even be stronger and more flexible than you were before.
The muscle hurting all of our shoulders and necks
The Pec Minor is a muscle that gets a lot of attention from physical therapists because it can cause a whole range of issues. Let’s unpack this.
The pec minor is a muscle that gets a lot of attention from physical therapists. It’s a muscle that connects your scapula also known as your shoulder blade to the front of your rib cage around your chest area. It’s famous for tipping your scapula forward. And often times due our modern lifestyle. This gets too stiff because we’re always in that position. If you have a stiff pec minor this can cause a whole host of issues. From putting pressure on your neck, to making it hard to raise your arm, to compressing your nerve. Also, it just makes your posture look worse
However, If we loosen the pec minor we can see that we get way more range of motion in the shoulder, take pressure of the neck, and free up tension in the nerves going to our hand.
The first thing I like to do is stretch this muscle, by placing my hand against the door and stepping forward while rolling my shoulder blades back. After that, I like to strengthen my muscles to keep my posture in a good position, so that muscle stays nice and supple moving forward.
Do you have flat feet?
Have you been told you have “flat feet”? Let’s discuss if this can be fixed and what to do?
You may have been told you have flat feet. But did you know some people’s flat feet are “fixed” and others are “flexible” meaning they can be improved with muscular strengthening. It’s a pretty easy test to determine. If you cross your arms and twist side to side and your aches lift it’s a pretty good chance your “flat feet” is flexible and can be improved.
If that is the case, then we need to determine what muscles do we need to work on to improve the foot posture. For instance, the muscle imbalance can be coming from the foot and ankle muscles or it can actually be coming from the hip. If your glutes are weak or inactive, then it will force your knees to roll inward and as a result your arch will “collapse” and your foot will appear to be flat.
The good news is once you identify the root cause you can easily work on it and improve it so you can run, dance, or do whatever sport activity you enjoy more.
How can we run better?
Do you have pain while running? Want to run better? Let’s talk about two very important stabilizer muscles that need to be active so you can run as best as possible.
If you were too get a super camera and slow down the foot while running you would see that the arch of foot naturally “collapses” AKA pronates at the beginning to absorb shock. And then the arch comes back a.k.a. supinates so that the foot is locked and can propel forward to be more energy efficient. The whole time we have a series of muscles that are controlling these movements so they don’t happen erratically.
It’s a really cool mechanical process that our bodies naturally do however if we increase our running more than usual, and we are not prepared for that we might start straining those muscles that are controlling the motion.
Let’s break down each one of those phases and what we can do to keep ourselves, healthy and effective at moving.
The shock absorption phase: this is the phase where your foot arch may seem like it collapses. And although we hear all the time that it collapsed, arch is bad. This is actually good during this phase of running. This phase happens, almost immediately after your foot makes contact with the floor. The muscle that controls this phase is known as your posterior tibial muscle that muscle points your foot and roll it inward. But in this case because it’s fighting gravity, your muscle slowly losing but it’s controlling the rate at which your arch “collapses”.
If you’re having pain with running or walking, and it’s right, when your foot makes contact with the ground, it may be due to a weak muscle here and strengthening. It can help.
The propulsion phase: this phase is right after the absorption phase and your foot arch goes back so that it is locked in more energy efficient for moving forward. The muscle that controls this phase is a set of muscles called your fibulari muscles. These muscles also point your foot, but unlike the posterior tibial muscle, they roll your foot outward. If you’re having pain during this phase of running, which may be hard to tell, without having an expert set of eyes look at it, it may be due to a weak muscle here. Often times when people have a history of an ankle sprain this muscle gets a little bit weaker and then when they go back to running, they have pain until they strengthen this muscle.
Here is a recent Instagram post. I did that highlights this interesting biomechanical process and the exercises that can help with it.
https://www.instagram.com/reel/C2iNQFhPet5/?igsh=MzRlODBiNWFlZA==
The shoulder muscle you are neglecting
Are you missing this key muscle in your strength training?
The shoulder is a very complex joint that can do some pretty remarkable things. From lifting hundreds of pounds overhead, to do balancing on handstands, or helping us swim across seas, it is incredibly versatile and impressive.
However, shoulder pain is a very common complain that I see many times. Often time there is one muscle that gets neglected and as such causes a host of issues down the chain.
The lower trapezius (AKA Trap 3) is a muscle that I believe is heavily under developed in most people and is causing issues.
Maybe that’s because this super important muscles doesn’t even attach to the shoulder bone. It starts at the spine at attaches to the shoulder blade. But what often times people don’t understand is that the shoulder blade is the root of a lot of shoulder dysfunctions.
Our modern lifestyle has put everything in front of us. Our computers, phone, and cars keep our arms in front of us all the time. We are not often lifting things overhead and rowing back. Because of this our back muscles get underdeveloped.
However many people know the importance of good back musculature but they still often miss the lower trapezius. That’s because since it’s so weak on so many people, they overcompensate with so many other muscles. Instead if you can teach that muscles to get stronger with very specific exercises we see that people’s shoulder pain gets much better and they can go back to doing all the things they enjoy.
How to pick you physical therapist?
Having a good physical therapist is a game changer? How do you know if you are picking the right one? Here are some things to consider.
Having a good physical therapist in your corner can change your life, but the field is really new and not all physical therapists are the same. Even the requirements to become a physical therapist in the United States has changed a lot in my lifetime.
For instance, not a lot of people know that some physical therapists have a bachelor degree and some have a doctorate degree. Some do additional training after graduate school (if they went), and some work immediately.
Here are a few different things to consider when selecting your physical therapist.
Level of training- Did they just finish school and go straight into the field or decided to residency? Unlike MDs, residency is optional for physical therapists and very few choose to do it. For instance, I chose to do one and less than 10% of my classmates in graduate school did it with me. It makes a big difference if you do one because if you complete one you can be a specialist.
Insurance- Sometimes a PT not accepting your insurance, or even taking insurance to begin with may not be a bad thing. Cash based clinics (no insurance) often means you get more time with the therapist and may get better results in less time.
Niche- Different clinicians have different niches. For instance, a lot of my clients are stunt performers and martial artists because I happen to be one too. I understand their needs and it makes it easier to treat them. Finding a PT that understands your needs is very helpful to getting great care.
There are few more reasons I outline in this video. Check it out and let me know if there are any other questions I can help you with regards to picking a physical therapist so you can improve your health and performance.