Return to Performance Series Discharge….. What happens next?

A small study that highlighted a rehabilitation need with Evolution Healthcare and FItness now providing a solution. See end for details.

 

The truth is…. you may leave, but you never graduate from physical therapy!

This may seem a dramatic statement, but through your rehabilitation journey you should have learnt something about yourself. That may have been that you were not strong enough or mobile enough resulting in injury or perhaps you have suffered significant tissue damage and despite healing you will never be quite the same. Either way you are now aware of something that needs to be at least monitored to avoid future injury. In nearly all cases the medical profession does not provide great support for that future.

I am going to talk in terms of ACL rehabilitation for the rest of this blog as it is well researched and because it is the topic of a small study I recently completed; looking at what happens to athletes after they return to sport post ACL reconstruction.  The principles of this study could be applied to almost any injury.

We have developed a mindset around physical wellness based on the healthcare model. We offer an accessible service when injured but comparatively we offer very little services or support when well. I appreciate this is not groundbreaking news. In PT this hard cut off means that one week we are working hard to achieve our rehabilitation goals, the next week we hit our targets and off we go. Sometimes just a couple of percent change between these 2 weeks which could easily be reversed with a quiet few weeks of training. 

With ACL rehabilitation we essentially train specifically for 9-18 months to pass a handful of return to sport tests. Then most likely, we drop 90% of the work that got us there as now we are considered well and beyond the need of intervention.

Firstly, of course we should look to mentally move on from the injury so we can return to performance without feeling like the handbrake is on. We should however continue to have a rehab component to our weeks. A good injury prevention program should be a few targeted exercises that closely mimic a periodized performance program, so in most cases there should be only subtle changes. This program is best when based on objective testing so we have data to determine an athlete’s needs. 

Recently I conducted a mini study on a few athletes who had returned to sport after an ACL reconstruction (3-12 months) to see if they would pass return to sport testing widely seen as the point of graduating from physical therapy…..

Despite returning to sport, 75% of athletes tested failed to meet an evidence based criteria for safe return to sport. 

This is a pretty significant finding considering that around 1 in 5 who return to multi-direction sport go on to sustain a second ACL injury.

Firstly, I must accept that it is a small number of athletes tested and hard to translate results to an entire population. However this small study supports the sentiment commonly held with performance therapists. When athletes leave PT they are poorly prepared to transition from rehabilitation into their normal training routine. When I consider optimal sports PT, I look at the professional sport model as it has essentially limitless budgets and a 360 degree service with preventative and post injury care. The facts suggest that us as recreational athletes should be seeking the same support but it is hard to find. Like the pros, after an ACL we should be seeking periodic testing to identify strength and movement deficits and then looking for a precise program that considers a periodized approach to ongoing injury prevention. As I mentioned before, a good injury prevention program is a performance program, designed to make you a better athlete.

In this mini study, 75% of athletes tested had insufficient quad strength for return to sport, which is seen as a red flag for reinjury risk. All athletes demonstrated minor to significant deficiencies in force absorption of the ACL limb (A non-contact ACL injury is a force absorption issue). 

After conversations with these athlete’s about their rehabilitation journeys it became apparent that I could support these athlete’s better. I already offer ‘performance training’ to help the athletes return to optimal performance but I need to offer something else…… 

This is why I will be starting a weekly specialized rehabilitation class that will focus on supporting both lower limb end stage rehabilitation, while also offering further support for athlete’s who have returned to sport post injury. This will be suitable for end stage ACL rehabilitation.

For more conversations around this topic or for interest in this class.

Please email nathan@evolutionhealthcareandfitness.com. More details will follow.