Use Aquatics for Each Stage of ACL Rehabilitation
Rehabbing ACL tears can be a challenge for many reasons and for both the athlete and the athletic trainer. Athletic trainers want nothing more than to help their patients heal and get healthy, but athletes often experience pain and discomfort daily from the ACL tear due to soreness and swelling. Despite the dread of beginning rehabilitation, it is important for the athlete to begin a physical therapy program to regain the range of motion and strengthen the injured area as soon as possible.
Randy Cohen is the Associate Athletic Director of Medical Services at the University of Arizona and has over 12 years of experience utilizing aquatic therapy to rehab ACL injuries. In a webcast, a few years ago, he shared how to use therapy from just days after surgery to low-impact conditioning after the athlete has returned to sport.
To learn more about ACL rehabilitation using aquatic therapy, download the ACL Recovery with Water Therapy tip sheet.
Most commonly seen after surgery is the lack of range of motion, knee extension and flexion of the knee. Randy demonstrated numerous exercises and activities to cue athletes to perform within the first few weeks of the therapy program. He suggested incorporating different types of stretches, strengthening exercises as well as walking and jogging to emphasize the importance of strengthening the whole body rather than solely focusing on the knee.
Randy shared that using aquatic therapy often gets the athlete back quicker than on land but the major benefit is when you get them back to land after using aquatics, and they’re already functional because of their experience in the water.
It is important to keep the athlete’s entire body strong to enhance recovery and reduce the risk of re-injury. In the webcast, Randy demonstrated many exercises but he primarily focused on stretching, core stabilization and active motion including cardiovascular exercises (e.g. walking or jogging on the underwater treadmill).
Randy always suggests waiting until the swelling gets controlled before beginning therapy. Once the athlete’s swelling is at an acceptable level, begin by using a recovery program, like the one below, for an ACL patient. Continue to gauge the athlete’s gait during the program by giving them cues to make sure they’re demonstrating all the techniques that they weren’t using due to the tear.
- Warm up on the underwater treadmill by jogging. This begins giving the athlete confidence right out of the gate after surgery by enhancing the range of motion, getting the heart rate up, experiencing “sweat therapy” and reducing the swelling without the added load.
- Begin by asking the athlete to demonstrate exercises such as: flexion of the foot, high knee walking, knee flexion, heel up to your butt, butt kicks, hip motions – extension and flexion and calf raises. Suggest to the athlete to watch themselves on the camera to make sure they’re executing the exercises properly based on cues from the Athletic Trainer.
- End the 10-minute program by walking or jogging on the underwater treadmill followed by extensive stretching.
Randy mentions multiple times in the webcast how athletes regain their confidence when rehabbing on the underwater treadmill. For the full webcast with more protocols of each stage during ACL rehabilitation, progression timelines and exercises to return to play, view the video below.
To learn more about ACL rehabilitation using aquatic therapy, view the ACL Recovery with Water Therapy tip sheet.