10 Mistakes why ACL rehab regularly fails
The aim of this blog is to summarize the key aspects why physical therapist may fail to achieve optimal results after ACL injury and/ or ACL reconstruction. Note that this summary is not meant to blame anyone. But just to make sure we can do better in the future.
1. Lack of clinically applicable guidelines
The first limitation we are currently dealing with is that there are only a limited amount or there is a lack of clinically applicable guidelines for rehabilitation after ACL injury and ACL reconstruction. Some guidelines have been published but these guidelines remain very general and non-specific.
2. Gap between research and practice
Secondly, there is clearly a gap between what we know from research and what is typically done in clinical practice. This can be due to many reasons. For example for many of us physical therapists, it can be very challenging to keep up to date. Given the fact that a lot of research remains behind a paywall and that we often have minimal time to dig into the individual studies while working all day in the clinic. This ACL Rehab online course might offer of course a good opportunity to get up to date again. Furthermore, as mentioned in my first points the research findings are often too non-specific to apply directly in clinical practice.
3. Most patients are not ready when RTS
A third important barrier to achieve optimal results of ACL injury is that a lot of patients are not ready when they return to sport. A lot of patients just return because they think they can return based on no test, no criteria or just based on time after injury or reconstruction. They often lack the physical, psychological and physiological capacities to return successfully to sport and performance. Hereby increasing the chance for a second ACL injury or other lower extremity injuries or reduced performance and lower quality of life.
4. No criteria-based progression
Number four is related to the previous point actually. A lot of therapists progress the athletes during the rehab continuum based on no criteria or criteria that might not be sufficient to deal with the demands of the following phase or return to sport. A rehab based on criteria based progressions can be very helpful to set clear goals and guide your exercise prescription according to the functional level of your patient.
5. Low quality rehab
Point 5 is also really essential and is focused on the quality of the rehabilitation. Without optimal rehab, you will not go for results you are achieving or you wish to achieve. However, we see that the rehab quality is often relatively poor in general (Dingenen et al. 2021), not for everyone, but in general. And even though it might be very difficult to define high-quality rehab, there are some key points to pay attention to. First, I think we often fail to achieve the full potential of an athlete. This can be due to the fact that there is in general not enough knowledge on all aspects that need to be trained. Or a lack of knowledge and skills to be able to target all the aspects that need to be addressed in your rehab program to return to sport and to return to performance. In addition, we are often not specific enough in our exercise prescription. A detailed exercise prescription is important to achieve desired training goals. One of the points here that we also addressed in this online course is the fact that often rehab is underloaded. We need to train hard and smart to get the results that we want to achieve, especially if you really want to return to sports performance.
Dingenen B, Billiet B, de Baets L, Bellemans J, Truijen J, Gokeler A. Rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament reconstruction: an online survey. Physical Therapy in Sport 2021 Available online 12 February 2021.
Truong LK, Mosewich AD, Holt CJ, Le CY, Miciak M, Whittaker JL. Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review. British journal of sports medicine. 2020 Oct 1;54(19):1149-56.