Research Assessment #11:

ACL Rehabilitation: Re-injury and Return to Sports Tests

      I have had a lot of success in my research and discovery since I began my mentor visits with Rachel recently. One of these successes is that I have zeroed in on a potential topic of interest for both specialization and a final product subject idea. This topic is the ACL return to play protocol, a process I am all too familiar with and passionate about.
      The article begins by offering some basic background information and statistics about ACL injuries, all things I have heard about and researched before. Then, it went into some details about ACL re-injury, which is basically one of the worst things that can happen to an athlete. This information gave a general overview of why it happens (muscle weakness and returning too early), who it’s most likely to happen to (female athletes, of course), and when athletes coming back from an ACL injury are most at risk of re-injury (up to six years after). It also identified four neuromuscular control deficits that are considered to create the highest risk factors for a second ACL injury; hip rotational control deficits, excessive frontal plane knee mechanics, knee flexor deficits, and postural control deficits (Hashem 1). These factors are wll worsened in an athlete by returning to play too early - which can be all the more devastating. Athletes should not consider returning to play until they have achieved full knee range of motion, absence of effusion, less than 10% deficit in strength of the quadriceps and hamstring on isokinetic testing, less than 15% deficit in lower limb symmetry on single-leg hop testing, less than 3 millimeters of increased anterior-posterior tibial displacement on a knee arthrometer test, greater than 60% normalized knee separation distance on a video drop-jump test, normal patellar mobility, little to no patellar crepitus, and painless activities without swelling (Hashem 7-8). These tests are extensive and numerous, but they are completely necessary in clearing an athlete to play. I had to pass each and every one of these tests myself, and it was no easy feat. It takes months of hard work and dedication.
      A typical ACL return to play protocol consists of five stages; dynamic stabilization and core strengthening, functional strengthening, power development, sports performance symmetry, and sports integration (stage five being my personal favorite) (Hashem 2). Stage one, the dynamic stabilization and core strengthening, consists of regaining full range of motion as well as building up core strength - one of the most important factors of maintaining a healthy athlete. In my case, my weak core led to my lower back having to do more work, which led to my hamstrings being tight and weak which made me susceptible to an ACL tear. This stage is crucial as it sets the athlete up for success in all the following stages. Stage two, functional strengthening, is essentially just a couple months of intense strength training. The goal in this stage is to get your hamstrings and quads strong enough to help you to prevent another injury after returning to play. Then is stage three, power development, which is basically the same as stage two with power exercises and some increased change of direction movements. Stage four, sports performance symmetry, is where the athlete is retrained to use proper and safe biomechanics in their every move. This step is crucial for females who, as per usual, are at a significantly higher risk of reinjury. Lastly is stage five - sports integration. This is where the athlete finally achieves their goal and is able to get back into their sport and practice again. This process is long and difficult, but the reward at the end of stage five is worth every second.
      This topic is something that really resonates within me on a very personal level and I love researching more about it. I cannot wait to discuss my findings with my mentor and learn even more about ACL return to play protocol as I begin the work for my final project.