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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

 

 

Antibodies and the Immune System

Antibodies and the Immune System

Dec 20, 2023

Photo by Artem Podrez from Pexels

We have already looked at the role of antibody testing in the fight against COVID-19; however, there was just too much information to discuss in one post. Therefore, this post is aimed at diving into a bit more detail on antibody testing for SARS-CoV-2 and looking at misconceptions surrounding this.

When taking an antibody test, we are looking for anti-SARS-CoV-2 antibodies, which can be found in your blood as early as ten days after experiencing COVID-19 symptoms. Therefore, not only is antibody testing useful on its own, when combined with PCR testing, these detection methods minimise the likelihood of receiving a false-negative test. Moreover, antibody tests for SARS-CoV-2 are based primarily on the detection of antibodies against specific proteins. But, what does this mean? The novel coronavirus has four main structural proteins, the nucleocapsid (N), the spike (S), the membrane (M), and the envelope (E), as seen in the image below. However, antibody testing solely focuses on the detection of the S protein, consisting of S1 and S2 subunits, and the N protein, as these are the main immunogens of this virus.

The S protein of SARS-CoV-2 is located on the surface of the virus and is highly immunogenic. Each subunit of this protein plays a different role, with the S1 protein containing the receptor binding domain, a key target of neutralising antibodies. The N protein, on the other hand, plays a crucial role in the replication of viral RNA, enabling the virus to survive in our system. Its role in transcription enables the virus’s genome to be packaged into virions and also inhibits the cell cycle process of our cells. During infections, the N protein is vastly expressed and possesses high immunogenic activity.

Image taken from: https://www.invivogen.com/covid-19-related-genes

Although antibody testing is focused on detecting antibodies against either the S or N protein of SARS-CoV-2, it has been recommended that a testing method that detects antibodies against both proteins be used to gain the most accurate results. This method has been adopted across the UK, and the antibody testing at Opus is no exception to this.

COVID-19: Same-Day Fit to Fly Testing

COVID-19: Same-Day Fit to Fly Testing

Dec 20, 2023

Photo by Alex Koch from Pexels

Rapid antigen testing, also more commonly known as lateral flow testing, is a faster method of COVID-19 detection than PCR testing. Rapid antigen tests have a specificity of over 97% and have been widely adopted across the UK as a measure of controlling the COVID-19 pandemic.

These easy-to-use tests can either be done at a local test site, a healthcare provider, such as Opus Biological, or from the comfort of your own home. The tests themselves will either require a throat or a nasal swab, with our staff providing you with the instructions on which is needed. This will be done at your short medical consultation prior to the test, carried out either in person or via video consultation.

Although lateral flow tests have been largely discussed for regular COVID-19 testing in the UK, they are now being used under the Government travel guidance for those travelling to England. 

You will need to take a COVID-19 test before arriving in the UK if you either do not qualify as fully vaccinated or you have been in a country or territory on the red list in the ten days before you arrive in England. A full list of the red list countries and territories can be found here, whilst the Travel to England guidance to find out if you qualify as fully vaccinated can be found here.

This use of lateral flow tests has been termed fit to fly testing, and it does what it says on the tin, ensuring you are not carrying the COVID-19 virus before you begin your travels or return to the UK. Whether you are jetting off somewhere warm or you are simply flying with the UK, a lateral flow test offers you the freedom to do so. It is, however, important to remember that these tests must be ordered and performed through a private provider and booked in advance before your trip.

How to get your Fit to Fly test Private testing for this scheme is available at several pharmacies up and down the country. At Opus, our tests are undertaken in a UKAS accredited partner laboratory and are CE marked, ensuring you receive the most accurate results. The Fit to Fly test itself will tell you if you are infected when taking your sample, with this information being relayed to you within 24 hours of the sample reaching our labs. We also offer same day access to testing for both the COVID-19 virus and for COVID-19 antibodies, easing your mind when it comes to last minute trips.

Going abroad and want to book your Fit to Fly test at Opus? Get in touch with us now.

Health Screening: Why regular appointments are important

Health Screening: Why regular appointments are important

Dec 20, 2023

Photo by MART PRODUCTION from Pexels

Health screening checks are a great option if you are looking for a summary of your overall health. They enable us to identify any risk factors you may have for more serious health conditions that could develop later down the line. Beyond this, our health screening checks can assist you in your long term health goals, whether that be losing weight, reducing stress, or simply getting in better shape.

Our team at Opus will support you on this journey and help contribute to your healthier lifestyle. So, what exactly can our health screening checks tell you?

There are so many different health problems that may arise throughout our life, and we cannot test for all of them. However, most health problems have a similar set of underlying risk factors that can be detected. This includes a sedentary lifestyle, an unhealthy diet, high blood pressure and cholesterol, and smoking, to name a few. If you are still wondering how health screening checks and lifestyle changes can lower your risk of health problems, let’s take a look.

The phrase sedentary lifestyle often implies that your physical activity levels are very low; this may be a result of your occupation, but moving around throughout the day is detrimental to your health. The World Health Organization details that a sedentary lifestyle alone significantly increases the risk of cardiovascular diseases, diabetes, obesity, colon cancer, high blood pressure, osteoporosis, lipid disorders, depression and anxiety. Likewise, smoking represents one of the largest causes of health problems in the UK, including lung cancer, coronary heart disease, stroke, pneumonia, and bronchitis. Simply increasing your daily activity levels and cutting back on the number of cigarettes you have can significantly reduce the risk of developing these health problems in the future.

During your health screening, we will start with gaining an understanding of your daily habits, identifying any that might increase your risk of health problems later on in life, before moving on to testing. Depending on the health screening package you have selected, or that has been tailored to your needs, tests may include hydration levels, body fat percentage, urine analysis, a full blood biochemistry profile including liver and kidney function, blood glucose test for diabetes, cholesterol profile, dietary analysis, a lung function test, resting ECG, and cardiovascular risk score, amongst many others. Collectively, these will provide a great starting point for the changes that need to be made in your everyday life.

Booking a health screening can often be overwhelming, with a host of different options available online. Although we offer several different health screening and wellbeing packages available for you to book directly, our team are able to tailor the packages to your individual needs, providing you with that added peace of mind.

Get in touch today to book your health screening check and start your journey to a healthy lifestyle with Opus.