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ACL Rehabilitation Protocol

Many of us have heard of our ACL and some of us may have injured or had surgery on this. But what happens when we need surgical reconstruction on this area? What is the rehab protocol? It can be confusing and there's a lot of misinformation out there so to make life simpler we've condensed some of the important points using the Melbourne ACL Rehabilitation Guide 2.0 by Randall Cooper & Mick Hughes:

The ACL rehab protocol is broken down into 6 phases, and there’s a list of goals and outcome measures that need to be satisfied at the end of each phase to move onto the next one.

The six phases are:

Pre-op Phase: Injury recovery & readiness for surgery

Phase 1: Recovery from surgery

Phase 2: Strength & neuromuscular control

Phase 3: Running, agility, and landings

Phase 4: Return to sport

Phase 5: Prevention of re-injury

Pre-op Phase - Injury recovery & readiness for surgery

Whilst people may want to have the operation as soon as possible, it’s important to allow the knee to settle from the injury and regain a good level of strength and function before surgery. Recent research has suggested that people who attain full range of motion, good quadriceps and hamstring strength, and minimal swelling prior to surgery have better outcomes than those who don’t up to 2 years post surgery.

Exercises and activities during this phase typically include regular icing of the knee to reduce swelling, range of motion exercises, low impact aerobic exercise such as cycling, and a progressive strengthening regime.

Strength exercises should progress in parallel with the clinical condition of the knee. As the pain & swelling settles, and the range of motion increases, strength exercise can progress to include weighted exercises in the gym and jump and land activities such as hopping drills. Aggressive change of direction activities should be avoided during this phase.

The three most important goals of the Pre-op Phase are;

• Eliminate swelling

• Regain full range of motion

• Regain 90% strength in the quads and hamstring compared with the other side

Recovery from surgery

Phase 1 - Recovery from surgery

It’s best to let the knee settle for the first 1-2 weeks with basic range exercises, quadriceps setting drills, ice and compression.

The three most important goals of Phase 1 are:

• Get the knee straight (full extension)

• Settle the swelling down to ‘mild’

• Get the quadriceps firing again

Phase 2 - Strength and neuromuscular control

Regaining muscle strength, balance, and basic co-ordination are the goals of Phase 2. This phase usually commences with easy body weight type exercises and progresses into a gym-based regime with a mixture of resistance, balance, and co-ordination exercises.

The three most important goals of Phase 2 are:

• Regain most of your single leg balance

• Regain most of your muscle strength

• Single leg squat with good technique and alignment

Phase 3 - Running, agility and landings

Phase 3 of this ACL rehabilitation protocol sees a return to running, agility, jumping and hopping, as well as the continuation of a gym based strength and neuromuscular program.

The three most important goals of Phase 3 are:

• Attain excellent hopping performance (technique, distances, & endurance)

• Progress successfully through an agility program and modified game play

• Regain full strength and balance

Phase 4 - Return to sport

Phase 4 ACL rehab should be highly individualised, and exercises and training activities that are usual for the athlete when not injured should be integrated into the regime. Focus should not only be on getting the knee ready for sport, but the whole person.

Phase 5 - Prevention of re-injury

ACL injury prevention programs aim to improve the neuromuscular control of individuals during standing, cutting, and landing tasks.

Key components of an injury prevention program should include:

Plyometric, balance, and strengthening exercises

That the program must be performed for at least 10 mins before every training session and game

That the program is on going

It is highly recommended that athletes continue with an ongoing ACL injury prevention program whilst they continue to play sports.

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