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! 

Lessons Learned in the Land of Kettlebells

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

I distinctly remember having a conversation about kettlebell training with a patient a year and a half ago.  He asked if I had considered going for the Strong First certification and my initial reply was I just didn’t know if my shoulder was up for that.  I have been dealing with a labral tear from my years of volleyball and completing the snatch test (100 snatches with a 16 kg/35 pound bell in under 5 minutes) and overhead pressing with the same weight seemed like a daunting task.  However, the leaders in my Physical Therapy and Strength and Conditioning world (Cook, McGill, Liebenson, and of course Brett Jones, etc) reference kettlebell training and the work of Pavel frequently.  Naturally the next step in furthering my education was to sign up, buckle down, and see how things went.

                I have been using kettlebells for years with my patients as they are one of the most versatile tools for training functional movements.  I have never trained with the level of intent and focus as when I first met with my kettlebell coach (Craig Valentine, Loomis Kettlebell).  Fast forward through months of training (and special love to my shoulder with lots of arm bars, carries, and heavy get ups) and I passed my certification last weekend in Denver, Co.  There were a few shoulder hiccups along the way, but my awesome Strong First leaders helped me manage through all the high-volume work.  I wanted to share a few of the things I learned through this experience. It was one of the best and most rewarding events I have ever been through.

Sweaty and starving after completing the SFG certification

1.)    Kettlebell training has made me stronger than ever before.  The focus on stabilizing and strengthening my shoulder lead to some heavy get ups that I would never have thought possible.  I also can press a 44 pound kettlebell overhead without any shoulder pain. My training program was not fancy but man has it been effective in making me strong.  

2.)    You don’t need fancy equipment for an awesome work out.  Kettlebells are a simple piece of equipment that allows you to work your entire body.  Build strength, build endurance, train your stability…you can do it all.  Plus, they are portable.  Mine came on the road with me many times.

Tucker and my traveling bells 

Camping kettlebell

3.)    Kettlebell training reinforces seeing the big picture and looking at movement as a whole.  This has reinforced all that I have learned in the land of FMS (Functional Movement Screen).  As I was assessing a team member's dead lift at the course my instructor advised me to literally take a big step back and look at her, and the problem area jumped right out at me.

4.)    Kettlebell training transferred power to other areas.  I watched my vertical jump improve.  When I was home for Thanksgiving I decided to do some interval hill runs and felt like I was flying.  Even though I hadn’t been specifically training these things my kettlebell training improved them.

5.)    There is nothing more functional than kettlebell training and it is a tool that can be utilized by everyone.  The movements can always be progressed or regressed.  There is truly nothing more functional than getting up from the floor, squatting, picking something up from the floor, and carrying heavy things.  

Overall, I had a wonderful experience and am so excited to start incorporating all of the new things I learned into my physical therapy and coaching (as well as my own training).  Good thing there is no shortage of kettlebells over here!