ACL 101: Common 6 Pitfalls of ACL Care (When Avoiding Surgery)

Danh NgoKnee Pain, Uncategorized

bike4This article is my latest continuation of the ACL 101 series.  ReVITALize Rehab Club is designed to simplify the medical jargon so every member can be empowered in their own care.  Social media and medical information in the internet are notorious for giving snippets of fitness and medical care and I want to bridge that gap so every member can get in the heads of the medical and fitness professionals to make the best decisions for themselves.

Recent studies showed that 60% of ACL rehab make a full recovery, less than 60% return to sport, and more than 50% develop knee osteoarthritis by middle age.  My goal is to inform our club members on how to not fall into this category of less optimal outcome.   Most studies are happy to demonstrate above average statistical significant, but if one desires to bulletproof their knee, one needs to get the upper hand in short and long term care.

Read “ACL 101: the Breakdown of How Not to Break Down (The What?!)” and “ACL 101: How to Be the Last One Standing (After Surgery)” in which I wrote about how to test your ACL, the shift in ACL care, risk factors, and what to expect after the early phase of ACL surgery.  Having an ACL tear is not all doom and gloom.  Did you know that research has categorized ACL patients into 3 groups.  The three groups are: “copers” without brace, “copers” with brace, and “non-copers” needing surgery.  The name of the game with the first two groups is to teach the whole body (notice I did not say knee) to find a different strategy to move efficiently with a weakened ACL.  I will take this idea a step further and will teach you how to bulletproof your knee to not be another statistic of having meniscus or total knee replacement surgery in the future.

Common Pitfalls During ACL Care (To Cope Well or After ACL Surgery)

1. De-emphasizing the basics.
In “ACL 101: How to Be the Last One Standing (After Surgery)”  I talked about the importance of managing knee swelling, maintaining strict focus on regaining and rebuilding your front thigh (quadriceps) strength, and rebalancing to have an (inner and outer) “core” advantage.  This concept applies to being a coper.  The good thing about this is that one can focus on these three principles right after an ACL injury.  As a performance specialist (and to be a superhuman), one simple thing that can get a client to unlock their movement potential so they can run, jump, and throw faster is to have a core first strategy.  Having an injured ACL does not change this concept.

2. Accepting “compensation” (dysfunction).  This sounds easy to address and a “no-brainer”, however the pressure of work or your sports team needing you back drives an emotional decision that makes you stray away from the proper regiment of knee care. You can rationalize how you can take care of the compensations another time but it never happens.  Compensation can come in the form of a few overlooked reasons: having old injuries that is holding the ACL from better performance, dragging improper knee care when one’s life gets busy, and not matching our leg’s need to the desired sport or daily tasks.

3. Getting too fancy with exercises.  This concept is overlooked by many trainers and medical practitioners.  I believe the (social) media hypes up exercise trends that can be unsafe and inappropriate.  I admit I did chase fitness trends during my early career but realized the importance of having a rehab and fitness purpose that drives a fundamentally sound program.  If you are after strength, then do strength training.  If you want better balance, then focus on balance only.  This idea sounds simple, but many try to combine the two without understanding the reason for doing the exercise in the first place.  It is common to have clients do weight training while on stability training devices like a BOSU or swiss ball.  Practice your squats/lunges using bodyweight.  Master this then add loaded squat/lunges if you want to desire strength.  If you are after performance specialization phase of your ACL program (usually much later than you think), you can blend the two when you are STRONG and have GOOD handle of your body’s movement. Yes, studies do show that doing leg exercises on a swiss ball is a good option for training the core with the leg, however they also forget to mention that other studies show that you tend to sacrifice other muscles for good form.  Keep it simple everyone.

4. Not finishing your rehab with a return to sport/work criteria.  This applies to ones who skip out on a complete rehab program.  There is evidence that those who pass this test can avoid surgery.  This consists of a series of hop test, maximal strength test, and a questionnaire.

5. Protecting the ACL too much.  Once you have mastered the basics, learned how to move correctly to “protect” the ACL, and specifically trained to have strength, flexibility, and core balance, the next step is to teach your knee to buckle in.  Will this hurt your ACL?  Not really because you are allowing your knee to feel this disadvantage position.   Your body and brain will know how to protect you once your knee dives inwards by accident.  The confidence in knowing that you are doing more help than hurt is that you have done number 1 and 2 so well, that your program and commitment to your knee care will bulletproof your ACL from everything.

6. Not training for life options and saying that it is “aging”.  Aging gracefully requires a huge commitment to ourselves.  Sounds easy but difficult to be consistent.  We tend to go to the gym and do the easiest exercise or the popular class.  This tends to focus on parts of a comprehensive fitness program.  Your doctor and internet is right to say that it is unsafe for the knee to jump, squat, and perform crazy feats.  ReVITALize Rehab’s “rebuild” phase philosophy consists of body weight or machine strength training, yoga/flexibility, plyometrics, and a fun variety of high and low intensity cardio options.

This program does not need to be accomplished every week, but if you purposely sprinkle in a comprehensive program, you can “out of the blue” help your friend move out of his apartment.  You can spontaneously chase after your grandchildren or jump to catch a kite caught in a tree.  Your knee is trained for the occasional crawling and kneeling plumbing issue that needs to be fixed (usually on a Friday night).  You get my drift?
If you want to ensure superhuman status and sleep easy that your ACL will hold up in the long run, contact us for a second opinion.  I am more than glad to offer my input.