A Day in the Life of Post ACL Sports Physical Therapy

By Kirsten Carmichael PT, DPT, CSCS, SFGI

Post ACL reconstruction surgery is one of the most common things I see as a sports Physical Therapist.  Here at Next Level you will see many patients working through different phases of return to sport rehabilitation. Here's a glimpse of some of our different phases of progress.  It is important to respect the healing of your graft and to have a PT who understands how much loading is appropriate (and when) so that you can continually build strength and keep moving towards your sport specific goals.

In early therapy if your quad is have trouble firing we use NMES (neurmuscular electrical stimulation) to help the muscles contract.  Due to all of the swelling these muscles become inhibited after surgery.  It is a big goal to get them firing again.

Also in early therapy our goals are of course to get you walking normally again. As quickly as possible we begin training more functional patterns, challenging your core strength, strengthening your hips, and retraining balance.

Regaining single leg strength is another big goal.  Therapy often involves many different exercises utilizing only one leg at a time so no compensation is allowed.    

As you continue to get stronger another goal is to keep your mobility looking good.  We work hard to restore full range of motion of the knee but also to maintain mobility particularly of the quad (we don't want it getting too tight) and the other tissues surrounding the knee.  Myofascial decompression (cupping), instrument assisted soft tissue mobilization, rolling, and mobility bands all help to accomplish this. 

And then we continue to work hard on strength, stability, and endurance...sweat is normal here.

Your Physcial Therapist will progressively load you and watch your movement patterns so that you continue to get stronger. 

Once you meet specific strength, mobility, pain-free criteria you will move into more dynamic and sport specific training.  Here is where things get fun!

 A sports specific physical therapist will have the tools to cater this towards your individual sport's demands and be able to ramp you back into these activities in a controlled environment.

As you can see most of the rehab process looks like a strength and conditioning program but tapered down initially to respect the healing process and integrity of the graft.

 If you are looking for a therapist specialized in returning athletes to sport give us a call or send us a message! 

Running Injuries: Prevention From The Ground Up Part 1

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

I frequently get to work with runners and one common complaint is with foot/ankle discomfort or pain.  I decided it would be great to provide some preventive tips and tricks starting at the feet and working my way from the ground up.  These are also great tips for other athletes who may be experiencing similar problems.  Give them a try! 

First, many problems up and down the leg can occur from a limitation in ankle mobility.  To test this you can stand with your toes about 5 inches away from the wall in a lunge position.  Keeping your heel on the ground, bend your knee and reach it as close to the wall as possible.  If your knee easily touches the wall your mobility is looking good.  If you can't reach the wall without your heel lifting or feel stiffness in your ankle then this is an area to work on.  In the same position as the test (see video below) you can perform some active glides.  We recommend performing 10 repetitions on each side. 

Next, there are some great tools to keep your soft tissue mobility looking good.  One awesome tool for plantar fascia health is rolling on a lacrosse ball.  Simply place your foot on top of the ball and roll along the ball of your foot, the inner arch, and along your heel.  If you feel any tight or "crunchy" areas then give these spots a little extra love.  

You also want to make sure the soft tissues in your calves stay loosened up.  Sometimes using a foam roller for this area can be a bit awkward so I prefer to use a stick.  If you get in a half kneeling position as shown you can also get a little extra stretch on the calf as you roll.  If you find any "bumps" in the road you can move the stick (as shown) side to side to create a cross sectional release.  I usually recommend 10 rolls up and down on each side again spending a little extra time on any trouble spots. 

Now that you've mobilized your ankle joint and soft tissues you want to stretch in that newly found range of motion.  A good gastroc stretch is first on the list as shown.  Make sure you keep that toe pointed straight ahead and your heel on the ground. 

Deep to that gastroc muscle is the often neglected soleus muscle.  As shown below move the back foot in just a bit and give the knee a bend to stretch this guy as well. 

Finally, after all of this mobilization and stretching it is great to reinforce those deep muscles that support your arches.  A great way to get this started is called "arch doming". In standing you will focus on grounding your big toe and making an arch along the inside of your foot (see video below).  I usually recommend 20 repetitions. 

Definitely give all of these a try pre-run or work out to make sure your mobility and stability are in check before you load the system.  Performing some of the soft tissue release and stretching after can also be beneficial if anything has tightened up along the way.  Over time you will develop a beautifully balanced foot and ankle and prevent any future issues! 

Hope you found these tips useful!  If you are still experiencing any pain or discomfort contact us!  We love nothing more than to help athletes perform pain-free and at their best! 

Follow our blog, Instagram, and Facebook (@gonextlevelpt) for upcoming posts with more tips and tricks and all things sports releated!