{"id":2517,"date":"2017-04-12T05:20:05","date_gmt":"2017-04-12T12:20:05","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=2517"},"modified":"2017-04-12T05:22:22","modified_gmt":"2017-04-12T12:22:22","slug":"the-importance-of-appropriate-functional-acl-rehab","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=2517","title":{"rendered":"The Importance of Appropriate Functional ACL Rehab"},"content":{"rendered":"

Unfortunately, I see far too many patients following ACL reconstruction in my sports medicine practice. In any given month, I am rehabbing between 10 and 15 patients who have lost their season to this injury. Most of the time it is a non-contact mechanism of injury, often involving additional trauma to the collateral ligaments, menisci and\/or cartilage within the joint.<\/p>\n

Throughout my career, I have rehabbed several hundred athletes with ACL tears. It has always been an area of interest and passion for me as well as prevention. Blending my background in performance training with rehab, I have fostered through much trial and adjustment what seems to be a very effective approach to rehab and return to sport. \u00a0Rehabbing higher level athletes is much like working on a high performance sports cars.<\/p>\n

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If you own a high performance vehicle, you would prefer to have it serviced at a dealership where the mechanics are experienced working on similar cars, yes? I feel the same care and application is relevant with ACL rehab. \u00a0PT that is too aggressive or too conservative can impede progress and negatively impact peak performance.<\/p>\n

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Over the past 5-10 years, I have seen our profession grow in terms of adding more functional testing (FMS, Y-Balance test, LESS, etc.) as we try to better determine when it is appropriate to allow said athletes to resume their prior activity levels safely. Many times, orthopedic surgeons will “clear” patient to resume activity around 6 months post-op provided their quadriceps looks good and graft stability is acceptable.<\/p>\n

In many cases, athletes are simply not ready for competition yet even when rehab goes perfectly. \u00a0My concern has been and continues to be the type of rehab the athlete is receiving. Is it progressive, sequential and functional? Does it include key milestones with subjective and objective markers we want the athlete to achieve? \u00a0Are we utilizing evidence-based criteria to assess the efficacy of our programs and ensure there is appropriate progression that is patient dependent<\/strong>, not protocol dependent?<\/p>\n

I am writing this post after I recently helped revise the ACL protocol used in my organization to ensure that all of my peers and I have a similar lens with which to assess these things, thereby ensuring the patients win and get more standardized care. In the end it does really matter. I will illustrate why using a case study with a female 22 year old high level club soccer player at a D1 institution.<\/p>\n

She underwent a BTB autograft ACL reconstruction with a partial lateral meniscectomy on 7-13-16. She had therapy with another clinician up until she was referred to me for “functional rehab” on 1\/18\/17 (27 weeks post-op). \u00a0Upon my assessment I discovered the following:<\/p>\n