Limitations of the ‘traditional’ model in ACL rehabilitation

Traditional rehabilitation protocols do not satisfactorily develop the lower extremity strength required to effectively protect the knee and enhance performance. For multidirectional sports, athletes must sufficiently develop their fast-twitch, Type II muscles. These are responsible for high-intensity force production, stabilization and force reduction.

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Rehabilitation protocol

Knee joint injuries negatively affect neuromuscular control (AMI) of the lower extremity and specifically affect Type II fast-twitch muscle. The exercises used to best develop this Type II neurophysiological profile are often contra-indicated for 3–5 months to protect the healing graft (such as heavy resistance training, plyometric, sprinting, fast-eccentric and concentric training). While strength training is encouraged during this time (0–5 months), it is still underestimating what will be required to best protect the knee in competition. Moderate intensity functional exercises (targeting Type I muscle) often predominate the rehabilitation protocol.

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Plyometric training

High-intensity ‘sport-specific’ training is usually indicated by month’s 5–6 post-op. This usually involves sprinting, cutting, technical sport skills and other plyometric training.

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Following this, athletes are typically cleared to ‘Return to Play’ at 6 months post-op after spending the least amount of time training the muscle fiber types (Type II) that contribute the most to protecting the knee under high stress.

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Concluding remark

The Return to Competition program would not allow an athlete to return to team training following ACL surgery without multiple months of progressive Type II activation training as part of an overall plan of reconditioning. A qualified athletic development professional makes decisions from a preparation and performance perspective, not a timeline based on biological healing.

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