Choosing The Right Practitioner For Your ACL Rehab
40 milliseconds. Tearing your anterior cruciate ligament (ACL) only takes a fraction of a second. These 40 milliseconds can alter the course of your life (Patel, ACL Ath). The rehabilitation process following ACL injury is a tedious journey which requires a lot of hard work and dedication to not only recover physically but mentally. Your physical therapist should act as a guide along the journey, if not it may leave you not achieving your goals/returning to prior level of function. My name is Dr. Matt Feder and the following blog post will cover how important it is to choose the right practitioner and facility to complete your ACL rehab in Miami.
Before we get into that, here’s a brief explanation of the ACL. The ACL is a ligament inside your knee joint that runs north to south. This ligament is considered one of the primary static stabilizers of your knee joint. It restricts hyperextension and provides rotational stability to the joint. It is commonly injured in a hyperextension or valgus moment (when the knee caves inwards). In addition, it’s common to see injuries where the leg is fixed and the upper body rotates causing excessive rotational stress to the knee joint. Most commonly occurs in activities such as skiiing, snowboarding, and more rigorous hiking. Contact injuries commonly happen in American football, when a tackler hits the knee from the front or outside. Unfortunately ACL tears are extremely prevalent within the population and may even occur during tennis, pickleball, soccer, and falls. The reconstructive surgery is done by replacing the torn ends of your ACL with a graft harvested from elsewhere in your body or from fresh cadaver specimens. If you have more specific questions about the ACL or your knee in general please email us at admin@asrphysicaltherapy.com
Now, back to the focus of this article
The following are things to consider when choosing a practitioner/facility for ACL rehab:
Does the clinic have the right equipment?
I’m starting with this point because this is potentially one of the biggest red flags of a physical therapy clinic and one of the easiest one’s to catch. During your ACL rehab, regaining strength is going to be one of the most important aspects. If the clinic you’re looking into does not have weights greater than 10 pounds, RUN. You will need more than that to return your strength or even improve it following surgery. Our goal for you at ASR Physical Therapy is to return stronger physically and mentally than you were prior to your injury.
New research suggests that testing your strength (especially of the quadriceps) is very important to returning you back to your sport, hobby, and/or job safely. If the clinic does not have a dynamometer (a device with a sensor used to accurately measure strength) they are most likely guessing that your strength is sufficient to progress through the rehab continuum. Don’t get me wrong, there are other functional ways to look at your strength and clinicians have been doing fine without them in the past. However, this is the most measurable way to ensure you are making the strength gains you need to succeed.
Evidenced based technology: blood flow restriction (BFR) is a modality we use early in the rehabilitation process to improve strength and neuromuscular control faster. It’s been shown to improve strength and also have systemic effects including increased release of insulin-like growth factor (IGF) (Yinghao et al., 2021). The Alter-G (anti-gravity) treadmill is also a fantastic way to normalize your walking pattern and return to running more efficiently *read more about it by clicking here.* ASR Physical Therapy is equipped with one of the only AlterG Treadmills in all of Miami Beach in addition to a full set of automated blood flow restrictions units.
Does the clinician have experience treating patients after ACL reconstruction? Have they had ACL surgery themselves?
The feelings you will have in your knee are very unique to ACL surgery and can only be understood by a clinician that has vast experience treating them and/or has been through it themselves. It’s important that your physical therapist can appreciate the ups, downs, and little nuances of ACL rehab. In addition, being very familiar with timelines of healing, graft incorporation/ligamentization, and the most up-to-date post-operative protocols is crucial. I’ve been through an ACL surgery and rehab myself therefore, I have the empathy and perspective to understand what my patients are feeling throughout the process. If you are reading this because you had a recent ACL reconstruction surgery in the Miami and Miami Beach area, I would LOVE to help you on your journey to a full recovery!
Do they actually care?
This is perhaps one of the most important points however it may be difficult to recognize initially. I truly care about the outcomes of each of my patients. My goal for you is to return to what you love doing as soon and safely as possible. Unfortunately, many clinicians lose sight of this due to burn out or loss of passion and become what I like to call “9-5 PTs”. They clock in and clock out, going through the motions to collect a paycheck. They aren’t appreciating the individuals in front of them and their livelihood. I’m passionate about ACL rehab because I was a patient who received sub-par care before I became a DPT. I’ve experienced what poor physical therapy is like and I’ve also experienced great physical therapy.
Do they care enough to stay up to date on the latest research? Utilizing the best available research evidence allows us to improve outcomes.
Will they challenge you enough?
After ACL surgery or any knee surgery for that matter a phenomenon called “arthogenic muscle inhibition” (AMI) will take place. From the swelling in your knee joint, muscles of the leg (mainly the quadriceps) will be inhibited. This will cause a feeling of weakness and you likely will see muscle atrophy (muscle will get smaller) on the involved side. Research shows that this asymmetry in strength may persist through 1-2 years after surgery. That’s why it’s extremely important to be progressively challenged from a strength stand point. We also want to restore global strength in the hips/core, endurance, and aerobic capacity throughout the process. If you aren’t sweating during ACL rehab, you’re doing it wrong!
Do they provide patient-centered care?
If your physical therapist is constantly running around because they are treating 3-4 people at the same time, it will be very difficult for them to properly supervise and progress your exercise. In addition, manual therapy is an important part of our treatment which requires some 1-on-1 time. This is the standard of many clinics that work on an in-network basis. At ASR, you will never be treated alongside more than one other patient. Working on an out-of-network basis allows our clinicians to be more present with each of our clients. Having these quality standards ensures you are progressing each visit with functional, task specific activities.
If you just had ACL surgery, or are preparing for surgery, and are looking for a physical therapy clinic in the Miami and Miami Beach area to compete your rehab, we check all of these boxes. Don’t hesitate to reach out. We look forward to helping you get back to doing what you love.
References:
Patel, Ravi. The ACL Athlete Podcast. 40 milliseconds. 2021
Yinghao L, Jing Y, Yongqi W, Jianming Z, Zeng G, Yiting T, Shuoqi L. Effects of a blood flow restriction exercise under different pressures on testosterone, growth hormone, and insulin-like growth factor levels. J Int Med Res. 2021 Sep;49(9):3000605211039564. doi: 10.1177/03000605211039564. PMID: 34486432; PMCID: PMC8424606.