By week 16, agility and plyometric exercise can be initiated if the injured athlete has good proprioception, postural stability, and strength. However, those exercises should not cause any pain or other complications like swelling. Balance and proprioception are hard to measure objectively. Some may use how long they can balance on one leg and other may use BEST as a measurement. Strength may be hard to measure also if isokinetic machine or hand-held dynamometer are not available. However, before plyometric training is initiated, the athlete should have about 80% of the strength back when compared to the uninjured side.
Then, the athlete can gradually progress to sport-specific training and back to practice. The return to play criteria should include 1) full ROM, 2) no pain, 3) no swelling, 4) optimal strength (at least 85% compared to the uninjured side), especially quads, 5) good proprioception and postural stability, 6) good mechanics (risky movements such as jump-landing, cutting motion, etc.), 7) no instability. It is also important to ready the athlete psychologically.
Rehab program should also include injury prevention program for both of the knees since some studies show that athletes with history of ACL injury may be more at risk of reinjurying the same knee or the other knee. It usually takes about 6 months plus minus one month until return to sport.
 |
| 2 leg box jump (start) |
 |
| finish |
Rehab as described is critical, but most studies on the subject indicate that a 5-6 month return to play risks re-injury and damage to graft due to partial graft maturation at that time. This is a biological process that cannot be "sped up" with rapid rehab. We are likely doing a disservice to these very young athletes by returning them to sport too quickly.
ReplyDeleteVery well written and explained. Thanks for sharing an informative post.
ReplyDeleteDo stay in touch and keep posting.
manhattan sports medicine