Mick Hughes
@mickwhughes
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Sports Physio at NQPC - Townsville. Clinical interest in ACL injury. Co-founder of the Melbourne ACL Rehabilitation Guide & @learnphysio
Townsville, Queensland
Joined November 2012
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I've found 25 recent ACL papers that will significantly help your clinical practice in managing ACL injuries.
Better yet, all of these 25 papers are free, full text papers.
What are you waiting for? Click on the link below and dive right in!
Blog link:
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I have put together a list of 22 ACL papers from the last 10 years (including full text links) that have shaped my clinical practice. See link below 👍
Do you have any other papers that have shaped yours? If so, let me know in the comments below 🙏
Link
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72.5% ACL injuries in
@NFL
are non-contact (Johnston et al, 2018). 34/50 of these however were considered indirect contact. Don't overlook perturbation drills in your "injury prevention programs". Here are some examples you could adapt to your sport. LINK:
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67% of non-contact ACL injuries in females can be prevented with the regular implementation of ACL injury prevention programs. According to Petushek et al (2018), exercises like these can help! 10-15mins before every training session and game is all it takes 👍
#NoBrainer
#Physio
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The Tantrum - I've been dishing this out lately for both ACLR & hamstring strain pts during mid-stage rehab to improve strength & capacity to assist running plan.
Anyone else use it? If so, what's your experiences? Both positive and negative; Let me know in comments ⬇️
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Great share by
@robhobscience
👏 👏
Check out the springs on this athlete! This is how you should do your box jumps; It's not about how much you can flex your hips and knees to get on top of a box stacked with a silly amount of 20kg plates...
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Not all sports have their own version of the FIFA 11+. So what I've put together are some examples of key components of what ACL Injury Prevention Programs should cover (especially female athletes) - as per Petushek et al (2018).
Full video ⬇️
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Lots of great discussion and questions over the last 48hrs on ACL healing!
I'd just like to weigh in with my 2 cents if I can.
A thread ⬇️
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If you manage ACL injuries, I hope you find these papers as valuable as much I have!
Blog link:
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Did you know that if you have 5 of these jump/landing drills in your injury prevention program, you are well on your way to significantly reducing the risk of ACL injuries in your athletes?
Checklist of the key components below ⬇️ (as per Petushek et al 2018)
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11 ACL blogs to help you manage ACL patients and athletes better; all the way from acute ACL injury all the way through to return to sport!
See 🧵 below for direct links to all of them ⬇️
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The Melbourne ACL Rehabilitation Guide is now available for FREE!
Here are some hamstring rehab options for your mid-late stages of ACL rehab
Click ⬇️ to get your copy of the guide
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ISOMETRIC KNEE EXTENSIONS: CKCs aren't enough in ACLR rehab. You need to hit the quad in isolation too. Here's an early ACLR rehab option to help minimise quad atrophy + decrease pain & swelling. Also has 0% strain on the graft at these angles (Beynnon et al)
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Single leg vertical jump assessment has become part of my non-negotiable return to sport assessment for ACL patients - largely due to the findings from Kotsifaki et al 2022.
Full text paper:
1/3
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In contrast with wall-assisted RDLs I shared recently, this hamstring option would be more suited for those at the back of their hamstring rehab and using it to facilitate their return to sport/high speed running
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RUNNING DRILLS: return to running is a key milestone for ACLR patients. I find running drills work a treat to help bridge the gap between being strong in the gym and being confident to run. Here's a few that I like to introduce 2-4 weeks out before running program starts 👍
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Well done Canada! Now Australian schools need to follow suit.12 wks of 15min dynamic warm-up before every PE class resulted in:
70% ⬇️ all sports injury
69% ⬇️ lower limb injury
73% ⬇️ ankle sprains
64% ⬇️ in knee sprains
(compared to "usual" warm-up) Richmond et al 2016
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"Partner Push"; good way to prepare for "indirect contact" ACL injury. This type occurs in 20% elite football & 50% elite netball
#Physio
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Do OKC exercises strain the ACL? Yes they do. Do CKC exercises strain the ACL? Yes they do. Keep these exercises and strain % in mind next time you're prescribing exercises for your ACLR patients. For more info, see ⬇️
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Love the side hop test as part of a battery of RTS tests for ACLR pts! Assesses COD & anaerobic capacity AND has norms (M 55, F 43; Gustavsson et al, 2006).
