The Eight (8) Characteristics of Successful ACL Rehabs for Soccer Players
Finding the best coach, facility, or clinic to do your ACL rehabilitation can be confusing and frustrating. Here are eight (8) characteristics that every successful rehab program includes. If you are an athlete, parent, or coach, use this list to vet out your choice of rehab program or ensure that you get the best care in your current situation.
Principle-Based
There must be training philosophies and methods in place that are grounded in current research, fundamental human biology, and strength and conditioning best practice. For example: At the beginning of the rehab process, minimizing swelling, restoring pain-free range of motion, and reestablishing the ability to walk are principles that all practitioners can get behind. In the later stages of rehab, learning how to sprint, jump, change direction, and execute soccer skills under fatigue are advanced principles that coaches should value as fundamental. Operating under a principles-based approach will ensure that every aspect of the program is lean and targeted towards the objectives and benchmarks established at the beginning of the process. It will also ensure that the coaches and athletes don’t grasp at “shiny objects” when the process becomes difficult or slow.
2. Emphasis on Return to Performance
The components of training must produce physical adaptations that prepare the athlete to play their sport. Ultimately, the objective is to help the athlete safely and thoroughly prepare for an inevitable return to playing soccer. The training must emulate the physical demands of sport while (theoretically) reducing the risk of re-injury. This does not mean training must LOOK like sport. Rather, the training must reproduce the forces, velocities, biomechanics, and energy systems of soccer. For example, soccer is known as a repeated sprint ability sport. Therefore, rehabilitation must include well-executed sprinting and conditioning methods that target the aerobic energy system. These two components will ensure that the athlete can sprint frequently and aggressively without experiencing debilitating fatigue.
3. Individualization
The course and rate of rehabilitation will be determined by the athlete’s response to training. There is no magical timeline that indicates an athlete’s readiness to return to the field and operate at the same level as they did before the injury. One of the many myths of ACL injuries, that has been debunked in recent research, is that an individual can complete a successful rehabilitation in 6-9 months. Every athlete will progress through rehabilitation at a unique pace. The athlete should understand this is a long and arduous journey. The coach should honor this variability by challenging the athlete appropriately and gently pushing boundaries in training, being mindful not to overwhelm them with the pace and urgency of the process.
4. Criterion-Based & Objective-Driven
Successful rehab includes assessments, pre-tests and post-tests to establish baseline data. The data collected in these assessments can be referenced against benchmarks to ensure progression. Strength coaches and physical therapists should collect important metrics like quad strength, symmetry between legs, and jumping outputs. These data points indicate when an athlete has cleared an important criteria for progression and is ready for the next stage of rehab. Other examples of valid assessments for ACL rehabilitation include knee range of motion, triple hop tests, change of direction deficit, and flying sprints.
5. Load Management
Successful rehab requires the intelligent integration of technical training (aka soccer practice) and the proper management of external load. Injury risk, or the possibility of re-injury, increases dramatically after periods of detraining. Athletes are often haphazardly thrown back into heavy practice loads and introduced to open soccer environments far too aggressively. At best, this habit leads to fatigue and poor performance. At worst, muscle strains and re-injury, oftentimes in the other knee. Loads should be gradually introduced and tracked diligently, and coaches should ensure that high intensities are achieved in a safe, structured training environment BEFORE being introduced in open, soccer environments.
6. Audibles
Good coaches have a plan when the plan goes wrong. Progressions, regressions, and audibles are critical in the rehab process, especially as an athlete gets closer to returning to practice. Coaches should be able to answer the following questions: What do you do when an athlete isn’t responding well to an exercise? What if an athlete has pain or swelling that prohibits movement? Conversely, what if they are responding well, feel great, and need more challenging tasks? Athletes often progress quickly through early stages of rehabilitation because their ability to progress is accelerated when training variables are tightly controlled and rehab is their sole focus. However, the more variables (like soccer practice) are introduced, the more difficult it is to ensure recovery. Changes may need to be made to the training program to accommodate pain, soreness, and fatigue from heavy workloads.
7. Collaborative Care
In reality, it takes major cooperation between the athlete and several specialists to rehab an ACL. The strength coach needs to communicate with the PT. The PT must communicate with the doctor/surgeon. They all communicate with the athlete and the sport coach. There are several opinions and expectations that need to be considered. The consideration that matters the most is the health, safety, and longevity of the person who was injured. All decisions should be made with this in mind. Communication amongst all major players in the rehab process will prevent gaps or overlapping roles and facilitate better outcomes long term.
8. Environment
Patience is an absolute necessity because setbacks are likely. No athlete will return to the field on a perfect timeline. Two steps forward and one step back is an expectation in some rehabs. Remember that when an athlete suffers an ACL tear (and subsequent surgery), they have been physically and psychologically injured. There will be fear, hesitation, and doubt. Coaches should create a challenging, but not overwhelming, environment for the athlete to rebuild their physical resilience and confidence. My golden rule for the psychological game is to make the player execute drills and skills in training so intense that there will be no doubt in their mind about their readiness when asked to step back on the soccer field. This takes time, trust, and safe, intelligent programming.
Have questions or want to know more?
TKO Athletic Performance specializes in early, middle, and late-stage ACL reconditioning programs.
