This is by no means an all-encompassing list, but I think it provides some insight to give a better idea of what you can look for to make the most out of your situation and set you up for success in the ACL rehab process. As with most things, there are always outliers, which is why this turned into 5 (plus some add-ons) and not 5.
Ask your provider how many ACL rehabs they see every year
You need someone who has experience in this area. Now, experience doesn’t always make for quality care, but it can:
- Help to set expectations about what this journey may look like.
- If you’re using your insurance, the clinic should be able to work WITH you to make sure they use it efficiently. Using insurance doesn’t always ensure a more affordable, efficient road. This topic probably deserves its own podcast episode.
- I think it’s always great to ask your prospective provider how they’ll know when it’s appropriate to progress you through different stages. If their answer is to just follow the surgeon’s or someone else’s protocol, then it’s time to go looking for a new provider.
- The truth is that the majority of providers aren’t practicing with the most recent guidelines when it comes to return to play testing and decision making.
- Greenberg et al., 2018 showed that out of 1074 physical therapists who were surveyed, 56% only used their hands (manual muscle testing) to try to accurately assess strength. Another 89% only used single leg hop metrics as their assessment to allow return to sport.
- For more on this process as a whole, check out Optimizing the return-to-sport paradigm following ACL reconstruction
Are they willing to work with other stakeholders?
The rehab process shouldn’t just involve the main rehab provider. If you’re trying to return to your sport(s)/activities, there may be others who need to know how they can best work with you. A couple of examples:
- Keeping you involved with your strength coach and/or athletic trainer can help facilitate recovery and give you the ability to continue to work on other athletic elements within your sport.
- Miscommunication with sport coaches can be frustrating, and consistent communication can help to mitigate this to set expectations for coaches and allow the athlete to stay involved with their team(s) appropriately.
Can the clinic/gym space facilitate your recovery?
If you look around the prospective space, would you want to work out there?
- The space should have enough room for you to sprint at full speed and get back to cutting.
- The clinic should be set up with enough weight to progress you through most stages of rehab.
- If not, do they work in conjunction with someone who does, or are they willing to give you plenty of direction outside of the clinic too?
Does the provider have a strong strength and conditioning background?
If not, do they work in conjunction with someone who does? The ACL rehab process is long and has different elements that need attention. Having a strong strength and conditioning background can help to progress elements appropriately, such as:
- How to periodize and plan a long term approach to regaining strength and power.
- How and when to progress/regress things like jumping and plyometrics.
- Knowing when it is appropriate to progress sprinting/cutting as well as treating the athlete as a whole athlete.
Like I mentioned at the beginning, this is not the perfect list. However, I do believe it’s a good place to start! You get to choose who you want in your corner and it’s never too late to pivot and start looking elsewhere.
References:
Greenberg EM, Greenberg ET, Albaugh J, Storey E, Ganley T. Rehabilitation Practice Patterns Following Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists, 2018, Journal of Orthopaedic & Sports Physical Therapy, (48), 10, 801-811. DOI
