Returning to competitive sport after major surgery can be a daunting task. How can you know when you are ready? And that your surgical site won’t be re-injured when you go back? Return rates to competitive sport following ACL reconstruction can range between 60% to 70% and return to prior performance levels dip to ranging between 40% and 50%. Re-injury rates are quoted to be as high as 15 times more likely in patients with prior ACL rupture. The current literature indicates that re-injury rates, as well as successful return to prior performance, are affected directly by strength, jumping and landing mechanics, agility, and on-field physiotherapy.
On-Field Physiotherapy bridges the gap between the clinic and the field by focusing on cutting manoeuvres, jumping, landing, sports-specific drills, speed training, and sports performance. These take place in a large outdoor setting at increased speeds, which cannot be replicated in the clinic. The drills are progressive; planes of motion, velocity, magnitude, duration, and fatigue are all manipulated to ensure that the athlete/patient are returning to biomechanical tasks in a way that is safe for their injury.
How can you avoid re-injury or failure to return to play?
- Go into surgery strong – the recovery will be quicker. Continue to strength train regularly throughout the year following your surgery to regain the strength to return to sport safely.
- Progress as your function dictates, not by how long it has been since surgery. Everyone progresses at different rates.
- Realize that although you are allowed to run forwards after ACL surgery as early as three months post operatively, cutting and changing directions can take up to 3 months more to even begin. These manoeuvres are the main causes of on-field ACL ruptures. As such, you must progressively return to these activities, which are best guided by an on-field physiotherapist.
- Make sure you take objective measures. Landing and jumping have been shown to be one of the best indicators of an athlete’s readiness to return to the field following a lower extremity surgery. These measurements should be monitored and all goals should be achieved before progressing to full participation to ensure safety.
Unfortunately, these types of on-field programs are rare in the city, as I found out when collaborating to write the different protocols for its standardization. Luckily at UBC, the varsity athletes who sustain a “catastrophic lower extremity injury” (i.e. ACL rupture) do have such a program on campus and -the good news- it’s available to the public. These drills are the same ones the Whitecaps or Thunderbirds would do if they had the same injury!
You can be confident that you “know you’re ready” by using the most recent scientifically-proven methods to test your return to play parameters. You will also be guided in a very precise manner into activities that are at appropriate progression rates for your functional strength, and end with speed training to focus on not just return to play, but return to performing.
Ryan Leaver PT, DPT, SCS, Sports Dip
Ryan has been involved as a physio at all levels of sport including the Vancouver Whitecaps, WFC2, WNT Soccer Canada, and Idaho Steelheads (Dallas Stars Affiliate). He is a former professional soccer player in England and Canada, has Coached University soccer in Buffalo, NY for 5 seasons, and has also been the strength and conditioning coach for WFC2. Ryan has been honing his craft on field since 2009, making him one of the leaders in this field in Western Canada.
McCullough et al.Return to High School– and College-Level Football After Anterior Cruciate Ligament Reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study.
First Published August 24, 2012 AJSM
Clin J Sport Med. 2012 Mar; 22(2): 116–121. Incidence of Contralateral and Ipsilateral Anterior Cruciate Ligament (ACL) Injury After Primary ACL Reconstruction and Return to Sport
Mark V. Paterno, PT, PhD, SCS, ATC,*†‡§ Mitchell J. Rauh, PT, PhD, MPH,|| Laura C. Schmitt, PT, PhD,†‡**Kevin R. Ford, PhD,†§ and Timothy E. Hewett, PhD*†§††‡‡§§
Kyritsis et al. BJSM 2016 Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture vol 50 issue 15