ACL Rehab Timeline: Month 5

"I just want to feel like an athlete again!" 

Does that sound familiar?  

If you are going through ACL rehabilitation it is likely you will start thinking this same thought at some point.  For most, the first 4 months of ACL rehab are grueling physically and mentally. 

It is a huge adjustment to go from 2-3 hours of practice and 1-2 games per week to just doing squats, lunges, and running in a straight line.  Physical therapy allows you to feel like you are getting strong and stable, but up through month 4 post-op, you don't feel much like and athlete.

That all changes in post-op month 5

Now that you have put in the hard work, in months 1-4, building your quadriceps, gluteus, calf, and hamstring strength you are now ready to put that hard earned strength to good use.

This month marks the start of phase 1 agility, plyometrics, and single leg jumping drills!

Goals of ACL Rehab Month 5

  • Continue to hit the weights hard for the quads, hips, calves, hams, and core
    • Consider adding Power lifts if proper control is demonstrated
  • Demonstrate competency with double leg jumping, box jumps, and depth jumps
  • Work on running form to improve shock absorption
    • Increased knee and hip flexion in stance phase 
  • Begin single leg jumping anterior and posterior directions
  • Begin faster lateral shuffling drills (50-75% speed)
    • Normal lateral walking form with resistance band prerequisite (no knee collapse, flexed trunk, or knee rotation) 
  • Normalize single leg step down control (15 reps ideal)
    • Level pelvis, hip strategy, proper knee alignment, no pain

"Finally Some Agility...Now This Feels Like Sport Training"

Part of the draw to dynamic sports like soccer or basketball is the fast and quick cutting, pivoting, and changing of direction goes on when competing.  It is a great feeling to crossover a defender on the court or head fake for a quick slant in football.

Just having that precise control of your body and the feeling of movement mastery is exhilarating. 

At month 5 post-op you can finally start building the movement control and dynamic stability necessary to be that player that everyone wants to watch (aka Steph Curry).

Example of lateral shuffling drills with force plate biofeedback

Agility can come in many forms and difficulty levels; however, there are some standard movements that make up the majority of most dynamic sports motions.

In most sports, you need to sprint forward, backwards, move sideways, change direction, and in some jump and counter jump.

If you break down the components of these motions you come up with some common movements. 

Common Movements In Sports

1. Lunges 
2. Deceleration
3. Lateral shuffle
4. Cutting (45 and 90 degrees)
5. Double and single leg jumping (after of course training double and single leg squatting)
6. Dynamic change of direction

These movements are part of every dynamic sport and training for these can begin starting in month 5 post-op ACL reconstruction.  It is best to start slow 50% of full speed with the emphasis on proper movement and true form practice.

Video feedback during this phase is a must.  Athletes respond well to seeing how they move versus the "internal feeling" of how the think they are moving.   It is best to receive feedback that is varied and more regular at the start of training and then have the feedback removed as your form improves.  This will help to prepare you for practice and game like settings where little to no feedback exists. 

I have also found, at my human performance lab Competitive EDGE in San Jose, that ground reaction force feedback is a great learning tool to improve shock absorption as well as proper knee alignment.  As mentioned, ACL injuries have been linked to improper knee control during fast sports motions, and having feedback on proper knee position is ideal for those recovering from ACL surgery.

Example of plyometric training that would be appropriate at 5 months post-op ACL reconstruction (assuming all clearing tests up to this point have been passed)

ACL Rehab Month 5 And Beyond

Month 5 marks the beginning of true "sport training".  This specificity of training will continue until the completion of your rehabilitation and will grow in difficulty, complexity, and speed.

Practice is crucial in this phase as hundreds to thousands of repetitions are needed to ensure you can demonstrate optimal sports performance.  Physical therapy training will provide you approximately 30-50% of this training while you need to put in the other half.  Your PT will lead you through training with specific exercises, sets, and reps.

Although you are not yet able to play your sport, do not let that fact get in the way of your road back to the game you love.  I like John Wooden's quote from the start of the post, "Do not let what you can not do interfere with what you can do."  

What you can do right now is work harder than anyone else in your sport to get strong, fast, agile, and powerful.  Dominate your training, dominate your sport!

For specific information on improving your strength, power, and speed for sport be sure to check out our FREE guide on strength and conditioning.  You can download it free here!

Train Smarter, Train Harder, Perform Better!

Written By: Kevin Vandi   DPT, OCS, CSCS

Physical Therapist serving San Jose, Los Gatos, Almaden, Campbell
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