The Proper Protocol
To date there continues to be a lot of ACL rehabilitation research released. Most of which continues to prove the things that we as practitioners already know. Research is great, we definitely need it, but what about the practical application of that research? Are clinicians actually following the recommendations or are we continuing to take patients through the same ACL protocol that has been around for years. You know, the one they gave you when you got hired at the clinic that there are a million copies of in the file cabinet under “standard injury rehabilitation protocols for our practice”.
We know that the initial post op protocol is to decrease inflammation, activate knee extensors and flexors, and obtain full range of motion early. This is necessary but there is something missing….first, was it a contact or non-contact injury? More than likely it was non-contact (research shows that greater than 75% of ACL injuries are non-contact). Think about that for a minute………the individual missed out on a proper prevention protocol and as a result of muscle imbalances and movement compensations, sustained an ACL tear. Does that standard protocol that you are following take this into consideration? Probably not. And if you are a decent clinician, you probably begin to factor this in around week 12. Problem is, by that time you are almost out of visits authorized by the patient's insurance company (another issue that has many factors).
In my humble opinion, a proper protocol would include assessing the other factors and not spending 100% of efforts on the injured knee. After all, the goal is full function, right? The knee was not the original problem, it is the result of other problems that were not addressed. Many of which can be assessed with your handy goniometer (a very effective tool when used properly).What if the pelvis was anteriorly rotated, what if there is SI joint disfunction, what if dorsiflexion is very limited? How about we assess the LPHC, non affected knee, and bilateral ankle range of motion the first time you assess the injured knee. The amount of information gathered would be huge in determining why the injury occurred. This information could then be utilized to restore optimal range of motion and function of the whole body and not just the injured limb which was caused by faulty mechanics.
You did all that great work on the injured leg and it was the non-injured side that lead to the problem and you did not address it. Does that make sense? No, it does not. Yes, rehabilitation is designed to fix a problem but as practitioners we have a responsibility to prevent injury as well and the current protocol does not do that. Many times too often an athlete is returned to play and sustains a new injury. Then everyone says that “they came back too quick…”…….NOPE, the true problem just was not addressed. LOOK DEEPER!
Posted on June 13, 2014 | Permalink
