acl rehab

Monday, January 27, 2014

For most athletes, the Olympics and the Super Bowl are a once in a lifetime experience. Peak athletic performance, injury avoidance and opportunity have to align to allow the opportunity to show up on center stage. One athlete’s demise is another’s opportunity. For the Broncos champ Champ Bailey, the chance to play in his first Super Bowl after a 15 year career was made possible by the ACL injury to his teammate, Chris Harris. Nine women made the US women’s alpine Ski team and one of those spots was made available when Lindsey Vonn tore her ACL in November.

Sometimes, though, ACL injuries can be overcome in less time than is customary.. The often cited example is Adrian Peterson of the Minnesota Vikings whose rehabilitation after ACL surgery took only six months instead of the customary 9-12. However, the poster child for quick recovery from knee injury may be Sarah Hendrickson, the world champion of women’s ski jumping. Shemo who will be representing the United States in Sochi just 5 months after undergoing surgery to repair, her ACL, MCL and meniscus…O’Donoghue’s terrible triad. Surgery August 29, jumping in mid January, named to the Olympic team on January 22 and at the top of the 90 meter hill on February 11.

The anterior cruciate ligament used to be the death knell for an athlete’s knee but with better surgical techniques and physical therapy, the chance to resurrect a career has become much better. While surgical technique is important, some surgeons may be more skillful than others, the key to success is in the physical therapy and personal motivation of the patient.

Generally there are three phases of rehab but each orthopedic surgeon may have tweaks to their own program.

  • Prehab occurs after the injury and before the operation. The goals are to reduce swelling in the knee, maintain range and strength in the quadricep and hamstring muscles that move and maintain stability on the knee. Without the cruciate ligament to maintain a stable joint, the knee is at risk for further damage with running, cutting and jumping or any sports. The goal is increasing the muscle strength because once the operat8ion occurs, those muscles will weaken again.
  • Physical therapy in the initial weeks after surgery concentrates on returning range of motion ad increasing muscle strength. The repaired ligament needs time to heal and the fibroblast cells that are the cornerstones for tissue repair cannot be rushed to do their job. It takes weeks before the ACL graft can be solid enough to withstand sports moves. The first 6 weeks get the knee moving and if all goes well, the stationary bike, elliptical trainer and swimming might be added.
  • The third phase of therapy aims to get the athlete back on the field. Month 3 and 4 work on strength, flexibility and cardio fitness. Month 5 adds agility. Six months after surgery is when the athlete can begin drills that are specific to the sport and a month later, practice may be allowed. This leads to return to play about 9 months after the operation.

In addition, there needs to be special attention to proprioception, the ability of one part of the body to know where it is in relation to the whole and to the rest of the world. There is an unconscious ability of a joint to adapt to its surroundings. Neuromuscular control, where nerves and muscles work together, allows subtle adjustments depending upon the forces put on a joint or a limb. Proprioception allows the body to make minor adjustments to running on uneven pavement, cutting on a basketball court or twisting away from a tackle in football. The conscious brain has to trust that unconscious neuromuscular control before an athlete can return to play, safely and at their previous level.

While the time for each phase of physical therapy is not set in stone, the common thread about successful surgical outcome is patient motivation. For elite athletes, the therapist is often charged with slowing down and tempering their patient’s desire to train. Ms. Hendrickson seemed to live at the US Ski team’s center for excellence in Park City, spending 6-8 hours per day in rehab. It is a reminder that while the weekend warrior, who has to work for a living, may spend a couple of hours a week in therapy post-op, the elite athlete’s job is to train and get better faster.

For the football players in New York and for those athletes in Sochi, their commonality is a mix of innate athletic ability, the determination to maximize potential, the good fortune to avoid injury and for all three to come together just as the opportunity to compete arrive on the calendar. For Mr. Bailey and Ms. Hendrickson, all came up roses. For Ms. Vonn and Mr. Harris, their timing was off and their flowers died a coupe of weeks too early.

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