When can I return to sport or exercise after ACL reconstruction ?
Usually this is the first question that we get asked and i think its good to get it out of the way is to set realistic expectations on when you can return to sport or exercises:
- Returning to the gym should be part of your rehabilitation, ideally should be in the gym at week 8 onwards.
- Return to running, usually around the 3 month mark, can be earlier depending on milestones achieved in rehab.
- For contact and collision based sports: up to 12 Months.
Unless you are in a professional sports environment or have had an injury that was not surgically repaired there is little to be gained from accelerated style rehab for these sports except another injury. The sports that i would consider in this bracket include :
- Football and touch football codes
- Basketball
- Netball
- Hockey
- Combat sports
ACL reconstruction : rehabilitation do it right, do it once.
There are a lot of sports specific facets to develop and retrain to get you back to these types of sports. You need to develop multiple high level skills to maximise your successful return to sport and minimise a risk of reinjury. As such we need to retrain and improve the following areas
- strength endurance and absolute strength of the lower limb and core
- ability to jump and land effectively.
- coordination of movement patterns such as running , pivoting and sudden change of direction.
- Ability to cope with unplanned movements e.g collisions with players
- Sport specific drills
It sounds like a lot, but in reality each of these areas will be addressed and progressed throughout your program to get you ready for game day.
Cutting corners is a bad idea and it’s often a case of your confidence will be better than your knees competence by the time you reach the 6 month mark.
Return to running and the gym after ACL reconstruction
This would include running and return to the gym. This can be recommenced quicker depending on the demands of the activity or sport.
You should be in the gym by at least the 8 week post surgery mark doing your rehab and certainly running should be on the agenda by 10-12 weeks.
For a return to running there are criteria that you should meet ,we discuss this in more detail here
The first 3 – 6 months of ACL reconstruction rehabilitation.
From about the 6-8th week you should have already commenced your gym based rehab program. At the 3 month post operative point in time the graft is still going through its healing, repair and adaptation cycle.
At this stage the priority in rehabilitation is to concentrate on the following areas:
- Regain strength in the lower limb
- Address balance and proprioceptive deficits
- Return to running
We covered the exercises and expectations in our previous blog . Typically we would expect general strength levels and function to be progressing well but it is highly likely that there will still be deficits in some areas.
That’s why it’s good to test the function and strength of the injured and uninjured sides to get an understanding of what you need to focus on as you progress down the rehab path. The testing protocols we use look at a combination of :
- strength : split squat 3 repetition max test , tuck jump
- agility: lateral hop test
- endurance: Single leg squats for time
- power based: single leg hop, triple hop
Below are the ACL reconstruction testing protocol standards that we are looking for. Ideally there should be no more of a 10% deficit between the injured and uninjured side.
ACL reconstruction: 6 months and beyond.
Progressing the ACL reconstruction rehab and preparing for return to sport.
I think the biggest mistake that can be made here is over complicating the gym based rehab and trying to change every component of it.
Keep it simple and it will be effective and achievable, make it complicated and it likely won’t get done.
So what needs to be done in the next phase of ACL rehabilitation ?:
- Look at what has been achieved to date with rehabilitation.
- How left and right leg compare in strength and movement strategies.
- what your end or next goal is.
With this information and the results from your testing you can work out what the weaknesses are. Usually at this point we are looking at continuing to develop the following attributes:
- strength endurance or absolute strength. Increasing intensity and volume of exercises . Adding to the Single leg strength and strengthening sport specific patterns.
- ability to jump and land effectively. increasing jumping / power based exercises see more here in our plyometrics blog
- coordination of movement patterns such as running.
- Agility based training, increasing complexity and speed of the movements
- Sport specific drills, including cutting , change of direction and impact drills.
Often your gym based work will start focusing on higher intensity and less volume to build more strength, include power based exercises and possibly higher level lower limb and core based work.
You’ll often find us making up complexes of strength based exercise along with power, agility or skill based exercises in our sessions.
Check these simple mini hurdle drills out for examples and ideas for agility and sport specific court drill training.
So when can return to sport again after ACL reconstruction ?
The million dollar question, this should be criteria based, sport dependant and time dependant.
As a rule it should be about 12 months before return to contact sports or those that require the ability to pivot.
As discussed previously we want to make sure of the following:
- Completed your rehabilitation phases successfully.
- Completed sport specific elements in training and rehabilitation.
- Testing results of operated side are within 10% of non operated side.
- Gradual return to training environment doing drills in collision and contact sports.
If you want an outstanding result from a knee or sports related injury book here to see one of our team.
Dave.
Wellsandt, Failla & Snyder-Mackler (2017). Limb symmetry index can over-estimate knee function after ACL injury. Journal of Orthopedic Sports Physical Therapy: 47 (5), 334-338
Melbourne ACL guide by Mick Hughes and Randall Cooper