The side hop test forms just a part of the Melbourne ACL Rehabilitation Guide; get your copy ⬇️
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💥 47 ACL Papers that have changed my clinical practice 💥
I hope you get some value out of these papers as much as I have!
25 ACL papers:
22 ACL papers:
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Do you have the 30sec side hop test in your RTS testing battery for ACLR patients? Nice test of change of direction ability, confidence and anaerobic capacity.
FYI: The Melbourne ACL Rehabilitation Guide has it included. Download your copy here ⬇️ ⬇️
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ACL rehab: KISS principle
These exercises won't get many likes compared to some of the circus acts getting around Instagram at the moment, but I can guarantee these are some of the most important exercises someone will need to have a good outcome followi…
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No Leg Press, no worries! Here's an early exercise for quads & glutes that could be introduced in the first few weeks following ACLR or any other type of knee/lower limb injury when you don't have access to a gym 👍
Melbourne ACL Rehabilitation Guide ⬇️
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Band Assisted Hops: I'm finding this to be really helpful for those in mid-late stages of lower limb rehab, and who have lost their "spring" or can't quite hop confidently on the spot or over hurdles. Thanks for inspiration
@TheUofStrength
👍💪
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A tremendous guideline for clinicians and those working in sport looking to reduce the risk of ACL injury
Thanks to Amy Arundale and colleagues for putting together this important body of work
Full text link here:
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No Leg Press, No Worries! This would be a suitable, early exercise for most knee patients in the first few weeks following surgery/injury, who aren't keen on the gym and have a Swiss Ball lying around.
For more info on ACLR rehab, click on the link ⬇️
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Open chain exercises are the only way to target the quads in ACLR patients.
The person with a weak quad will find a way to cheat during Squat/Lunge/Bulgarian/Leg Press via strong Hip muscles.
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When it comes to running performance, it's not all about the GLUTES! Soleus produces far more force during running than any other muscle group of the lower limb. Thanks
@rwilly2003
for this wonderful slide; I hope you don't mind my graffiti! 😉
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"Find the opening" - This is by far one of the best late stage rehab drills for lower limb injury that I've seen in a while - multiple changes of direction, decelerations, agility, decision making. Ticks a lot of boxes for me! Thanks for this one
@TheUofStrength
👏👍
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Only 30% of ACLR patients completed plyometrics & agility prior to returning to sport (Ebert et al, 2017). Here's some options to get ACLR patients better prepared for sport based on
@lachlan_wilmot
plyometric continuum.
For more info on ACL rehab ⬇️
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I'm not sure if this exercise has an actual name, but I'm calling it "The Pyro" because after doing it.. everything BURNS! Listen to video for cues. No hard/fast dosage, but at least 5x10sec holds each leg makes you feel alive!
For more on ACL rehab, check out
@LearnPhysio
👍
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I love this unanticipated change of direction drill so much! Great preparation exercise to throw in the toolkit before progressing the athlete into the true chaotic nature of training. Perfect for any type of lower limb injury rehabilitation. Thanks for sharing
@DanielKadlec
👍👍
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Band-assisted Nordics - handy to build capacity in the hamstrings for those that can't do the traditional Nordic, so they can eventually move on to the real thing.
For more information read my recent post on this topic ⬇️
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Plyos are key ingredient to high quality ACLR rehab; But did you know only 5% of non-elite ACLR patients perform evidence-based guidelines that include agility & landings? (Grindem et al, 2018). Here's some jump/land options that I like - what are your go-to plyo/land drills?
