Cruciate ligaments :
harmless? - - Posted by dominatnthagame (dominatnthagame), 18 January 2005
I am about 6 weeks post op, ACL reconstruction. I play basketball so natually I dont like this sitting out and watching but I was wondering... at practices I've been shooting around a little bit on the side, the trainer and coach dont see this as a problem but when mentioned to my PT he was shocked and told me not to. Honestly, I dont see the harm in it. The only thing I can see is over doing it (which I'm likely to do) but Im not doing anything other than shooting. Is this really a problem?
Brandon
Posted by Wookster (Wookster), 18 January 2005
Mate you're asking for trouble here. Your OS has a rehabilitation protocal for good reason and doing more than you're recommended to could result in you damaging your graft and needing surgery again.
Posted by Bballbaybee2110 (Bballbaybee2110), 18 January 2005
Brandon,
I did the same thing your doing... i would always shoot around at practice... my coaches and the trainer watched constantly to make sure i wasnt over doing it... they said as long as i didnt do jump shots or do anything that would over do it i was fine... when i told my PT she flipped out too... but it didnt hurt anything... i honestly think it made me return to basketball faster... when you shoot... just stand there... worry about your form more then anything... ABSOLUTLEY NO JUMPING... haha sorry but i had to get the point across... other then no jumping and not over doing it... you'll be fine... dont worry about your PT just ignore him or her... thats what i did and i'm fine! good luck 
Posted by ATsoccergirl (ATsoccergirl), 18 January 2005
Brandon,
As long as you are not jumping, what you are doing is fine and I would highly encourage you to keep it up. You need to remember that the majority of PT's work with elderly people far more than they do with athletes. They have very little insight in what it takes to properly return an athlete quickly, safely, and in the best condition possible.
I would keep working with your athletic trainer and follow their advice closely.
Posted by Wookster (Wookster), 18 January 2005
One thing you have to be very careful of is falling over. After major surgery like this balance receptors in your knee are seriously affected making it more likely that you will fall over.
Posted by dominatnthagame (dominatnthagame), 19 January 2005
Thanks for the advice. The shooting I was referring to was strictly form. Just keeping good form and techniques. No jump shots. I did shoot and go after the rebound too fast and that kinda hurt but no big. I just dont see how doing nothing can be helpful to returning as quickly as I would like. Also I dont get the feeling that my PT is as interested in me getting back in the least amount of time as I am. AAU season starts in April... is that pushing it and too risky? I'll be a senior next year and I'm wanting to be 100% all out and Im not wanting to do anything to keep that from happening... it would suck to have to graduate on the injured list.
Brandon
Posted by Elly (Elly), 19 January 2005
I don't know how it works in America (I think you are American?) but I would try and consult a really good sports Physiotherapist to answer your question. They work with lots of atheletes returning to sport.
I know it's frustrating beyond belief but from all I've heard and discussed with my many varied sources, the most dangerous time for re-injury or damaging the graft is when you return to a little more activity. I suppose you have to think is it better to wait a couple of months and get stuck into your physio in the meantime, or do a little of what you love with the risk.
Something I was thinking is that if you split up with a boyfriend/girlfriend or somethiing, everyone is really understanding, but if you have to stop a sport you love, no one is really that bothered for you!?
It's a funny old world 
Posted by Kaz (Kaz), 19 January 2005
heya guys, I was a national competing Gymnast and i injured my Ligament and it killed me having to sit back i was allowed to go into the gym to do any physio excersises that i was told to do and watch the others but i had to be careful not to over do it, my PT understood that because she was an ex athlete herself but no-one from school understood why i was miserable for a couple of months! Strange i know! Unfortunately my Knee hasn't recovered and when i first did it i was too young for a reconstruction so in the end i had to quit gymnastics, and i was down but ive got a knee brace at the moment and am coaching some 8 year olds and im waiting for a reconstruction, so dont give up and i hope it all works out for ya
Kaz x
Posted by ATsoccergirl (ATsoccergirl), 20 January 2005
In the US physical therapists can basically buy crediantials. So in my opinion the SCS (sports certified specialist) and similarly the OCS (orthopedic certified specialist) are worthless. You would be far better of seeking someone who is both an athletic trainer and a physical therapist.
Posted by dominatnthagame (dominatnthagame), 20 January 2005
Yeah Im American.
