In the last month there has been a lot of discussion of ACL reconstruction and the subsequent rehabilitation. We met 3 patients who are a year out from surgery and still have a lot of pain, poor range of motion (ROM), poor strength, and therefore poor movement patterns. The concept is simple - movement. Movement rules.
#5 Early/aggressive movement vs Conservative Care
In my 15 years of performing rehabilitation on people with ACL reconstruction surgeries, there have been a lot of changes. Several trends have come and gone. There are a few principles, however, that never seem to change. Movement is better than rest. The path to reduced swelling, reduced pain, full ROM, and full strength is shorter with early intervention. Early intervention is the onset of care within 2-3 days of surgery. Heck, professional athletes start rehab the same day as surgery! The longer the swelling pools, the more the muscles will turn off - thus slowing recovery. There is also a lot of evidence supporting pre-surgical PT for ACL tear patients. Normalizing ROM, adding strength as much as possible, and educating the patient on how to handle the first few hours after surgery are crucial. Patients need to know there are landmark times in the healing process in order to stay on target for return to play. Interestingly, the long-term outcomes of both treatments are the same. Meaning after 2 years, the two treatment styles find patients at the same place physiologically. However, the early group can get to “normal” at around 6-12 months depending on the activity. Nice.
#4 There is a very high correlation between ACL reconstruction and early Total Knee Replacement
For some reason this fact does not get relayed to patients. The obvious conclusion is that the surgery itself causes the knee to fail prematurely. That is not the case. The movement or biomechanical flaw with how a person, stands, walks, runs, jumps, climbs stairs, and cuts etc, is what causes the joint surfaces to erode and ultimately require total knee surgery. Just getting your ROM, general strength, and basic return to play is NOT enough. Incorrect movement habits need to be corrected. Full movement make over is the skilled aspect of returning the patient to a healthy knee. After all, if you keep moving the knee the same way you did before the injury, you will keep feeling the same thing. Don’t just patch it up. Take the time during rehab to fully restore healthy movement.
#3 ACL Brace Does not Help
The combination of PT and coach offers a new perspective. The injury rates in patients who use the brace and those who do not are NOT DIFFERENT. In fact, when a patient is dependent on the brace the injury rates sky rocket. The brace gives a false sense of stability. The biomechanical mechanism to stabilize the knee doesn’t even happen at the knee! Why would plastic on the outside of the body stabilize the knee? Fact is, it cannot. Again, attention to detail on movement, retraining of the core, lumbar spine, hip, and ankle are far more reliable. The knee is the shock absorber, the joints above and below set the knee up to absorb shock. The brace has been shown to limit ROM, limit strength, and therefore, limit speed, and performance. Consider this - if using a brace does not protect the knee from re-injury ANY better than not wearing one, AND the brace limits movement and performance, then why use it?
#2 ACL reconstruction is ALWAYS about movement restoration
Normal ROM, normal strength, no swelling, and no pain have nothing to do with normal outcome of ACL reconstruction even if you are not an athlete. Activities of daily living have a huge impact on the health of the graft and the future of the knee. Perhaps, NOT acting like an athlete is your training error. Spine, core, hip, knee, and foot ankle biomechanics influence the knee in a big way. Can a muscle imbalance in your trunk cause the ACL tear? ABSOLUTELY. There is no one-way-fits-all approach. Each person arrived in the same biomechanical place to tear that ligament via a different route. Maybe it was traumatic? The effects of the surgery itself now place you in the category of addressing this movement error. Electricity, ultrasound, ice, heat, recovery boots, needles, brace, tape, and any other “outside-in” approach will simply not protect the ACL. Bosu balls, balance boards, foam, and any other cute balance device also will NOT CHANGE movement. The way your muscles work in those situations do not transfer over to balance on the flat ground. Your body has to set up the movement to be efficient, sound, and powerful.
#1 Movement Oriented PT is the Key
These days, the ACL reconstruction surgery is fairly routine. Yes, there are some surgeons that are more experienced and more skilled than others. The angle at which the graft is reinstalled is the key component from the surgery. The type of graft is important, but there are benefits and pitfalls to each. The important outcome is how the knee functions once the anatomy is properly repaired. If your Physical Therapist is too busy to discuss your trunk angle, lumbar spine position, hip stability, knee location, and foot/ankle interaction with the ground, consider finding one who does.
Those are the factors that can reduce the chances of re-injury, prevent a total knee, and make you a better athlete. At MVPT we understand these principles well enough that when you leave after this surgery you are a better athlete. You can trust your body to move in a way that is efficient, pain-free, and powerful. But MVPT doesn’t take insurance? Yes, and that is for the patients sake. Taking the time to correct movement flaws cannot be done in a factory setting. “My doctor says I have to go 3 times a week for 12 weeks.” That is 36 visits! We can minimize your contact to the clinic. We are seeing people a ¼ of the visits for more quality minutes and changing biomechanics, including pre surgery. Most insurance companies will reimburse you for our services. We are happy to provide an invoice of the number of visits and the dollars spent to submit to your insurance. 1-2 visits a week is sufficient to restore normal ROM and strength by facilitating home program. Could you do both “traditional” and MVPT? Sure! Around the 10 week mark is when the insurance starts cutting off traditional patients. We would love to take you over and get you into athletic shape! Feel free to stop and chat to discuss your potential rehab. Please do not hesitate to call the clinic to set up your appointment today! If you prefer head over to the website, www.maxvelocityPT.com and request an appointment today!