The Fit Institute ACL Program

October 23rd, 2020

The Fit Institute is proud to announce the establishment of The Fit Institute ACL Program! It was developed to provide the best possible care for someone recovering from an ACL injury in Chicago and the Chicagoland area. It is unique compared to other physical therapy clinics as it is designed to progress to working with our strength and conditioning coach following the completion of formal physical therapy. If you need physical therapy and rehabilitation for an ACL injury The Fit Institute will help you get back in the game. Please read on to learn more about this new initiative!

ACL Program Goal:

The goal of our ACL Program is simple: Help you return to your activity as quickly, and safely, as possible. Even prior to surgery it is important to start rehabbing the knee to improve swelling, mobility, and strength. Our therapists will guide you through your rehabilitation from pre-surgery preparations through discharge and return to sport. Whether you need to get back to your high school soccer team, weekend pick up basketball games, or afternoon bike rides with the kids, we are here for you.

Our therapists work closely with our strength and conditioning coach and personal trainers to ensure the transition from therapy to return to sport is effective and ongoing. Our program is designed to transition you to our strength and conditioning coach when you are formally discharged from physical therapy. This allows us to safely and effectively bridge the gap between physical therapy and return to sport. 

Our Experience

Our therapists have nearly 25 years of experience and have worked with individuals recovering from ACL reconstruction at a variety of levels. They have helped high school, college, and professional level athletes return to their sports. They also have enjoyed working with weekend warriors looking to stay active playing basketball, hiking, skiing, or biking. Our therapists stay up to date on the most cutting edge research in ACL rehabilitation and course work. They work closely with your rehabilitation team and communicate with your surgeon, their physician assistant, and your athletic trainer. 

What sets us apart

The Fit Institute is a physical therapist and personal trainer owned facility. Our priority is your recovery. The Fit Institute offers a state of the art facility that has all the tools needed to complete your rehabilitation. Our clinic boasts the standard weight room equipment that most physical therapy clinics do not have. We have a variety of cardio equipment, squat racks, kettlebells, dumbbells, and resistance bands. We also have the equipment to make your rehabilitation specific to your needs. We have a turf track, access to a grass field for return to sport drills, weight sleds, and battle ropes. These tools allow us to develop the strength, endurance, and power required to get you back in the game.

The ACL

The anterior cruciate ligament, or ACL, is a dense connective tissue that attaches to both the femur and tibia. Its role is to limit anterior translation and rotation of the tibia. The ACL, along with the posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament, provide stability to the knee joint. These ligaments are commonly injured along with the ACL.

How the ACL gets injured

The ACL can be torn in a few different ways. The most common is non-contact such as a quick change in direction, or coming down on one leg from a lay up. Direct contact with an opposing player can also result in an injury. Secondary contact is also responsible for injuring an ACL. An example of this would be getting bumped by a defender while going up for a header in soccer and landing awkwardly on one leg. ACLs are rarely injured in isolation meaning the PCL, MCL, LCL, and menisci are also at risk for injury. Whether it is a non-contact or contact injury, the knee is put in such a position that the ACL essentially becomes overstretched and is unable to handle this load, thus leading to a tear.

The Rehab Process

Each surgeon may have a variation on their rehabilitation protocol. These variations can depend the type of surgery performed and if other structures, such as the meniscus, were involved. While most protocols are based on time, it is important that certain criteria is met to progress to the next phase. Our therapists ensure that you are achieving the appropriate goals prior to progression of activity to ensure a safe and effective recovery. Below is a general outline of how physical therapy for an ACL injury and surgery progresses.  However, it is important to note that there are variations and each person has a unique recovery.

Prehab

You should start rehabilitation immediately following your injury. This is called prehabilitation. Prior to surgery it is important to reduce swelling, improve any limp that you may have, improve range of motion, and start working on strength. Our therapists will guide you through this process and educate you on what to expect with surgery and postoperative rehabilitation. 

Prehab phase goals:

  • Reduce swelling
  • Improve gait mechanics (eliminate limp)
  • Improve mobility (important to get knee as straight as possible)
  • Initiate strengthening
  • Assess non-injured lower extremity strength to establish baseline for injured lower extremity

Phase I: Post op 0-4 weeks

You will start formal physical therapy within the first 5 days. Following surgery you will be wearing an immobilizer brace locked in extension and will be using crutches. Depending on the type of surgery you will be able to place weight through your surgical leg, however following certain types of ACL reconstructions you will be non weight bearing. 

Phase I goals:

  • Gait training
  • Reduce post-operative swelling
  • Start range of motion exercises with focus on achieving full extension (knee straight)
  • Initiate strengthening exercises focusing on quad activation and engagement

Phase II: Post op 4-12 weeks

In Phase II, it is important to continue working on gradual progression of strength. During this time, discharging the brace and crutches will occur as strength occurs. 

Phase II goals:

  • Normalize gait without crutches
  • Discharge brace
  • Progress ROM to full
  • Progress more challenging exercises focusing on strength and balance

Phase III: Post op 12-16 weeks

Phase III sees a continuation of lower extremity strength with ongoing focus on quad, hamstring, and hip strengthening. We also progress more balance type activities and start introducing movements to prepare for running

Phase III goals:

  • Full ROM
  • Progression of lower extremity strength and dynamic balance
  • Initiate walk/jog program

Phase IV: Post op 16-24 months

Phase IV is the time of rehabilitation that we are able to increase the demand of your sport into therapy. We are able to progress running, cutting, agility, and jumping type activities. These tasks are introduced gradually so your knee can adapt to these new loads. Near the end of this phase we start our return to sport testing and compare your surgical leg strength to non-surgical leg strength established during prehab.

Phase IV goals:

  • Progression to agility, running, jumping and directional changes
  • Ensure no compensation with landing, cutting, and jumping to reduce risk of re-injury
  • Complete return to sport testing

Phase V: 6 months and beyond

Phase V is used to continue progressing sport specific and more aggressive movements to prepare for a return to sport. These activities are added in gradually to ensure reducing the risk of re-injury for both involved and uninvolved knees. Return to sport is criteria based and not time based. However, evidence does promote waiting at least 9 months shows a reduction in the re-injury rate. 

Phase V goals:

  • Gradual progression to return to sport
  • Ongoing strength, agility, mobility, and balance
  • Development of maintenance program
  • Discharge to strength and conditioning coach for further training

This general outline is the progression of rehabilitation following an ACL injury and ACL reconstruction. It is important to note that this is very fluid and dependent on the individual and how they progress. As said earlier, our goal at The Fit Institute is to help you recover from your ACL injury and surgery as safely and effectively as possible. 

If you have recently sustained an ACL injury or will be undergoing an ACL reconstruction contact our physical therapy office today at Chicago, North Center, Lincoln Square, Lincoln Park, Roscoe Village, IL. We will set up an evaluation for you so you can get started on your road to recovery. At The Fit Institute (TFI), our physical therapists are dedicated to helping you return to your sport as quickly as possible!