BOULDER, Colo. — In a presentation at the International Extreme Sports Medicine Congress, John A. Nyland, ATC, EdD, PT, discussed factors athletes should focus on during rehabilitation after ACL reconstruction to return to sport safely and effectively.
John A. Nyland
According to Nyland, it is important to educate athletes during rehabilitation of an ACL reconstruction. He noted rehabilitation is the time to identify and fix an athlete’s impairments and deficiencies and to educate the patient.
“Someone needs to talk to the patient, and I would suggest it is the physiotherapist and athletic trainer’s responsibility, at least, to do that,” Nyland said in his presentation.
Patients need to develop self-efficacy and resilience, and quality should be emphasized over quantity in exercise movement, Nyland noted. He added patients need to not only be biologically and biomechanically ready to return to sport, but also psychologically and behaviorally ready.
Prior to returning to sport, Nyland said athletes need to have neuromuscular control, need to re-establish non-impaired active knee extension and work on flexion.
“This is a big missing piece of a lot of traditional physical therapy approaches because the first time [athletes] go back, they have to go in this position of extended hip, high knee flexion and they are going to tear something or they are going to cause patellar tendonitis,” Nyland said.
Nyland noted athletes need to undergo basic strength training in physical therapy to restore quad function and high knee flexion function and to improve strength in the hip and entire lower extremity.
“You have a healthy hip, a supple strong hip, you are not going to have back problems. You are not going to have knee problems,” he said.
With agility training, Nyland said he tends to go from more exploratory movements to performatory movements that focus on the athlete’s sport and his or her position in that sport.
“Too often we see motion constraints after surgery,” he said. “[Athletes] get so used to going from fun and playing and recklessly moving to being constrained in uniplanar motions. We see this all the time post-reconstructive surgery of the knee. It is important to get them to move again.”
Finally, according to Nyland, all athletes recovering from ACL reconstruction need to have continued maintenance training.
“In my opinion, the ACL injury is a permanent injury,” Nyland said. “As long as you are going to be an athlete, you have maintenance requirements particularly at the hip, not just the quads.” – by Casey Tingle
Nyland JA. Rehab after ACLR — Can I be stable again? Presented at: International Extreme Sports Medicine Congress; June 1-2, 2018; Boulder, Colorado.
Disclosure: Nyland reports no relevant financial disclosures.