ACL Injuries: The Road to Recovery — Part 3 in LaVerneOnline’s Exclusive 4-Part Series

September 10, 2009
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An ACL injury temporarily sidelined legendary receiver Jerry Rice.

An ACL injury temporarily sidelined legendary receiver Jerry Rice.

Following is the third in LaVerneOnline’s four-part series on ACL tears, which La Verne’s Rick Rossman, MS, PT and Administrative Director of Pomona Valley Medical Center’s Sports Medicine Center, has called “the No. 1 nemesis of an athlete.”

“Except for catastrophic injuries to head and spine, an ACL tear is the injury athlete’s greatest fear because in spite of all the technological advances, it still puts them on the bench for six to 12 months, and they lose a entire sports season, which when you’re a young athlete is a lifetime,” Rossman said.

Following our earlier look at 1) how and why ACL injuries occur and 2) what treatment options are available (Surgery, yes or no?), today’s piece looks at  3) rehabilitation and recovery. With Rossman’s and the Sports Medicine Center’s long experience and expertise in this field, we’ll try to guide you and get you the facts about ACL injuries, treatment options, rehab regimens and prevention strategies.

If you missed the two earlier articles, please go to Lifestyle/Health & Fitness on  and click on Sports’ No. 1 Nemesis: ACL Injuries and Part II: The Weekend Read: ACL Injuries Part 2 — Your Treatment Options.

Part III: Rehabilitation and Recovery

 As a young, aggressive, hard-charging athlete, you’ve never been one to take short cuts. Diagnosed with a tear of your anterior cruciate ligament, or ACL, you are not ready to give up the stops and starts, twists and turns, and darts and dashes of sports like football, soccer, basketball and baseball. Weighing your options, you elect to have reconstructive surgery because it gives you the best chance to return to your favorite sport and be playing at the same level you were at before your injury.

Your doctor has explained ACL reconstructive surgery, and while surgical techniques have vastly improved, you understand the operation is still invasive. “This is still a big deal. Even with today’s technologies it’s a big operation.” said Rick Rossman, MS, PT and Administrative Director of Pomona Valley Medical Center’s Sports Medicine Center (SMC). “Orthopedic surgeons must put another tissue in the knee to replace the stretched or torn ACL. That’s why it’s called a “reconstruction”. Unfortunately, you can’t simply repair the two ends. They don’t heal if you just sew them together.”

Ultimately, a successful outcome will greatly depend on the skill of both your surgeon and rehabilitation team, combined with your personal effort and commitment to your recovery.

Rossman says many post-surgery athletes expedite their recover by applying their same athletic mentality to their rehabilitation program. “Athletes will say, ‘Give me a challenge … if there is a chance you’ll clear me to play in six months, tell me what can I do to get there?’”

That said, Rossman noted that working faster and harder is not always better. “The injury combined with the reconstruction are traumatic events for the knee joint.” said Rossman. “Timing is everything. Protecting the graft while it heals, matures and incorporates into the knee is a critical part of early rehabilitation. We encourage athletes to work hard … and we ensure they work safely … through each of our three phases of recovery.”

In the end, an athlete’s return to action is decided in large part by Mother Nature. Not even one of the world’s greatest athletes can defy her healing schedule.

“Jerry Rice came back from his ACL injury years ago in 111 days,” Rossman said. “He was playing against the Raiders on Monday Night Football, when he slid to catch a ball and broke his knee cap. Here you have the hardest working NFL athlete in the world – and arguably the greatest player ever to play the game, but the knee simply wasn’t ready at less than four months.

“You can work hard, but we must remember, body tissues heal at a certain rate.”

 The SMC at Pomona Valley Hospital Medical Center has helped thousands of athletes recover from ACL injuries. “Phase 1 focuses on decreasing post operative pain and swelling, restoring the knee’s range of motion and normalizing the athlete’s walk” says Rossman. “Appropriate progression through these first six weeks allows the remaining phases to go smoothly,”

Rossman adds, “With the initial injury the leg atrophies and muscles shrink and weaken. This is one of the hardest things for athletes to deal with. Phase 2 addresses progressive strengthening from simple leg lifts to traditional weight machines. We also work a lot over these two to three months on simple balance, coordination and timing drills and help the athlete regain confidence in their leg.”

“Finally, Phase 3 involves higher level strengthening such as plyometrics, sports specific drills and endurance training, all in preparation for return to practice and then full-speed play. We won’t let recovering patients return to competition until they have regained 90% of their quadriceps strength and 110% of their hamstring strength. “This strength is necessary to tolerate the pounding associated with running and jumping, day after day,” Rossman said.

Rossman said this program comes with caveats, noting that rehabbing athletes also have to incorporate an ACL injury prevention program into their recovery regimen. They literally have to retrain and reeducate muscles, a process known as Prioceptive Neuromuscular Facilitation (PNF), to increase strength, flexibility and proper mechanics to keep from repeating the old stresses that contributed to their initial injury.

“That’s all part of their rehabilitation because we don’t want them back,” Rossman said. “We don’t want them to tear their other knee, and that happens unfortunately if they didn’t do their rehab correctly or take their jumping program seriously (to learn how to land with more balance and less impact).

“If all goes well, and everyone does their part, athlete’s can be playing at six months from surgery.”

Rossman has seen many athletes with ACL injuries make full recoveries based on improved surgical techniques and ever-advancing rehabilitative programs. But even the best outcome has a long-term negative consequence to the aging process of the knee and you cannot make up for the lost playing time off the field or court of play.

Therefore, prevention of ACL injuries should always be the first goal of every coach, parent or athlete.

LaVerneOnline will address that topic in the fourth and final installment of our exclusive series on ACL injuries next week.

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