Saturday 9 September 2017

ACL Prevention and Rehab: Where We Are and Where We Need to Go

Posted by at 9:06 PM

ACL Prevention and Rehab:  Where We Are and Where We Need to Go

What historically was believed to be a sagittal plane injury of excessive forward tibial translation, is now understood to be more of a frontal and transverse plane injury due to excessive knee valgus and internal rotation during loading(with the foot planted on the ground). 

 Research has demonstrated that only 55% of athletes who have an ACL repair, return to their pre-injury competitive level of sport and the athletes who do return to sport are up to 15 times more likely to sustain a second ACL injury.  Additionally, a 2014 Systemic review found statistically significant strength deficits of the operated leg even after ACLR rehabilitation was concluded. This evidence calls in to question traditional rehabilitation methods.   It is our responsibility as movement and rehabilitation professionals to improve these statistics and  these out-comes.

Improvement starts with understanding the functional biomechanics of the human body,  the kinetic chain, tri-planar movement, gravity and ground reaction forces and applying these concepts to the rehabilitation process.  Understanding that stabilization of the knee occurs from above at the hip/core and even the thoracic spine and shoulder and from below at the foot/ankle, is imperative to evaluate the athlete and design a rehab program which will address those deficits that placed the athlete at risk of ACL injury in the first place.  

Recently published research is just beginning to shed light on what functional bio-mechanical based movement specialists have clinically known for years: 1. Altered movement patterns of the trunk is strongly associated with primary ACL injury risk  2. Knee abduction loads predict ACL injury risk with high sensitivity  3. Weakness of hip abductors may contribute to dynamic valgus at the knee, putting the ACL at risk  4. Frontal plane trunk displacement alters ability to control knee displacement.  All of these studies uphold the bio-mechanical approach to ACLR rehabilitation.  In upcoming blogs we will discuss those biomechanics and how to apply the concepts to ACLR rehabilitation and prevention .  To learn more about functional biomechanics and rehabilitation for all athletes, go to or click here.