You can't cheat the grind...It knows how much you've invested. It won't give you nothing you haven't worked for." ~Unknown
Month 7 begins the second half of your yearlong ACL recovery journey.
Sounds daunting to hear right...beginning of the second half. It may sound daunting but it's the truth. If you are going to get the most out of your recovery you need to put in the hard work for a full year.
Why does it take a full year to recovery from ACL surgery?
As mentioned in previous posts in this series, the ACL graft itself takes about 3 months to adapt to the environment of your body. Following surgery, atrophy is present at the quadriceps (particularly VMO), hamstrings, calf, and gluteal muscles. Following an intensive and consistent strengthening program, you can expect to achieve muscle strength equal to the non-surgical leg by about month 6-9 post-op.
Following graft healing and normalized strength is the need for optimal motor control in sports based game-speed actions. Training proper biomechanical sports movements involves training the muscular and neurological systems to respond to variable and fast stimuli.
To pass a comprehensive biomechanically based return to sport test your movement at fast speeds needs to be fluid, efficient, and powerful. Typically, to achieve this level of movement mastery takes about 3-6 months. Most athletes start dynamic movement training around month 4-6 which would bring us to the 10 months-1 year return to sport time frame.
- ACL Graft Healing------3 Months
- Normalized Lower Extremity Strength (Isometric)------6-9 Months
- Optimized Biomechanical Sports Movement------3 to 6 Months
- Total Rehab Time------9 Months to 1 Year
Goals For Month 7 ACL Rehab
The goals for ACL rehab month 7 are similar to those of month 6 with the addition of increased intensity and speed.
Hopefully in month 6 you will have obtained some solid data on your movement strategies and deficiencies during your initial return to sport test. Going through testing is essential to aid in designing your rehab program going forward. You have to address your weak links to minimize your risk of injury and to improve your sports performance.
Most athletes will have achieved or are close to achieving full quadriceps, hamstring, calf, and gluteal strength compared to the opposite extremity by month 7.
The most common issues, at month 6-7 post-op, that I find during the ACL return to sport tests that I have run are:
- Pelvic drop during step downs, deceleration, and triple hop
- Decreased shock absorption during jumping and running (limited knee and hip flexion, usage of a knee strategy)
- Knee collapse (valgus and rotation) during 45 and 90 degree cutting drills
- **Lack of confidence in single leg power actions**
Therefore the goals of month 7 ACL rehab include:
- Normalize quadriceps and gluteus maximus/medius strength
- Train shock absorption with single leg drills
- Single leg bench squats
- Single leg forward and box jumps
- Use a force plate to equal force readings side to side
- Control pelvic drop and compensated trunk lean
- Step downs
- deceleration practice
- Single leg fast squats
- Perform multi-direction agility drills at 50-75% speed
- Variable practice with distracting stimuli
- Throwing a ball while jumping
- Catching a ball while decelerating or cutting
- Changing direction at the last minute
Although this video is for runners it provides great examples of how to train single leg shock absorption.
Pain Free Motion Is Not Enough
From a young age we are ingrained to believe that if something doesn't hurt than its OK. It's the first question you get asked when your injured, "does this movement hurt"? This is a very important question for the initial stages of rehab but by month 7 you need to be asked a different set of questions...
..."Does this movement feel as strong as the other side...Do you feel confident performing this drill...Do you feel weakness anywhere while practicing these sports actions...Are you worried you are going to get hurt again?"
By combining your answers to these questions, with proper feedback from you physical therapist, a definitive program can be created to help you make strong strides in month 7 towards your goal of full recovery.
Kevin Vandi, DPT, OCS, CSCS
Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.