Part 4, Phase 1-3 Training ACL Return to Sport Series

Updated: Jun 2, 2021

As we all [should] know, returning to any training program after a period of time off is not easy. Aside from the physical aspect, the psychological aspect of returning to a training program post catastrophic injury could become demoralizing for more people. People always wonder, "will I ever be the same again" or "am I ever going to be able to play the way I used to"? These questions affect an persons mentality, with any type of injury. Heck, I tore my medial gastroc once, and I remember asking myself, "damn, will I ever be able to run and jump like I used to"? Eventually, I was able to, however at the expense of a lesser ability (I was 30 and very far removed from any playing career anyway). Proper measures and approaches must be taken in order to bring the athlete as close to their former "one-hundred-percent-self" as possible.

The training program focuses on the basics. PERIOD. Nothing extremely fancy, no secret juice, no special stuff...BASICS. Relearning motor patterns is the key early in the program. I focus on a few things that might seem rare, or "physical therapyish" in the program, however it is all aimed at relearning some fine and gross motor patterns that eventually lead to painting the bigger picture.

Before we dive into the program, I want to address the overall goals of the program:

1) Asymmetries to work on

Postural control deficits

Knee flexor deficits

Excessive frontal plane knee mechanics

Hip rotational control deficits

2) Four predictive factors for secondary injury risk:

Uninvolved hip rotation net movement impulse during landing

Frontal-plane knee motion during landing

Sagittal-plane knee moment asymmetries at initial contact

Deficits in postural stability on the reconstructed limb


The GOALS for phase 1 & 2 are:

Achieve full ROM

Improved core

Proximal and distal joint endurance and strength

Postural stability

Pain-free uncompensated movement

Build symmetry


PHASE 1 - SPEED TRAINING

It is very obvious from a point of view outside of the data you've collected from the assessment that the athlete is not prepared to run at high velocities. The focus of the speed program in phase-1 speed training is aimed to teach:


1) acceleration angles

2) foot striking

3) knee drive

4) deceleration


Everything is basically done in a marching-fashion, with very ample amounts of short distance runs (5-10 yards). Some people might not want to teach deceleration this early, however I find it to be extremely important to being this early in training because it allows the athlete to begin to understand force absorption. Everyone teaches landing mechanics prior to any extreme jumping right? So why should deceleration be any different. Again all these focal points are aimed to help the athlete relearn important motor patterns needed to mitigate the occurrence of a re-injury. Teaching the athlete how to understand proper angles, foot striking patterns, and proper knee drive is paramount at this stage of training. Focus on QUALITY. It will be stressful at first, but the outcome will be worth the early headaches.


PHASE 1 - CHANGE OF DIRECTION / JUMP TRAINING

Frontal plane mechanics will be somewhat of an issue here, however this is the time to fix it. I use an identical approach to speed training, slow -- one step at a time, literally. My focal points to the change of direction and jumping program are:


Change of Direction

1) center of gravity positioning

2) weight distribution

3) base of support

4) deceleration


Landing Mechanics

1) force absorption

2) hip positioning

3) torso angle

3) base of support


I spend more time teaching change of direction than I do linear speed, because this is where most injuries occur - in the non-contact multi-directional movement. Most athletes I've worked with tore their ACL in a "cutting" fashion or landing from some form of a jump. That usually tells me that they have never been taught proper mechanics on how the change direction or how to absorb force; or they might have just been extremely fatigued and unfortunate to get injured. Whatever the root cause of their injury, it happened in a phase of having to absorb force.

Here are some drills I use:

Stationary Skater Shift (no march)

This drill teaches the athlete how to be in the "change of direction" position and how to shift weight from one leg to the other. The focus here is teaching them a proper base of support, how to distribute weight from one leg to the other, and maintaining an 'adequate' low center of gravity (this will depend on tolerance of discomfort).

Skater March

A tin bit more advanced than the stationary skater switch. Now the athlete is moving their feet without shifting their torso. A simple "switch" teaches them transfer of weight from one leg to the other while moving their legs. I usually rarely move on to a "speed skater" where they are shifting with a faster pace, again the focus here is QUALITY, not speed or anything else.

Lateral Push Offs with a single leg hold.

I noticed mostly every athlete struggles with this simple drill...and that's completely fine. We move to 10 yards, and I instruct the athlete to push off the outside leg. A lot of time spend on this drill, because most athletes do not understand shuffling mechanics.


As far as the jumping/landing program, I progress as follows:

Snap Downs

Done at a slow pace, I instruct the athlete to snap into a "landing' or "loaded" position (whatever you want to call it). My attempt here is to fix as many flaws as possible: hip shift, athlete center of gravity, torso positioning, base of support/foot positioning.

Box Drops

Usually done form a 6" box. Teaching the athlete how to absorb landing forces.

Low Box Jumps

Usually a 6-12" box is somewhat of a starting point, however it depends on the athletes Level 2 assessment. Sometimes jumping won't come into the program until adequate strength has been developed.


PHASE 1 - STRENGTH PROGRAM

Nothing extremely innovative here. This is a 4 week phase, focused on two things: work capacity & building eccentric strength. Here are some of the exercises I prescribe during this phase:

Day 1

A1. Split Squat - 3x8

A2. Miniband Clamshell - 3x20 ea

A3. Band TKE - 3x10 ea


B1. Step Down - 3x10ea

B2. Y Balance - 3x3ea

B3. Pallof Chops - 3x10ea


C1. Single Leg Leg Press - 3x10ea

C2. Single Leg Leg Extension (terminal position) - 3x10ea

C3. Single Leg Leg Curl - 3x10ea


Day 2

A1. Reverse Lunge - 3x8ea

A2. Straight Leg Hip Bridge (foot elevated) - 3x12ea

A3. Band TKE - 3x10ea


B1. Stationary Lateral Squat - 3x8ea

B2. Mini Band Lateral Walk - 3x30 sec (progress 10 sec each week for 4 weeks)

B3. Side Plank - 3x30sea


C1. Single Leg Leg Press - 3x10ea

C2. Single Leg Leg Extension (terminal position) - 3x10ea

C3. Single Leg Leg Curl - 3x10ea


The first two weeks have no tempo to the exercises. Build on work capacity and full ROM. Weeks 3 & 4 the athlete should be prepared to incorporate eccentric tempos, and please let them know that this part of the program will suck, but dividends will be paid.

My Linear Speed Day is paired with my Day 1 strength, and Change of Direction paired with Day 2 strength. Again, be creative as a coach and know what your athlete can tolerate and needs. Sets and reps will vary depending on your athlete.


Heading in to Phase 2

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