My PT is good and he is an ex- baseballer so he kinda gets it. I just told him that I wanted to play AAU and he just kinda laughed and blew it off. I was serious... I had surgery Dec 7 and I didnt think April was too soon at all.
Thats a good point Elly... never thought about it like that... but its true.
Hope your surgery goes well Kaz. I know what ya mean about gettin down about sitting and watching.
Brandon
Posted by dominatnthagame (dominatnthagame), 20 January 2005
I see an ATC and a PT. Would it be beneficial to see someone who was both?
Brandon
Posted by jbluestein (jbluestein), 20 January 2005
Hi, Dominate I'm reading your posts with interest.
I agree with ATSoccergirl, get an experienced, qualified athletic trainer/PT who has worked with ACL repaired basketball players to guide you through the rehab.
I have never heard of a college level (is this college or HS?) basketball player returning in 4 months. Have you?
Has your OS spoken with you about the importance of the graft re-incoporating as an indication of returning to sports?
Don't shoot the messenger but, autografts are quicker than allografts, but even they don't incorporate in 4 months.
I guess you take on the risk you're comfortable with, but do you understand what you are risking?
Posted by spartanpele (spartanpele), 20 January 2005
Wow...why would you want to risk a possible return surgery just to shoot a few hoops?
I've played basketball all my life, and played soccer for over 30 years (hint..yeah, I'm an old athlete).
I Just tore my acl and I've already in my mind made the decision that I will be out 6-9 months at a minimum and will likely not play soccer for 9-12 months.
To rush back before your graft has healed completely is just asking for problems. I know its hard to stand and not shoot, but believe me, its better not to torture yourself by doing it.
First you'll shoot a little, then it will be a little more, then a slight squat set shot, then a little lift off the ground, etc, etc. Before you know it you'll be testing and pushing yourself since it feels so good.
Everything I've read in books and off the web (I'm also a HS soccer coach), says that the most dangerous time is around the 2-4 month range as your body feels good...but...your graft is not completely healed yet.
Take my advice...put down the basketball...its not worth the risk. This is one of those times where you really do need to heed the advice of physical therapist or ortho surgeon.
Posted by ATsoccergirl (ATsoccergirl), 20 January 2005
SpartenPele-
With your way of thinking (not returning until the graft is fully healed) no one would return to sports outside of 18 months.
Although the ACL is important, the musclar strength is far more importmant at maintaining the integraty of the knee joint. This is why I am allowed to return athletes to full competition in 4 months. If the strength and proper control is there they are perfectly safe to return to sports. Most people aren't simply ready to return this early because their PT just isn't aggressive enough.
I'm now a little over 5 weeks about from a revision ACL reconstruction, and as long as my compartment syndrome doesn't get worse I will join my soccer team in April. I am a National level player so I have access to the best athletic trainers and orthopedic surgeons. I have never seen a physical therapist following surgery. PT's just aren't going to get the same results as an ATC. My OS does not believe that there is a point of weakness in the graft. He is very big on muscle control, and is one of the few OS who can properly manage an ACL defient knee.
Posted by jbluestein (jbluestein), 20 January 2005
AT, your posts are excellent,
I have a few questions:
How many hours/day, days/week are you talking about when you refer to aggressive rehab?
How do you measure the amount of risk you take on when returning before the graft is completely, or almost completely incorporated?
Are there any articles that compare results when athletes return in 5 months, 9 months or 18 months using aggresive rehab?
You are assuming access to the highest level of trainers and surgeons to help ACL repaired athletes return soonest. That access is not available to everyone.
Posted by dominatnthagame (dominatnthagame), 21 January 2005
hey,
Im in high school. I run track to stay in shape and I played soccer until last year when I decided I wanted to become more serious with basketball and do more off season stuff. Im not wanting to risk starting over just to shoot around, but I dont see it as a risk if I'm just shooting and nothing else. Im still going to the gym for practices and sitting on the bench for games so it gets hard to just sit, watch, and do nothing. I usually do my exercises and work with our trainer on the side. She said that 4 months wouldnt be hard, but it wasnt un-heard of. I asked my OS about it and he didnt really answer my question, just told me that I needed to work on building my quads back up.
Brandon
Posted by spartanpele (spartanpele), 21 January 2005
ATsoccer girl...
You've written that you have access to the highest level athletic trainers and that you have never seen a physical therapist following surgery. ... Thats really interesting to me as the athletic trainers I've encountered are not as qualified as the physical therapists..at least they aren't in the upper echelon circles I've been around.
