ACL Rehabilitation Timeline: Month Six

Okay, ACL warriors: it’s time to learn about all the thrills of your 6th month of rehab!

The first chunk of your recovery timeline has no doubt been grueling to work through, pushing you for countless hours of physical therapy and strength sessions. We’ve said it before, and we’ll say it again — you’ve been putting loads of hard work into your recovery, and the results are finally beginning to pay off.

So much so that it’s about time to put your efforts to the test!

As you progress further through your rehabilitation, it becomes more and more essential that you undergo comprehensive testing. This goes beyond the average or “standard” testing many athletes have experienced. While many aspects of standard testing will catch larger issues (i.e., failed ACL graft, global muscle weakness, or loss of range of motion), they will still ultimately miss other errors specific to your biomechanics and vital to safely returning to full activity…

And you haven’t been working this hard to leave the details out! Month 6 is a pivotal time in your ACL rehabilitation; read on to learn why.

Physical Therapy During Month 6

Biomechanical movement errors are only visible during high-speed, game-level movements where you’re working at maximum effort, and they’re the primary cause for reinjury when left unaddressed. So, rather than simply relying on basic ACL ligament tests and manual muscle tests (and waiting for time to do the bulk of the healing), you deserve hard facts and guidance.

True comprehensive testing involves a more deliberate and thorough assessment of your strength, power, balance, agility, and running form. And this is where you finally hit one of the most important moments in your rehab: your first Return to Sport test (RTS).

What is a Return to Sport Test?

return to sportYou may be able to infer what the test is about just by name alone — to test whether or not an athlete is ready to return to their sport.

In theory, it’s as simple as that… but of course, the actual components of the assessment are where the details and hard data kick in. A true return to sport test is a systematized, biomechanical test that evaluates an athlete’s ability to perform specific movement patterns and motor control in sports-based actions. 

The data that comes from these movement assessments are what determine the athlete’s preparedness for in-game intensity. Ultimately, the goal is to safely achieve optimal efficiency and power while mimicking movements found during game play.

However, there’s an important caveat to this benchmark in your rehab: this is the first RTS you’ll do, but not the last.

Although the concept of passing an RTS implies an athlete would be ready to get back to their sport, it technically isn’t that cut and dry… at least, when you’re being thorough about it.

What to Expect for a Return to Sport Test

At 6 months post-op, you’re still probably learning proper motor control for vital movements like cutting or lateral shuffling. This means you actually aren’t yet ready to get back out onto the field, which brings up an important point about this first RTS: you’re not going to pass it.

Don’t panic! We know that sounds dreadful (why take a test if you know you’re going to fail it??), but it’s all a part of the process. Most athletes will take anywhere between 9 to 12 months for a full rehabilitation and safe return to sport, so 6 months is far from achieving a successful recovery.

It is, however, an ideal time to use this first RTS as a means of thoroughly assessing your current capabilities. Based on the results from this first round of assessment, your physical therapist will have a much clearer idea on what to tackle for the remainder of your rehabilitation. (In other words, you’re not actually failing the test; you’re simply gathering data about your current performance to set the stage for the second half of your rehabilitation.)

Your first RTS is the same as the second one you’ll go through at 9 or 12 months — the only difference is that this first one is facilitated at much slower speeds. The specific intensities you move at will vary depending on your progression thus far.

But that’s all big-picture stuff; let’s take a look at what exercises you’ll be doing to measure your rehab progress and sports-readiness so far. (If you’re looking for a more in-depth breakdown of the “what’s” and “why’s” of an RTS, check out this blog for all the nitty gritty details!)

Step-Downs

This one is a pretty common exercise beyond the realm of ACL rehab. It’s a simple exercise: standing on a step, balance on one leg and straighten the other one slightly out in front of you. Maintain your balance as you gradually lower your lifted leg, lightly touching your heel to the ground, then ease your way back to the starting position.

Nice and easy, right? And, in addition to being a highly accessible exercise, it also provides significant insight into an athlete’s stability and lower extremity alignment.

