ACL Rehabilitation Timeline: Month Five

Okay, athletes, here it is… month 5 of your ACL rehab.

By now, you’re probably feeling more impatient than anything; all you want is to finally feel like an athlete again, but it feels like it’s taking forever. After all, it’s a huge adjustment to go from 1-2 games per week to solely practicing squats, lunges, and running in a straight line.

And while physical therapy might help you feel like you’re getting stronger and more stable, you still don’t really feel like an athlete through those first few months…

Until now!

Now that you’ve put in the hard work for your quadriceps, glutes, calves, and hamstrings, your body is finally ready to take all that hard-earned strength and put it to good use. This month marks the beginning of your first phase of agility, plyometrics, and single-leg jumping drills — so let’s get straight to the good stuff!

Physical Therapy During Month 5

Yes, you heard us right: month 5 is when you finally start to feel more like an athlete again!

Part of the allure of dynamic sports like soccer or basketball is the dynamism alone — the rapid cutting, pivoting, changing of direction. Dynamic sports are all about the forces that produce movement and the fast-paced, unpredictable nature of in-game mechanics. Just having that precise control over your body and feeling that movement mastery can be exhilarating for an athlete, especially when bouncing back from injury.

So, without further ado, let’s preview what your return to sports-like activity looks like!

Plyometrics and Jumping Drills

Once you’ve built up enough muscle strength, plyometrics are a key component for generating power in every movement you make.

You’ll typically start out with double-leg exercises at maximum effort; this familiarizes your muscles and joints with the mechanics of effective, explosive training without placing too much strain on one side or the other. Some of the most common plyometric exercises include double-leg jumping, box jumps, and depth jumps.

As your body further adapts to proper plyometric form, you’ll likely begin transitioning into single-leg work during this month. Because single-leg exercises place much more load on just one limb, you won’t be working at full capacity right from the start. Rather, these beginning exercises will focus on mastering shock absorption via that vertical, up-and-down action of jumping. 

Eventually you’ll be honing some forward and backward jumps, too, but the specific kinds of exercises will vary depending on your sport and overall end goals. (Runners tend to focus their jumps on the vertical and forward motions to best emulate running mechanics, whereas field athletes are much more geared towards side-to-side and directional leg work.)

Check out the video below of one of our youth athletes who was working through his ACL program a while back! This is a great example of what you can expect during your plyometric training at this point:

Higher Intensity Agility Training

Agility training is, at its most basic definition, learning how to practice unplanned movement: it’s all about emulating those instinctive, in-game decisions where you have to cut or change directions at a moment’s notice. Throughout your rehab so far, you’ll have practiced plenty of exercises that emulate movements similar to what you’ll work on in your agility training. But, even if your body is familiar with going through the motions, it’s been a while since you’ve been out on the field, so you still may not be ready to take on the unpredictable nature of in-game speeds. Or, on the other hand, there’s a chance that you still have fast reflexes, but your body moves too hastily for proper form…

And that’s the niche to agility training: learning how to move quickly and correctly in a split second. 

Last month, you were working on just a few movements at about 25% speed. That sets up a solid foundation to continue progressing into this month, where you’re now going to work around  50% of your maximum effort and speed. This allows room for steady progression as you further hone your reaction times and focus on agility drills that make your movements as natural and accurate as possible.

However, what many people don’t consider (nor utilize) is the crucial use of video feedback during this phase of retraining. Many athletes tend to work off of an “internal feeling” that tells them how they think they’re moving, but that’s unfortunately not a reliable means of ensuring proper movement. That’s where using video feedback proves invaluable — athletes can accurately see how they’re moving and what kinds of adjustments need to be made for marked improvements.

Force Plate

On top of video feedback, our clinic has also found that utilizing an in-ground force plate is an excellent learning tool. The force plate is a piece of advanced technology that measures ground reaction forces as you perform activity — not only the amount of force generated, but the direction as well, allowing our physical therapists to assess minute details of alignment. This can be especially helpful information, as ACL injuries are often linked to improper knee control during sports activities.

Receiving varied and regular feedback at the start of your training is an ideal way to measure progress and notice areas for improvement. Using a force plate is ideal for accurately assessing shock absorption capabilities and ingraining proper knee alignment as you return to agility exercises. Then, as your form improves over time, you can remove the feedback from your training to emulate practice and in-game settings, where you have little to no feedback throughout.

