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ACL Rehab: Return to Play Faster and With Full Ability

ACL Rehab

ACL Rehab: Tips for Returning to Play

When we see athletes, who sustain an ACL tear, often, the first question they ask is, “When will I be able to play again?” We know athletes are always anxious to get back in the game. However, a thorough ACL rehab program is essential to achieve desired functional goals, including a return to sport participation, and to decrease the probability of re-injury.

An anterior cruciate ligament (ACL) injury is a challenging injury to endure at any athletic level or to any age group. In fact, it is one of the most common traumatic knee injuries in sports. It is especially prevalent in female athletes (15-25 age group) who participate in multi-directional sports, such as football, soccer, and basketball. Female soccer and basketball players are significantly at a greater risk of an ACL injury than their male counterparts.

No matter the sport, no matter the gender, close to 90% of athletes suffering with an ACL tear seek surgical reconstruction if they want to return to their pre-injury level of function as soon as possible post-operatively.

Thankfully, many advances have been made in the treatment over the years. What was once considered a devastating, career-ending injury, now leaves room for hope, as medical research continues to evolve.

How ACL Rehab Speeds Return-To-Play After Surgery

Rehabilitation following ACL surgery is an essential part of a full recovery. This process can take anywhere between six to nine months. Objectives include the patient’s knee not presenting with pain or effusion, during or after functional sport specific training drills. The individual must also be able to demonstrate the appropriate strength and endurance needed for their specific sport.

Research suggests that the surgically repaired leg must perform at least 90% as well as the uninjured leg before a return to sport participation.

Prior to returning to sport, each patient should meet specific objective quantitative and qualitative criterion. If return to sport occurs too soon, re-injury is likely to occur. One study reports that one in four patients undergoing an ACLR will suffer a second tear within 10 years of their first. An incidence rate of a second ACL injury within 2 years after returning to sports was nearly 6× greater than healthy controls. Frequently the second tear is of the opposite knee.

At Twin Boro, we don’t put a generic timeline on the rehabilitation process or when the athlete can return to sports after ACL reconstruction surgery. Instead, return-to-play is based on an individual’s ability to perform sport specific agility activities at the desired functional level.

Each individual will have their own goals and treatment plan, but will include criteria for several domains such as:

  • Range of motion
  • Balance
  • Flexibility
  • Strength
  • Muscular Endurance
  • Proprioception
  • Gait retraining

All of this is achieved through a progressive ACL rehab protocol that is set in motion, before the surgery even happens.

The main goals of a prehab program prior to ACL surgery may include:

  • Gaining full range of motion for both knees
  • Minimizing joint swelling
  • Increasing strength
  • Improving neuromuscular control
  • Enhancing mental state
  • Walking with normal gait sequence
  • Educating the patient on their post-operative rehabilitation

Research has shown that pre-operative physical therapy is effective in increasing strength and balance, which may limit the number of episodes of ‘giving way’ and decrease the incidence of re-injury in the ACL deficient knee.

Goal of Rehab for the ACL Injury <h/2>
Due to extensive research, ACL rehabilitation has changed quite a bit over the past decade. Techniques used to consist of immobilization and delayed weight bearing and now have moved to early rehab programs with immediate ROM training and exercises that include weight bearing exercises.

Generally, the goal of rehabilitation for a patient with an ACL injury includes:

  • Improve functional stability
  • Regain muscular strength
  • Reach optimal functional level
  • Decrease risk for re-injury
  • Gain independence in home therapeutic exercise program

As patients regain strength and balance, they may begin resuming their sport activities such as running, jumping, and hopping. This will vary greatly from athlete to athlete.

Study: Return To Play Checklist Reduces Re-injury For Athletes Following Anterior Cruciate Ligament

Previously, after ACL reconstruction, time was the major criterion for determining when an athlete should return to play. A common guideline used to be six months after an ACL reconstruction. But, now, a new study, “Safer Return to Play Following ACL Reconstruction: Validation of an Evidence-Based Checklist,” sheds light on how a return-to-play checklist can help patients decrease the incidence of injury to the knee:

“Historically after ACL reconstruction, orthopaedic surgeons would use time as the major criterion for determining when athletes should return…The concept behind the return to play checklist was that the calendar didn’t optimally determine functional status to see if the patient had thoroughly rehabilitated or if they remained at risk for re-injury. With our latest study, we were able to put the checklist into motion to compare athletes whose return to play was determined by the checklist to those athletes whose return to play was determined by traditional clinical judgement.”

The evidence-based checklist, developed by sports medicine researchers at the Rothman Institute in Philadelphia, includes seven objective measures—including physical exam findings, functional testing (hop and agility testing, movement assessment for jumping and landing mechanics), and a functional outcome score.

ACL Rehab in NJ and Return-to-Play Safely

Recovering from an ACL injury, or any knee surgery operation, is far from a breeze. To ensure the best outcome it requires a strict, consistent rehab regime.


To help patients get back to their sports safely and with minimal risk of re-injury, Twin Boro developed the One2Four Protocol. Utilized at all of our locations throughout New Jersey, One2Four is a method for patients to follow in order to achieve specific activity goals. At the outset, these goals may seem impossible, but with the proper guidance and time, obtainable. This allows patients to progress from one level to another, resulting in performing at the required functional level. Level 4 has been achieved within the One2Four program.

Simply put, One2Four can help ACL rehab patients obtain higher physical performance/functional levels. Read more about our unique approach here.

Why Choose Twin Boro Physical Therapy

Voted Readers’ Choice Best of New Jersey, Twin Boro has provided NJ residents with high quality physical therapy and rehab for close to 40 years! It’s our award-winning approach, proven results and reputation that sets us apart. By incorporating the One2Four program into each patient’s program, the latest and most reliable scientific research and techniques are incorporated into effective evidence-based practice. We deliver only the highest standard of care with the unique One2Four approach.

It’s no surprise that Twin Boro Physical Therapy has also been voted the best physical therapy practice in New Jersey by the readers of mycentraljersey.com.

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