ACL Rehab - Phase 1 (Return to Weight Room)

As you know, ACL injuries are a part of sport, unfortunately. We deal with 3-5 a year. Some are contact related, but most are not. It's very frustrating because prevention is a huge part of the training philosophy. Sometimes a kid just puts their foot down wrong or has to move (react) in a way that doesn't agree and there's a "pop!" Every time it happens (any injury) it makes my stomach churn. I understand it's part of the deal in sport, but it kills me every time. Here's what the head athletic trainer and I have come up with as part of our rehab protocol. First, the athlete is rehabbed in the training room, exclusively. At a certain point they are released to me (training room and strength and conditioning -me) and we start the next part of the process. Before I show you what we do I have to mention that our doctors (Team Dr's for the Cincinnati Reds - so they're really good) use patellar tendon grafts when they repair ACL's (not hamstring grafts). This slightly changes the rehab process. The issues you run into with patellar grafts are usually patellofemoral - tendonitis and improper tracking of the knee cap because of lack of quad strength. Not a big deal at all. We train these kids 3 days/week with very basic exercises. DAY 1

• General Warm-up/Dynamic Stretch
• Extended Specific Warm-up
• 4-way Hip Machine: 2x10 each way (flexion/extension/adduction/abduction, TKE: 2x10, Plank: 2x30 seconds, Hip Extension: 2x10
• DB Squat: Wk 1 - 5x5/Wk 2 - 5x6/Wk 3 - 5x8 (at this point we decide whether or not we put them on a barbell. Goal: Men - 5x8@75lb DB/Women - 5x8@50lb DB)
• Band Hip Extension w/pause at top: 5x5/5x6/5x8
• RDL: 5x5/5x6/5x8
• Step-ups: 5x5e/5x6e/5x8e
• Leg Press (Concentric - Bilateral/Eccentric - Unilateral): 3x8 each
• Stability Ball Leg Curls: 2x10
• Upper Body Push/Pull

DAY 2

• General Warm-up/Dynamic Stretch
• Extended Specific Warm-up
• 4-way Hip Machine: 2x10 each way (flexion/extension/adduction/abduction, TKE: 2x10, Plank: 2x30 seconds, Hip Extension: 2x10
• DB Deadlift: Wk 1 - 5x5/Wk 2 - 5x6/Wk 3 - 5x8 (at this point we decide whether or not to put them on a Trap Bar - same weights as above with DB Squat)
• Hip Extension w/MB squeeze: 5x5/5x6/5x8
• RFESS (add DB or Airex pad): 5x5e/5x6e/5x8e
• Back Extension or Reverse Hyper on GHR: 5x5/5x6/5x8
• Leg Press (Concentric - Bilateral/Eccentric - Unilateral): 3x8 each
• Stability Ball Leg Curl: 2x10
• Upper Body Push/Pull

DAY 3

• Repeat Day 1.

The goal is to rebuild muscle mass, build general strength and to progress them to using the barbell on main lifts. The training staff and I meet weekly (sometimes after each workout) to decide how the next week/workout will progress. The next phase is very similar in how it's set up. The only reall changes are the addition of the barbell (squat, deadlift) and the increase in difficulty of the single-leg movements (ie: RFESS - add Airex pad under foot to create some imbalance or holding a DB to add some weight to the movement). This decision is made by the athletic trainer. I'll post the next phase so you can see the differences we hope to use as the athlete progresses.