Sport-Specific Movements

Now comes the exciting part: with your developing plyometric power and agility, you can start applying your rebuilt strength and biomechanics to sport-specific movements again!

Granted, since you’re still easing into the different layers of in-game movement, you’ll primarily only be working on a handful of the most common sports movements, but that doesn’t make it any less exciting! (This is the part where we see most people’s eyes light up at the chance to move and feel like an athlete again.)

The biggest focus for this phase of your rehab is, again, leveraging all that aforementioned strength development to improve your movement control and dynamic stability. Most sports will demand athletes to move sideways, change direction, sprint forwards and backwards, and often jump or counterjump — all of which requires a deliberate handle over biomechanical control and stabilization.

While each of these motions consist of wildly different mechanics, they can all be broken down into a handful of shared components:

  1. Lunges
  2. Deceleration
  3. Lateral Shuffle
  4. Cutting (45 and 90 degrees)
  5. Double- and single-leg jumping
  6. Dynamic change of direction

Each of these movements are a part of every dynamic sport, so it’s imperative that you begin retraining once your body is at optimal strength levels.

Keep in mind that practice is vital during this phase — you’ll need hundreds of thousands of repetitions before you can demonstrate optimal sports performance. It may seem tedious to continue learning bits and pieces of typical sports movements, but it’s all about mastering the skills for the best results in the long-term.

Goals for Month 5 of ACL Rehabilitation

Month 5 is pretty exciting! Now that your focus and diligence has laid most of the groundwork, you’re finally building up to more dynamic movements that take you that much closer to resuming your beloved athletic lifestyle.

As we continue to progress through your timeline from this point on, the specific exercises for each type of training will vary from one sport to another. But, the overall structure of your program and many of the big-picture goals will mirror the following benchmarks:

  1. Keep up that strength work — taking on new tasks doesn’t mean you’re slacking off with the others! Continue hitting the weights hard for your quads, hips, calves, hamstrings, and core. As you progress, you can consider adding power lifts to your training, as long as you’re able to demonstrate proper control. With adequate progression, you’ll be aiming to squat 3 reps of your own bodyweight! 
  2. Further improve running form — continue improving your shock absorption while running. (This is especially important for decreasing future risk of injury.) Focus on increasing flexion at your knees and hips during the stance phase of your gait to help with absorbing the impacts of every step. At this stage, your goal is to run for 1 mile or for 10 minutes without experiencing any pain or swelling.
  3. Practice plyometric jumps — as you retrain, you’ll want to focus on demonstrating competency with double-leg jumping, box jumps, and depth jumps.
  4. Begin single-leg jumps —  this is where that triple hop test comes in! Single-leg jumping is a helpful movement for both running training and sport-specific movements, so there’s no skimping out on these ones.
  5. Normalize single-leg control — more specifically, control during step-downs. Ideally, through this month, you should be able to perform 15 repetitions with a level pelvis, proper hip strategy and knee alignment, and zero pain.
  6. Begin faster lateral shuffling drills — now, before committing to the shuffles, you’ll want to be sure that you can first perform lateral walks with a resistance band without any issue. (This means no knee collapse, no flexed trunk, and no knee rotation.) If you meet those prerequisites, you can start practicing those shuffling drills anywhere around 50-75% of your speed.

Lots to do and relearn, and plenty to master! It may feel like a lot to take in, but that only means that you’ve progressed enough to handle as much. As you continue to measurably progress, the specificity in your training will increase in intensity and complexity (and enjoyability).

Onward to Month 6!

Look at you, working your way through the timeline! The progress may feel slow and steady, and it may feel like there aren’t quite as many milestones this month — but that’s actually a good thing. You’re finally at a point where your body can manage steadier, long-term work to hone your athletic ability (as opposed to the last few months, where you had to focus more on recovering from the acute effects of surgery). 

And remember: even if you aren’t able to play your sport just yet, don’t let that impede your road to recovery! Rehabilitation takes time and determination, and putting in the work will only make for a stronger, faster, and more powerful return to your sport.

So stay diligent, fellow athletes! You’ve made it this far, and you’ll only continue to conquer from here on out.

Stay tuned next month for the next installment of the rehab timeline!

ACL Month 5

By Dr. Kevin Vandi DPT OCS CSCS

Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.

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