ACL Rehab: The Final 3 Keys to Returning to Your Sport

This year 250,000 ACL injuries are estimated to occur in the U.S. Unfortunately, only 63% of athletes ever return to their sport after ACL surgery. Also, in the first 2 years after surgery, 30% who return to high level sports sustain a second injury.  These high level sports are those that require jumping, pivoting and hard cutting.  A few examples are basketball, football, and soccer.

So, what can you do to increase your likelihood of returning to your sport?  Also, what can you do to reduce your risk of re-injury when you do return?  In previous articles we mentioned several big factors like committing to prehab before surgery, aggressive early post-op rehab, heavy strength training, and doing a lot of single leg exercises.  This article highlights the last 3 keys you have to understand in order to return to playing.

#1 You Must Confidently Hop and Land on 1-Leg

Multiple studies suggest your ability to hop on 1 leg predicts your ability to get back to your sport.  A 2020 study of 64 athletes who underwent ACL reconstruction surgery investigated a battery of tests to identify those who safely return to their sport. Athletes who returned to their sport within 2 years of surgery performed better on 3 separate single leg hop tests.  These are the single leg hop test for distance, the side hop test, and the triple hop test.

How well you do on the triple hop test is also associated with suffering a re-injury after returning to your sport.  A 2017 study out of the Cincinnati Children’s Hospital found performance on the triple hop for distance test is the most important of the various single leg hop tests.  Both distance hopped and your performance on your injured compared to your uninjured leg helps identify if you are at a high risk for a second ACL injury.

Plyometric exercises are started when you have adequate strength and confidence on your injured leg.   Plyometrics start with landing on 2 legs and progress to jumping and landing on 1 leg.  It will take several months of plyometric training for you to develop the necessary strength, stability, power, and confidence to return to some type of sport practice.

#2 Wait 9 Months or Longer to Return to Your Sport

In the first 2 years after ACL reconstruction, 3 out of every 10 athletes who return to their sport will sustain a 2nd ACL injury.  This should get your attention!  But there is hope.  A 2016 study published in the British Journal of Sports Medicine shows delaying your return more than 9 months since surgery reduces your risk.

ACL injury
Waiting at Least 9 Months Reduces Your Risk of Re-Injury

Specifically, for every month that you delay returning, until 9 months after ACL reconstruction, your rate of re-injury by goes down by 51%.  Some experts even recommend athletes who are 18 or younger should wait 2 years until returning to high level sports.

We have found most young athletes who pass return to sport testing get back to playing within 1 year after surgery.  However, not all athletes are able to pass their testing within this time period.  Inadequate quadriceps strength, poor performance on single leg hop tests, and a lack of confidence are what holds most athletes back.

#3 Your Mindset is the Most Important Factor of All

ACL rehabilitation
ACL rehab will challenge you mentally and emotionally

You probably have high expectations for a smooth recovery after your ACL surgery.  The majority of athletes expect good knee function and a return to the pre-injury level after surgery. However, these high expectations are not always fulfilled.  Many athletes do not return to their pre-injury level of sports.  The biggest reason why is the grueling mental and emotional rollercoaster you will ride while trying to get back.

The biggest key is to remain motivated throughout your rehab.  It will not be smooth.  And it will not be without mental and emotional challenges.  A 2017 study of 65 athletes who underwent ACL surgery found those who returned to their sport at 1 year were more motivated during rehab.  They were also more satisfied with their activity level and knee function.  In other words, they had more confidence in their ability to perform at a high level.

It is no easy task to stay motivated during a year or more of rehab.  Your physical therapist will help you set realistic goals and expectations.  It is going to take a team approach.  You cannot do it alone.

Prepare Yourself for the Marathon of ACL Rehab

We have had some tough love conversations with athletes who expect to return to playing 6 months after their surgery.  Yes, professional athletes can sometimes return to their sport earlier than 9 months after surgery.  This is no way suggests you should rush yourself if you are not ready.

The truth is you are ready to go back to your sport when you prove it to your physical therapist and surgeon.  You have to check all the boxes.  This includes being physically, mentally, and emotionally ready.  Let our physical therapists take you through the return to sport testing process.  Give us a call when you think you are ready.


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