Anterior Cruciate ligament injuries are common in football. After ACL injury there is pressure to return the players to high levels of activity as quick as possible. However the challenge is to determine a safe method to do this. (White et al., 2013). The time from surgery is often used as the determining factor for both progressing rehabilitation and determining when an individual can return to play.
Recent research has been undertaken looking in to gait asymmetries post anterior cruciate ligament reconstruction. These altered movement patterns have been linked to the development of Osteoarthritis and as a risk factor for future injury. Therefore if these issues are not addressed, an increased risk of injury, knee re-injury and long term joint health could all be a consequence. Therefore this suggests that using time based criteria that are commonly used may not be appropriate as one year post injury these gait asymmetries persist.
White et al (2013) found that all subjects had gait asymmetries one year after reconstruction. These differences were smaller knee angles, moments and excursions. Other research has shown that athletes who had hip and knee multi-plane biomechanical asymmetries present at return to play were three times more likely to incur a second ACL injury within the next year, compared to those without (Paterno et al., 2010).
It is known that gait patterns differ between those athletes who pass return to play criteria and those who do not (Di Stasi et al., 2013). It has been found that athletes may adopt a stiffened knee strategy. This results in reduced knee motion. Other compensatory patterns also exist. It has been found that a contralateral hip compensation strategy also may be present. Specifically power is absorbed early in the uninvolved hip early during in stance and “overflex” the uninvolved knee during weight acceptance.
At Perform we focus on goal driven rehabilitation rather than it being temporal based. The surgeon will still lead the rehabilitation protocol. However the athletes are only progressed when specific criteria are achieved. This four stage process allows the athlete to have a clear pathway and goals whilst undergoing a structured progressive knee loading program.
By Donna Gormley
MSc MSc PgDip BSc (Hons) mCSP mMACP