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The Importance of Criteria-Based ACL Rehabilitation: A Structured Approach

The Importance of Criteria-Based ACL Rehabilitation: A Structured Approach

Nov 18, 2024

Recovering from an ACL injury can be daunting, but with the right plan, our patients can rebuild strength, regain confidence, and return to the activities they love. A structured, criteria-based approach is essential not just for recovery but for reducing re-injury risk and achieving long-term success.

Here’s the criteria based approach we use to guide our patients:

Acute Phase The focus is on reducing pain (≤3/10 on VAS), managing swelling, and restoring full knee extension. Early progress in these areas is crucial for setting the foundation for later phases. Key methods: neuromuscular stimulation, passive/active extension exercises, and gait re-education drills.

Early Rehabilitation This phase targets movement and endurance. Goals include achieving 120° of knee flexion and improving muscular control with exercises like leg presses and single-leg squats. Building strength here supports long-term stability.

Strength & Control We move into heavier strength training, focusing on 2–4 sets of 8–10 reps at 60–80% of one-rep max. Controlled jumping and landing drills (e.g., sub-maximal bilateral landings) are introduced to prepare for higher-intensity demands.

Advanced Plyometrics Single-leg plyometric training and advanced strength work dominate this phase. We aim for functional goals like an 80% limb symmetry index or 1.5× body weight on leg presses. This phase is about translating strength into power and functional movement.

Return to Sport Here, sports-specific training and multidirectional movements take priority. A safe return to play requires not only physical readiness but psychological confidence, assessed through validated tools and a multidisciplinary team (MDT) approach.

Why This Approach Works:

Recent research highlights the effectiveness of criteria-based protocols:

  • Tailored Programs: Improve outcomes and reduce re-injury rates, ensuring progress at each phase of recovery (Griffin et al., 2020; Hewett et al., 2019).
  • Strength and Neuromuscular Control: Critical for knee stability, reducing risks of compensatory injuries and re-injury (Krebs et al., 2021).
  • Psychological Readiness: Athletes report higher confidence and readiness to return to sport when mental readiness is prioritised (Fitzgerald et al., 2020).

Conclusion:

Recovering from an ACL injury isn’t just about regaining movement it’s about returning stronger and more prepared for the challenges ahead. A criteria-based approach ensures that every phase of rehabilitation has clear goals tailored to each athlete’s unique needs.

References:

  • Fitzgerald, G.K., Paterno, M.V., and Myer, G.D. (2020). Psychological readiness to return to sport after ACL reconstruction: A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 50(10), pp. 558–566.
  • Griffin, L.Y., Albohm, M.J., and Arendt, E.A. (2020). Understanding and preventing noncontact anterior cruciate ligament injuries: A review of the literature. Sports Health, 12(3), pp. 240–246.
  • Hewett, T.E., Myer, G.D., and Ford, K.R. (2019). Preventing knee injuries in athletes: An evidence-based approach to training. Clinical Sports Medicine, 38(1), pp. 1–24.
  • Järvinen, T.A.H., Järvinen, T.L.N., and Kalimo, H. (2021). Rehabilitation of the anterior cruciate ligament: A review. Sports Medicine, 51(3), pp. 447–461.
  • Krebs, A., Naal, F.D., and Maffulli, N. (2021). The role of structured rehabilitation in the management of anterior cruciate ligament injury: A systematic review. British Journal of Sports Medicine, 55(12), pp. 684–690

Biopsychosocial Considerations of Sports Injury and Rehabilitation: A Holistic Approach to Athlete Recovery

Biopsychosocial Considerations of Sports Injury and Rehabilitation: A Holistic Approach to Athlete Recovery

Oct 14, 2024

Opus, founded by David Porter, a new perspective on sports injury rehabilitation is taking shape. Together with Professor of psychology Dave Collins and lead physiotherapist Ian Gilham, the team promotes the biopsychosocial (BPS) model—a comprehensive approach that goes beyond treating the physical injury to address the mental and social factors that impact an athlete’s recovery.

This method aims to support athletes fully, enabling them to return to peak performance with resilience.

 

Key Points:

  • Interdisciplinary Teamwork: The BPS model draws on a team of specialists, including doctors, physiotherapists, psychologists, nutritionists, and coaches. This interdisciplinary approach ensures that all aspects of an athlete’s recovery are covered, promoting a more rounded and complete rehabilitation.

  • The Biopsychosocial Model: Traditionally, rehabilitation focuses on the physical aspects of injury. However, the BPS model acknowledges that injuries affect athletes in other ways too, such as their mental health (e.g., anxiety or loss of identity) and social status (e.g., their role within the team). The model addresses these factors together for a holistic recovery.

  • Patient-Centred Care: One of the core principles of the BPS model is putting the athlete at the centre of their care. This patient-centred approach ensures that athletes are actively involved in their recovery process, which can increase motivation and help tailor the rehabilitation to their specific needs.

  • Real-Life Examples: The article shares practical case studies where the BPS model has been effectively applied. In one case, a competitive equestrian rider with a severe pelvic injury received coordinated care involving medical, psychological, and social support, which helped her overcome fears about returning to competition.

  • Rehabilitation Stages: Recovery under the BPS model follows a clear, structured path, with each phase of rehabilitation managed by the interdisciplinary team. Early stages focus on reassurance and stabilisation, while later stages incorporate goal-setting to keep the athlete motivated and engaged.

  • Social Support: The social aspect of recovery is vital for maintaining mental wellbeing. The BPS model encourages athletes to remain connected with their teams during rehabilitation, helping them feel included and supported throughout the process.

  • Goal Setting and Progress Measurement: Setting clear, achievable goals is central to the BPS model. Breaking the rehabilitation process into manageable steps allows athletes to see progress and stay motivated. Tools like the “Challenge Ladder” help measure this progress, giving athletes a clear path forward.

  • Addressing Psychological Barriers: Injuries often bring psychological challenges, such as fear of reinjury. The BPS model incorporates psychological support to address these fears early on, helping athletes regain their confidence and return to competition without hesitation.

  • Clear Roles for Specialists: With many professionals involved, clear communication is essential. The BPS model establishes well-defined roles for each specialist, doctors, physiotherapists, and coaches, ensuring consistency in care and avoiding confusion for the athlete.

  • A Look to the Future: The authors advocate for broader adoption of the BPS model across sports rehabilitation settings, noting that its holistic approach leads to more effective and complete recovery. This model is particularly beneficial in helping athletes not only return to play but come back stronger, both physically and mentally.

In this article, David Porter, Dave Collins, and Ian Gilham highlight the benefits of the biopsychosocial approach to sports injury rehabilitation.

Focusing on the athlete’s physical, mental, and social well-being, the BPS model provides a more complete path to recovery. Through interdisciplinary collaboration and patient-centred care, this approach ensures that athletes return to their sport stronger and more resilient.

This innovative approach is setting a new standard in sports medicine, helping athletes achieve the best outcomes in their recovery journey. To learn more about how the BPS model can enhance sports injury rehabilitation, read the full article here