Time to Stabilization 

Next, we test that leg stability with an extra dynamic element. Beginning in single-leg stance, the athlete will be prompted to perform individual, single-leg jumps on an in-ground force plate.

The force plate will not only measure how much force is being generated in the jumps, but also how much impact force is created when landing. These data points also help the physical therapist determine how long it takes an athlete to stabilize after landing a single-leg jump.

Triple-Hop

A triple-hop test is like the next step up from the previous assessments; it incorporates even more dynamism! While balancing on one leg, you’ll be prompted to perform a series of three consecutive, forward jumps (landing your last jump on an in-ground force plate).

This will ultimately assess the athlete’s leg stability during dynamic and plyometric movement, as well as their distance force production and symmetry between both lower extremities.

Y-Balance Testing 

This test also evaluates your single-leg balance and stability... but with another twist.

Using a specific Y-balance test kit, an athlete will balance on one leg on the centerpoint of a Y-shaped contraption. They will then be prompted by their physical therapist to extend their other leg in one of three directions, pushing blocks away from the center and testing mobility and stability. (This one’s easier to watch than to read about.)

As you can observe in the video, this assessment demands a significant amount of stability and mobility to achieve maximal results.

Drop Box Jumps

Now we’re finally getting to some double-leg action! This is another simple-to-execute motion: start off on top of a plyo box and simply drop down onto the force plate.

In this exercise, you aren’t actively working on the push-off of your jump. The key is more central to how you land — the force plate will measure your landing impacts, providing key insight into your shock-absorption strategy.

Lateral Shuffle

Here’s one you’re familiar with — the good ol’ lateral shuffle!

As we’ve previously reviewed, the lateral shuffle is a quick, side-to-side movement with a change in direction. During the RTS, it helps assess how well an athlete can move with proper control and alignment through more intense, dynamic movements.

Deceleration

Similarly, being able to change direction in the sagittal plane (otherwise known as the “forwards” and “backwards” directions) is just as vital.

You can almost think of this as an assessment for how well an athlete can brake or slow down while sprinting at full speed. After starting out with a sprint, the athlete will land their “braking foot” on a force plate to measure how well their leg can absorb the impact and push off for the backpedal.

90-Degree Cutting

Reflecting a similar(ish) movement with a change of direction, cutting is a pretty big mechanic to master as you’re easing back into sports-like movement.

Because of the highly dynamic change in direction, this is the sport-specific movement that is the primary means of injury for most athletes. So, being able to assess an athlete’s ability to change directly (both quickly and accurately) is key to ensuring a safe return to play.

Physical and Mental Resilience

Phew… that’s quite a bit to take on, huh?

Even though you’ve spent the past half-year progressively building yourself up to get to this point, applying all your training to actual movement is a whole other ballgame. It can be a difficult mental hurdle to overcome, especially after having “failed” the first RTS.

But remember: this first assessment is specifically structured at this point in your timeline to show where you are and what you need to improve to get back out onto the field safely. It’s less a point of failure and more of a point of evaluating how far you’ve come (and what next steps will take you to that peak level of performance again). 

Take some time to remind yourself that you’re still only about 50-66% of the way through your full rehabilitation. It’d be unfair to you to compare your partial, in-progress recovery to full-level gameplay — so keep your eyes on the end goal! You’ve had the resilience to rebuild your strength and performance for all these months; there’s only upward and onward from here.

Month 7, Here We Come!

Congratulations are in order: you’ve made it through some of the most grueling and painful parts of your rehab, and the end is finally starting to feel more within your reach!

If you think back on how you first started out after surgery, you’ve come quite a ways in just half a year. (It will never cease to amaze us when we see how our ACL clients progress through their individual journeys!)

Now that you’ve had a proper evaluation of your current progress, the rest of your rehab will only further hone your abilities to build up a masterful and safe return to sport. So, stay tuned for the next installment, where we divulge more about how to round out your rehabilitation to finish out strong!


Kevin

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.

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