On the advice of Al Vermeil, I phoned up Robert Panariello many years ago and discussed ACL rehab progressions for about 90 minutes. One of the best calls I’ve ever made (aside from my weekly calls with Charlie!).
I suggest you get on-line and see some of the material Rob has published on ACL rehab. Here are a few links:
Also, there has been some research on the use of creatine to maintain muscle mass pre and post surgery. Might be worth while to maintain supplemental creatine use during this period.
As for EMS, there seems to be a greater use of EMS co-contraction therapy (quads and hams at same time) for knee rehab situations. As Charlie mentioned, keep it away from the surgery site if there is any metal used for pinning. I believe Robert Panariello had clients standing when doing the EMS co-contractions.
Charlie knows Rob - so perhaps he could offer some more insight into his methods.
Just as an aside, I was with Al and Rob P at an NFL team when Rob started asking why squats hadn’t been reintroduced yet in an ACL rehab case. The irate trainer said: “How many ACLs have you rehabed?”
Rob replied: “8000”.
That was the end of that conversation!!
Charlie,
I’ll definitely be using the pool. After my first ACL surgery I did not have access to a pool during my therapy and had sub-par therapy. My leg was only 50% the strength of the non-injured one. The doc released my to run after 6 months since the graft was healed completely. I ran the whole summer junior olympic season running a full second slower than what I should have been running in the 100m. Looking back at the film, it looks like I am galloping. Long story short, I went back to therapy and started pool use 3x a week. I believe it help a lot. What kinds of exercises would you suggest in the pool? The had me aqua-belt run against a current in deep water and backpedal and high knee in chest deep water.
On your trainer note, some of those trainers think they know it all, but don’t have a clue. At UM they would not let my lift my upper body b/c it would harm my knee. I laughed.
Number 2,
Thanks for those links. I’ll look at more of Rob’s material. I never thought to post the leg up to even out the bar when squatting. I had that same trouble squatting for about 2 months when I was able to start. I’m using creatine at the moment to help maintain and was planning on using it throughout therapy as well. The co-contraction EMS seems interesting. I will look into that.
Good to see your heads in the right place. An injury like this can be as bad mentally as physically. I had an operation last year and I found that really concentrating on rehab keeps you sane… you’ll be fit agin before you know it!
its coming along good. 8 month mark was yesterday. strength is about 80%. running is still awkward due to the strength deficit. I’ve been using the jump rope and the pool for tempo work and have been doing 2 heavy and one bodyweight leg sessions per week.
As a former acl patient I certainly can empathise on your rehab and agony. I healed too quickly cause I was running 3 months after my surgery but i didnt have full extention so I had to go back and get it scoped again. Thankfully I was able to run again but it took me forever to get my speed back (literally like a year after the 2nd surgery).
Secondly Im glad that you were able to make the team at u of m, unfortunately you have a idiot strength and conditioning coach in barwis so if I were you I would definately follow the advice of the administrators on this site. Also if your in that area, email ESTI or SPEEDCOACH, they both have extensive knowledge in that area, trust me I talk to them about once a week. Again I was blessed to have a excellent doc at michigan state (he does usa gymnastics on the side).
ACL’s take a minimum 6 months to graft. What graft did you get? Appears most doc’s recommend patellar for male athletes s and hamstring double bundles for female athletes (at least in my area).
I have seen it in every instance rehab does not address force absorption at all. Everything is force production.
I use a screen that I have not had an ACL case pass right out of therapy. It took several weeks of work to get into acceptable ranges.
Also, at your recovery so far, I would think you could start to work it harder on the strength side of things. Hard to say everything I have done in the past. I just had NFL guy coming off knee issues, and was babied for 7 months in therapy. Doing squats with bands for 2 x 20 reps isn’t going to help this guy get back to taking a pounding on Sundays.
I am often amazed at how many doctors, pt’s, trainers are so conservative with athletes that they truly hold back the athlete’s rehab. all the while the athlete loses further conditioning and additional, likely unnecessary atrophy. Certainly, as in any field there are good ones too.
I know of one PT who would not allow the athlete with the ACL injury to squat but did require the athlete to bound-no joke.
I understand in the rehab process that there, at times, might be discomfort even crossing over into a somewhat painful zone (for lack of a better term) but when the athlete told the pt repeatedly that this “rehab bounding” was really hurting her knee the PT kept insisting on this “protocol.”
If some method is causing a reaction from someone, in this case, with a fairly high tolerance for pain-a few previous injuries-one would think the PT would find another exercise or method to rehab.
Yes, been my experience with PTs as well. I feel you need to hold them back early and then increase things as time goes on while still keeping an eye on them. What appears to happen is they are babied the entire process and then let loose to do what they want. The result is usually another injury ala down in Charlotte. Not sure what doc would cleared that guy so fast.
Oh yeah, I did hear about Thomas Davis and was wondering the same thing about whether or not they brought him back too soon. Thanks for the link.
It’s somewhat(?) similar to the presentation I saw from Al Vermeil in 1999 when, though he was not really referring to a rehab situation, he was describing a potential scenario of working with a young athlete who had exhibited ability beyond his/her age. I think his main point is that they did not suddenly need the advanced program to progress them further and though they might be capable of some adult-like performances that they were likely deficient in other areas. His feeling was that this person, theoretically, was probably still in need of shoring up some areas of fitness/general training.
Great points ESTI, Pioneer. To follow along what you guys were saying, again I was blessed to have a good ATC. I told him on day 1 I need my speed back an they did not hold back at all, granted therapy hurt like no other but I was back walking and training hard quicker than the norm.
Highlander-
That is exactly what I did with my first acl. I ended back in therapy after running the whole summer AAU season. Barwis and football is not a concern. I went to the doc that did my first acl and Michigan wasn’t happy about that. I also only have one season of eligibility left.
Esti-
I got a patellar tendon graft. I’ve been hitting it pretty hard. With this being my second acl, I knew what I could handle. What is the screen that you have your acl athletes pass after therapy?
Pioneer-
I was lucky enough to have a great therapist out a Medsport. I was lifting heavy at about 3 months. With my first acl i had a cautious therapist that did not want to stress anything. Needless to say, when I was released to run, it wasn’t good. I ended back up in therapy at Medsport and got it right before indoor track season.
knows ACL’s. He has worked with some of the athletes I have trained, including a non contact ACL rupture. He is correct from my point of view. Most PT’s I have seen have done a piss poor job. I think it stems from 2 fronts. One, from a business standpoint, it makes sense to max out the recovery process for the PT clinic. Pads the bottom line. Second, most of them don’t do anything other than what I call “cookbook” rehab. They do A, followed by B, etc. My question is what happens when things don’t progress according to what the set outcomes are thought to be? Too often the therapy is both conservative and rather unimaginative. I have done back sugery rehabs where a carpenter went through physical therapy and “work hardening”. 18 months off on L5-S1 laminectomy. I got him for 3 weeks, back to work, no problems. They never even stretched his hamstrings. You could play a banjo on them. I stretched the hell, out of him ans was aggressive on strength training. Ridiculous.