Someone coined the term "Grassi Assessment", and I don't know if I would like to take 100% credit for it, however I think I'm going to have to run with it. Level 2 Assessment is geared toward seeing the inter-limb difference in power output. It will be obvious that the reconstructed limb will have lower outputs and strength than its contralateral partner, however the percent deficit between limbs is what we are looking at. A deficit greater than 10% is a MAJOR concern for athlete safety and re-injury. Level 2 Assessment is not a pass/fail like Level 1, it is more of a baseline measurement during the Return to Sport process.
Whatever you do, DO NOT rush the test. Allow the athlete to fully recover before performing a consecutive test. We are not training here, nor are we checking the athletes cardiovascular conditioning -- obviously it won't be close to good.
Starting off the Level 2 Assessment, make sure you put your athlete through a thorough warm-up as there will be jumping, running, and cutting involved. Perform each test twice, with ample rest time. For single leg tests, it will be 2 on each leg.
The test order goes as follows:
Bilateral Vertical Jump
Single Leg Vertical Jump
Bilateral Broad Jump
Single Leg Broad Jump
Single Leg Timed 5-yard Hurdle Hop (6 inch, or small cone) - record time it takes to clear every cone/hurdle. Looking to see repeat ability.
Single Leg Consecutive Triple Hop - Three consecutive jumps without a reset; record final distance after third jump. Start on one leg and finish drill on one leg.
Single Leg Crossover Hop - Have the athlete start on the right side of a line with the right foot on the ground. On "go", they will hop over the line and will also look to gain distance at an angle. Record the distance after the third jump.
Box Drop Jump - During this test, I test for reactive strength. I utilize an app called My Jump, which has been shown to be pretty accurate compared to force plates (in the event you cannot purchase or use a force plate). I use a 12" box for the test. I do double and single leg measures here, however if the athlete didn't look so good during the initial jumping tests, then I would just void the single leg drop jump test.
After the athlete has completed all the jumping tests, you will assess how the athlete looked during each test: Trunk control, symmetric/sufficient knee flexion, valgus, landing(loud./soft), balance, etc. The more efficient notes, the better. Also take note of your athletes facial expressions during some drills, face tells you everything.
The Run Test is very basic. Nothing extraordinary here, I set up two cones, 10 yards apart and simply have the athlete move in the following sequence: Sprint -> Backpedal -> Turn and Shuffle down and back -> Caricoa down and back -> "Sprint" through cone. Time how long it takes the athlete to complete this drill. Some won't possess the confidence in themselves to move at the pace they once did and will be extremely humbled by the experience. DO NOT ... I REPEAT ... DO NOT ENCOURAGE THE ATHLETE TO MOVE AS FAST AS THEY CAN, this will only lead to an injury and possible re-tear. Instruct the athlete to move to the best of their current ability and that this is more of an assessment of how they move, not how fast they can finish the drill.
Observe the quality of their movement: turning, planting/cutting, acceleration, deceleration, change of direction, center of mass, thigh drive, etc. ANY IRREGULAR MOVEMENT PATTERN IS A NOTE TO TAKE. Also, observe for any compensatory patterns you might see and engage with the athlete after the run and ask them "how did that feel?", "any pain?", etc.
With the information presented from the Level 2 Assessment, it will be obvious that the athlete will need A LOT of work to do to get as close to their former 100% as possible. If you see a deficit difference of greater than 10% between limbs in the jumping tests, then the athlete is not prepared to run just yet. If the difference is less than 10%, it would seem as if the athlete can start running, however I would not encourage any high velocity runs or explosive jumps just yet. Remember, we are dealing with a patient who just had their knee reconstructed, and another part of their body (patellar tendon or hamstring unit) snipped.
While you and your athlete might be very optimistic from good testing results, or opposite from poor results, from my personal experience this is the best time to hit a hard reset button on the athletes training and start from the extreme basics -- which is where the next blog will take you.
FULL DISCLAIMER
I AM NOT A LICENSED DOCTOR, NOR PHYSICAL THERAPIST. THE INFORMATION PRESENTED IS BASED ON MY PERSONAL EXPERIENCES WORKING WITH SURGEONS AND THEIR ACL RECONSTRUCTED PATIENTS AND DATA I HAVE COLLECTED. IF THERE IS ANY PAIN DURING ANY PART OF THE ASSESSMENT, PLEASE CONSULT YOUR SURGEON IMMEDIATELY AND REPORT SYMPTOMS. DO NOT PUSH THROUGH PAIN AS THIS CAN LEAD TO FURTHER INJURY.
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