ACL Reconstruction Rehabilitation With Non-Athletes

[Phil]:  Hey, everyone. I've been having some discussions with Dr. Kyle Matsel, and he's joining me again here. And we've been talking about ACL reconstruction rehabilitation, and we've really talked a lot about return to sport and high level competition.

But what I want to talk about is how do things change when it's a non-athlete? So we're working with someone who had an ACL reconstruction, but maybe they're not planning on returning to high-level sport. I think a lot of times people think that we really don't see the average patient. I think they always think that we are only seeing pro athletes, collegiate athletes, and high school athletes. But in reality, we have seen or see the gamut of patients.

I'll start it off here with a little few of my thoughts. I think the key theme that you hear from Dr. Matsel and I is that we need to be using biomarkers. And those biomarkers are scaled. They start with the most basic things of what do we want range of motion and strength to be? And then what do we want movement to be?  And then what do we want a person's aerobic capacity to be for their endurance? What does power look like? And then agility priior to return to sport.

What's great about that approach to me is that no matter which patient you're dealing with, whether it's an 85 year old, I know we're not doing many ACL reconstructions on 85 year olds, but again, it doesn't matter their age. What matters is what functional level are they trying to get. And you can see at the movement level, most people should be getting back to movement.  They're moving, they're getting up and out and off the chair and similar activities. And they all need good balance. So at a minimum, we're looking at a Y Balance Test and FMS markers that we're trying to achieve.

Then we also have to think about what is the potential doing additional things. We don't want to just get them to the level that they are currently at.  What if they want to start engaging in fitness or want to start a walking program or a running program? They decide now, couch to five K is the thing for me. I think we probably should be rehabilitating them to the point that their body is prepared to take that. But those are some of my thoughts. What do you think, Kyle ?

[Kyle]:  I couldn't agree more. I just think that we always want to push our patients for better wellness, right? Better overall function, better overall health. And a lot of our patients, if they tear their ACL, it's probably because they're somewhat active. And that active doesn't necessarily have to be sport or high level activity. It could be just their job, right? They're active at a factory job. They're active working on the line or in a restaurant. And maybe they tripped and fell, or maybe they had an overuse degenerative issue that complicated the joint and led to some issues. So there's lots of different reasons for their activity level. It doesn't always have to be sport, doesn't always have to be exercise. But with that said, a lot of people are wanting to get back to some level of activity, whether it's walking or whether it's pickleball, right? Pickleball is just really taken off. And I know that I've had several patients that I've rehabbed that have been well into their upper-end 30s, lower 40s that have had ACL reconstruction.

[Phil]: They're kind of old, right?

[Kyle]: No. Of course not. But they're in their 40s and they've had an ACL reconstruction and they're wanting to get back to walking. They're wanting to get back to playing pickleball. So with that said, yes, we need balance, we need movement. But also thinking about ways that we can start getting some baseline energy storing or power. And it doesn't always have to be a triple crossover hop. Obviously, for our higher-level performers, that's critical. But maybe for your 45-year-old, this is going to be playing pickleball. Maybe it's just like a broad jump off two legs, land on two, get a sense for what their power looks like. You can quickly turn that into one leg hop to get some symmetry if you need to. But like you said, scaling this to meet the needs of what your patient wants to do or where they want to go, but making sure that you're doing it in a safe way.

[Phil]:  That's awesome. So bottom line is, to me, the first parts of rehabilitation don't change at all. Probably the first, golly, three to four months at least, don't even change at all. And the only next part is what level of biomarker are we going to go to, what level of testing are we going to go to? Therefore, what level of rehabilitation. That's really our only decision.

And so really the choice is what does that look like? At a minimum, it's movement and balance for the most sedentary person. If they have any interest in anything beyond that, like you said in the fitness realm, well, then we probably are getting into some level of hop testing and working on that plyometric agility, because we all know that when you exceed your capacity, that's when problems happen. So we need to have capacity for that person that is beyond just their ADL.So that's the way we think about it. 

We love these questions. We love having these discussions, so don't hesitate to reach out to us at our websites and ask us anything. We're happy to answer them at www.philplisky.com and www.kylematsel.com. Thank you so much for joining us.

Do you want to know what biomarkers we use? Check out our ACL Reconstruction Guidelines. If you haven't seen our ACL Reconstruction Courses with MedBridge or performance, check those out. 

About  Kyle Matsel PT, DPT, PhD

Dr. Matsel is faculty at the University of Evansville where he teaches in the musculoskeletal content areas of the Doctor of Physical Therapy curriculum. He received his Doctor of Physical Therapy degree from the University of Evansville in 2011 and his PhD in rehabilitation sciences form the University of Kentucky in 2021. Dr. Matsel is the director of the ProRehab & University of Evansville’s Sports Physical Therapy residency program. He is a board-certified clinical specialist in sports through the American Board of Physical Therapy Specialties and a certified strength and conditioning specialist