ACL Rehab Timeline: Month 6

Now that you are at 6 months post-op ACL reconstruction, and after putting in countless physical therapy and strengthening sessions, it's time for your first official Return To Sport Test.

A "return to sport" test is a systematized biomechanical test used to evaluate your specific movement patterns and motor control in sports based actions.  Basically, the outcomes and data from a return to sport test tell you whether you are or are not ready to return to sport safely.

Rather than just relying on basic ACL ligament testing, manual muscle tests in the doctor's office, and time...

...true comprehensive testing  involves detailed assessments of strength, power, balance, agility, and running form. 

It is essential and imperative that comprehensive testing is performed rather than "standard" testing.  Standard testing will catch large issues such as a failed ACL graft, global muscle weakness, or range of motion loss, but it will MISS biomechanical movement errors that are only visible during high speed, game level movements that challenge your body at it's max performance.  These high speed movement errors are what cause re-injury and they are often missed.

Read here for the American Physical Therapy Associations take on return to play considerations after ACL injury.

ACL Return To Sport Test: 6 Months

Six months post-op is the perfect time to start return to sport testing.  Most athletes will still be learning proper motor control for movements such as cutting and lateral shuffling at this phase; however, testing at this stage both serves as a benchmark and a road map for future treatment.

Since most athletes will take between 9 months and 1 year to make a full safe return to sport, the six month test sets the stage for the second half of rehabilitation.   By highlighting areas of weakness, your physical therapist will know exactly what movements and drills to focus on to ensure your safe return to sport.

So what is the test?
Testing at 6 months is the same test that is performed at 9 months or 1 year just at slower speeds.  The goal is optimal, efficient, and powerful movement that mimics movements performed during game play.   Therefore, the test remains the same but the intensity of the test will change based on individual criteria and time.

Currently, there is no real "gold standard" testing procedure for post-op ACL return to sport; however, there is significant similarity and consistency among top level physical therapy practitioners.  The key here, for all of you who are recovering from ACL injury, is that you find a physical therapist that specializes in ACL testing.

The testing should incorporate:

- double leg jumping
- single leg jumping
- cutting
- agility
- running testing
- speed testing
- strength testing

Now, most physical therapy centers will lack the space and equipment to sufficiently perform these tests at game speed. Additionally, to fully analyze and critique these motions you need high speed frame-by-frame video.  Without video the best you or your physical therapist can do is "guess" about how well you are controlling your body.

That being said, the best situation would be to have video feedback from multiple angles to capture movement in all planes of motion.  If you are lucky, there will be a physical therapy practice that not only has high speed video from multiple angles, but also has the ability to track muscle function, force, and real-time joint motion.  This information will tell you everything you need to know about your movement and function without leaving anything to chance or "guessing" which puts your mind at ease.

Look for PT centers that specialize in motion analysis and biofeedback like we do here at Competitive EDGE Physical Therapy.  Having gone through ACL reconstruction myself, I wish I had the chance to be fully confident in my movement and control before being cleared for return to sport. 

Be Sure To Work The Non-Surgical Leg!

Over the past 6 months you have spent considerable time improving the strength, stability, and control of your operated leg to bring it up to the level of your non-operated leg.  

The BIG question is....was the non-operated leg at an "ideal" state in the first place?

Well, if up to 70% of ACL injuries occur due to non-contact injuries then we must assume that the majority of injuries in these cases were caused due to internal issues.   Those movement errors likely still exist in the non-operated leg and need to be addressed.  Be sure to perform all exercises in rehab on BOTH legs to ensure you don't have a similar injury on the non-operated leg.  

What is the likelihood that someone would sustain an ACL injury on the non-operated leg...some studies have reported up at a 19% injury rate (and up to 29% re-injury rate of the same operated leg)!  

Clearly you can see that return to sport testing and discharge criteria is a BIG deal and needs to be given significant weight as you decide when to return to sport.

Keep Physically And Mentally Strong

Keep up your physical and mental stamina during month 6 of ACL rehabilitation.  Find sources of strength in music, friends, mentors, and coaches.  Make objective goals for strength and conditioning and stick to them.

If you harness the power of your rehabilitation, you can return stronger, faster, and with more drive and passion that those who don't really know WHY they are playing sport. You know your your goals with passion!

Written By:  Kevin Vandi  DPT, OCS, CSCS

Physical Therapist serving San Jose, Los Gatos, Campbell, Alamden