From everything I've seen, read, heard, you can't expect to return to full contact soccer after 4 months removed from acl reconstruction.
I've played soccer for over 30 years, and been coaching soccer competitively at high levels (HS, Premier, ODP players, etc.), and I would never allow one of my players to return to action in 4 months after acl surgery. Please be careful...!!
I'm not saying you have to wait 18 months. I have read documented cases of athletes returning in 6-9 months (and also wearing a brace to prevent any side motion.) But even in those cases those athletes typically have had relapses and inferred that they wished they had waited longer and not rushed back.
Beyond the normal progression of: weight bearing, walk with no limp/pain, jog with no limp/pain, cutting with no limp/pain, balance, ROM, you also have a certain degree of physio healing internally that must take place in the body.
Its true that you can play without an acl...so long as all motion is straight forward or straight back. But any twisting or cutting, heavy for soccer, is going to put the new acl through its paces...and at 4 months, 50/50 physical challenges while in a twisting fashion are going to be bad news.
Excelerating the rehabilitation to an aggressive state does not mean return to action quicker beyond a normal physio healing state within the body. The body can only heal the fibrous ligaments, cartiledge, bone so fast regardless of what rehabilitation program is used. I can site different sources in college football, pro football, NSCAA soccer, Success in Soccer, that support 6-9 months at the earliest.
Now having said all of that...if you are successful in returning %100 to full competitive soccer after just 4 months...then please, please post your rehab program as I would love to use it myself for my rehab process!! The thought of being out 9 months doesn't thrill me at all.
Best of luck... : - )
Posted by ATsoccergirl (ATsoccergirl), 21 January 2005
Spartenpele-
Just so you know where I am coming from, I am a sports medicine professional. I am a certified athletic trainer with a master's degree in exercise science, I also have my CSCS (certified strength and conditioning specialist). I work with some of top orthopedic surgeons when it comes to sports related ACL injuries. I have and still do fully return athletes at 4 months. We have a highly aggessive protocol that is combined with sport specific skills that is highly effective.
Our athletes do not use a brace at all throughout recovery. There is no solid research saying that they offer any benefit. We also make sure that they stay in the best shape possible by incorporating safe cardio workouts very early on. This part of the rehab process is often neglected. We also allow them to keep up with whatever skills they can, and we incorporate them into the protocol.
We actually have a very good succcess rate, with an extremely low retear rate. It's important to differentiate between contact injuries and non-contact. In the two years of using the new protocol we have had no non-contact retears, and one HV contact tear.
You mentioned that you cannot play soccer effectively without an ACL. This is simply not true, with proper training of the muscles the knee can withstand the demands. I played for the better part of a year with an ACL and was able to do it through a pivot shift training program.
As I said before, the OSs I work with believe that the graft is strong throughout the process and there is no true period of weakness. This idea along with proper muscle training allows me to return athletes at 4months. It also needs to be said that all our athletes are required to have at least 2 weeks of prehab before surgery.
Posted by spartanpele (spartanpele), 21 January 2005
Atsoccergirl:
Your last post has really raised my interest in your rehab program...and given me some optimism.
Given my heavy soccer coaching regiment that incorporates lots of plyometrics, ladderwork, Coerver footskills, etc, I'm curious as to your rehab program and if it would work for me.
Could you possibly post your rehab program (in XL format, or Word, or PDF) so that I could look at it?
I know that every person reacts differently to acl tears and it depends on body chemistry, size, weight, age, speed of healing, pain tolerances, conditioning, work ethic, etc, etc....
But if you could post guidelines, routines, examples..that would be great. If its not possible to do that in this forum, I could email you directly if thats ok..?
Posted by Elly (Elly), 22 January 2005
Protocols...
This seems to be the key to all this discussion.
But are we not in dangerous territory to adopt aspects of other peoples rehab protocols without knowing the differences in their surgical technique and individual body type?
As frustrating as this is, it's important.
Posted by estogirl696 (estogirl696), 23 January 2005
I think shooting at this point is fine. As long as you make sure that you absolutely do not run after any balls, pivot, or jump. After 4 weeks, I was shooting. After about two and a half months, I was shooting jump shots. I am now at four months and just came home from my first basketball practice back. My knee felt strong and everythign went great. But I also had a trainer that pushed me so that I was ready now. As long as you don't push your leg to the point past breaking, then I think you are fine.
GOOD LUCK! 
Updated Mon Oct 13 2008