032. How to rehabilitate ACL injuries with Enda King

ACL injuries can be career ending, or they can be an opportunity to sort out movement efficiency, motor control and and technical skills, coming back from the rehabilitation process with more power, speed and efficiency than they had before they injured their ACL.

In this podcast, Enda King from the Sports Surgery Clinic in Dublin currently completing his PhD in 3D biomechanical analysis after ACL reconstruction, with the aim to assist in RTP decision making and identifying fully rehabilitated athletes, and David Pope discuss ACL injuries, and the most important factors in pre-operative management and post-operative exercise programming to get your patients back to sport with improved sporting performance.

Going deep on the details involved in ACL Rehabilitation, including:

• 01:20 Enda King and SSC, and working with ACL athletes PhD in 3D biomechanical analysis after ACL reconstruction, aim to assist in RTP decision making and what a fully rehabilitated athlete looks like

• What does a fully rehabilitated athlete look like?

• Incorporating performance goals into the rehab process

• Can athletes achieve better performance post ACL rehab than they were pre-injury

• Types of ACL grafts

• Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery

• Preoperative education

• Restoring knee extension, balancing pain and improved range of movement, empowering your patient

• Guidelines for pain, swelling when restoring range of movement

• Restoring quadriceps activation, normalising gait patterns

• Clinical Edge

• Clinical Edge's free webinar program

• Preoperative length of time

• Post-op - initial management

• To use or not use co-contraction exercises of quads and hamstrings

• Should you use squatting style exercises Week 1 post op

• Activating quadriceps - internal quadriceps cues or external exercise focus

• How much pain should a patient experience during or after an exercise

• Week 2 post-op

• When can heavy gym training commence

• Changing movement patterns throughout the kinetic chain

• Advice for patients in the early stages of rehab

• Frequency of exercise

• Week 2 onwards - exercises incorporating balance and proprioception

• Open vs closed chain exercises

• Advice for patients in weeks 2–6

• Nutrition and dietary advice for patients

• Gym based rehabilitation

• Choosing and modifying exercises for middle stages of the rehabilitation process

• Various types of squatting movement, and progressing the types of squats

• Goblet squats

• Retraining ideal squat patterns

• Progressing squats, deadlifts and lunges

• Front squats

• Front squats and trap bar deadlifts vs back squats during rehabilitation

• When can an athlete start cycling

• Disadvantages of using cycling as the main part of a rehabilitation program

• Hamstring rehabilitation after semitendinosis/gracilis graft

• Strength and power development

• Strength testing - mid thigh pull, leg press

• Should we use open chain strength tests

• When to perform strength tests

• Strength vs power and rate of force development

• Running - incorporating into the program. When can your patient start running?

• Preparation for running

• Running drills

• Ideal movement patterns in running

• Enda King and SSC, and working with ACL athletes

Podcast timeline

• 3:35 What does a fully rehabilitated athlete look like?

• 5:40 Incorporating performance goals into the rehab process

• 6:50 Can athletes achieve better performance post ACL rehab than they were pre-injury

• 8:20 Types of ACL grafts

• 11:10 Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery - an opportunity to prepare your patients knee, ROM, strength and educate them on the rehabilitation process

• 14:20 Preoperative education

• 14:40 Restoring knee extension, balancing pain and improved range of movement, empowering your patient with

• 15:40 Guidelines for pain, swelling when restoring range of movement

• 16:15 Restoring quadriceps activation, normalising gait patterns

• 17:10 Clinical Edge

• 18:45 Clinical Edge's free webinar program

• 19:30 Preoperative length of time

• 20:35 Post-op - initial management

• 23:20 To use or not use co-contraction exercises of quads and hamstrings

• 24:50 Should you use squatting style exercises Week 1 post op

• 25:25 Activating quadriceps - internal quadriceps cues or external exercise focus

• 26:30 How much pain should a patient experience during or after an exercise

• 27:30 Week 2 post-op

• 28:30 When can heavy gym training commence

• 29:30 Changing movement patterns throughout the kinetic chain

• 31:00 Advice for patients in the early stages of rehab

• 32:10 Frequency of exercise

• 32:55 Week 2 onwards - exercises incorporating balance and proprioception

• 34:10 Open vs closed chain exercises

• 35:40 Advice for patients in weeks 2–6

• 37:15 Nutrition and dietary advice for patients

• 37:45 Gym based rehabilitation

• 38:50 Choosing and modifying exercises for middle stages of the rehabilitation process

• 41:00 Various types of squatting movement, and progressing the types of squats

• 41:45 Goblet squats

• 42:30 Retraining ideal squat patterns

• 43:25 Progressing squats, deadlifts and lunges

• 44:00 Front squats

• 46:00 Front squats and trap bar deadlifts vs back squats during rehabilitation

• 47:25 When can an athlete start cycling

• 48:00 Disadvantages of using cycling as the main part of a rehabilitation program

• 48:30 Hamstring rehabilitation after semitendinosis/gracilis graft

• 49:45 Strength and power development

• 51:00 Strength testing - mid thigh pull, leg press

• 53:15 Should we use open chain strength tests

• 54:20 When to perform strength tests

• 55:00 Strength vs power and rate of force development

• 55:50 Running - incorporating into the program. When can your patient start running?

• 57:30 Preparation for running

• 58:35 Running drills

• 1:00:30 Ideal movement patterns in running

Links:

• Enda King
• Enda on Twitter @enda_king
• Sports Surgery Clinic, Dublin
• SSC Research Foundation
• David Pope on Twitter
• Review the podcast in iTunes