Most ACL Rehab is incomplete and outdated. Even at a year post-op people are not close to 100% and are walking around with the same problems that caused the tear in the first place.
While the images in this article are of athletes, this is definitely not information specific to athletes. Most people that tear their ACLs do not have sports goals and this information applies the exact same for everyone.
An ACL tear is a serious injury and has one of the longer recovery times of any injury (9-12 months). It can also be the best thing that could happen to you because of what you learn. The injury can help you understand movement problems that you have had long before the injury, so you can actually end up much better off afterwards as long as the information and advice you get is correct. Tearing your ACL can be very disheartening and scary and it is normal that people fear that they will never get back to their old self. We are fortunate enough to work closely with the brightest minds in fitness and rehab and we, along with them, want to pass on this new and empowering perspective on self care, prevention and rehab. Instead of thinking you will never be back to your old self, realize that you can truly be better, stronger, more durable, more athletic and more limber than you ever were before you got hurt. If you haven’t torn yours, you can make sure it never happens. You might be walking around with your check engine light on and not even know it.
Everyone reading this has either torn one of their ACL’s or knows someone who has. The main point of this article is to present some very important and empowering information regarding ACL rehab and prevention that is not as easy to come across as it should be. Below are the three main points we want to share:
1. Almost every ACL tear is preventable. With the exception of contact injuries such as someone falling on your leg in such a way that it bends the wrong way or a bike or skiing accident for example, they are almost 100% preventable. So if you have torn yours, chances are very high that certain assessments and training styles would have prevented it. The huge majority of ACL tears are not contact injuries. They mostly happen while changing direction during a seemingly low stress movement or during landing or deceleration. They happen much more often during landing or deceleration than they do during exploding or accelerating. This is because the brain’s software program for starting and stopping are totally different even though the same muscles are involved. This also shows why it is a neuromuscular and motor control cause rather than simply a weak muscle.
2. The huge majority of ACL tears are caused by a combination of dysfunctional motor control (reflexive stability) and asymmetries in the trunk and hips. Even though most people can describe the specific movement they were doing when they felt/heard the tear, it wasn’t that movement that did it – they had been waking up every day for months if not years with the underlying causes of that injury – the specific movement was just the random movement that finally did it. The problem actually has nothing to do with the knee. The problem is inadequate stability and control at the other end of the femur. The knee was an innocent victim. There is never anything wrong with the knee joint itself that causes the tear. The most healthy knee or ACL on earth will tear if it is put under the stresses created by asymmetries and dysfunctional motor control in the hips and trunk.
3. Almost all ACL rehab is outdated to some degree and focuses too specifically on the knee joint without correcting all movement patterns and dysfunctions that led to the injury in the first place. The knee got hurt because of a problem with the entire body system, so we have to fix that same system, not just rehab the individual part. Fixing the part only is like mopping the floor and thinking you have fixed the leaky pipe. Lots of rehab focuses on strengthening the leg and quadricep muscles, which are not where the focus should be even though those muscles are closest to the knee. The muscles in the trunk, as well as the glutes, and even the shoulder girdle – and how all of these segments interact and work together neurologically is what will stabilize the pelvis, hip and therefore the knee. While there will be some overlap, ten people who have torn their ACL can have ten different and unique sets of movement issues so we have to look at the feedback from the functional movement screen as well as other assessments to know where to start and where to focus.
We see so many people who are between one and 20 years post op are walking around with the exact same issues that caused the tear in the first place. They worked with brilliant surgeons who fixed the torn ACL in flawless fashion, but then their rehab missed all of the most important factors that need to be addressed. The good news is that there are a lot of therapists and movement specialists that can help. Regardless of the exact title of the professional you see, your best bet is someone who uses the FMS system or something like it. We are in southern California and if you aren’t near us we can find someone in your area who would be a perfect fit. Send us a quick message through our contact page.