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ACL becomes thicker over a competitive season of sport!
What a fascinating study by Myrick et al (2019). They looked at 17 division I female soccer athletes aged (mean age 19yrs). All players had no previous injury to their ACL. They had a clinical exam…
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Is the side hop test part of your ACLR RTS test battery? I love the side hop for its ability to assess COD confidence AND anaerobic capacity. As a result, it forms part of RTS test battery in the Melbourne ACL Rehabilitation Guide 2.0. Get your copy ⬇️
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20min progressive hip strengthening program carried out 3x per/wk in female basketball players reduces ACL injury risk by at least 60% (Omi et al, 2018). Helped by high compliance rate of nearly 90%. Amazing what happens when exercises are done..
Link:
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Just like the Nordic Hamstring exercise for the hamstring muscle group, the Reverse Nordic has been shown to significantly increase the length, thickness and cross-sectional area of the Quadricep muscle group; in particular the Rectus Femoris muscle
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Perturbation training via the "Partner Push" & "Partner Bump". Appropriate for primary injury prevention & late stage LL rehab
#Physio
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Make sure your clinic and every one of your ACL patients has one of these 👍
Download for free here:
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A simple 5wk pre-op ACLR strengthening, plyo and balance program shown to improve 2yr post-op outcomes (KOOS and RTS numbers) than those who didn't do the program (Failla et al, 2016).
For full protocol and references, see link below ⬇️⬇️
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If you found my 25 recent ACL papers blog yesterday helpful, maybe you'll also find these ACL papers helpful too!
Blog link:
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💥 Isometric knee extensions 💥
A great way to hit the quads hard when the patient can't work through full ROM knee extensions due to pain, swelling or post-op restrictions.
Here's a few options that can be easily performed at home 👍
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This paper is a beauty!
I've collated this paper, and 24 more recent free full text ACL papers, and put them into a blog
Click on the link below to get them all
Blog link:
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If you find it difficult to introduce plyometrics into your ACL rehab plans, this paper is a really helpful read!
Get this full text paper - and 24 other recent ACL papers that have helped improve my clinical practice - by clicking on the link here:
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Somehow we've managed to overcomplicate ACL rehab.
For the vast majority of non-professional ACLR athletes, this framework of progressive overload will enable them to progress slowly & surely towards a return to sport by the 12 month mark and a successful outcome.
Thread ⬇️
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Absolutely the ruptured ACL can heal.
We just need to give people a fighting chance to see if their ACL can heal.
To do this takes time.
A thread 🧵
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Following ACL injury, exercise therapy is important regardless of choosing ACLR or continuing non-operative pathway. All these exercises are used in the studies below showing a benefit of using such a program
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The Melbourne ACL Rehab Guide is now freely available to download at
Or you can use the free website:
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Reverse Nordics: After seeing a run of rec fem strains this week, I thought I'd share an exercise that is challenging & requires no equipment that could be used as a preventative exercise or a mid-late stage rec fem rehab exercise.
Click ⬇️ for more info
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Injury Prevention Programs: To have this effect on future ACL injury, all it takes is 15mins before every training session & game. Also helps that IPPs include Nordics, Lunges, Calf Raises and Landing Drills & Plyos.
References:
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How many single leg rises can you do? For ACLR patients, it has been hown >22 reps is associated with better QOL than those who can't do 22 (Culvenor et al 2016). For more clinical tips, follow the hashtag
#MelbourneACL
from my 2 day ACL workshop this weekend 👍
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How many single leg calf raises can you do? An updated list of normative values for healthy adults as per Herbert-Losier et al (2017) in blog below ⬇️⬇️
Blog:
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Having trouble finding the right set-up for your Bulgarian Split Squats?
Try this simple set up
🟢 🟢
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There's no magic tricks to a great outcome following ACL injury; just basic exercises done with appropriate progressive load, and performed at least 2x per week. See Eitzen 2010 free access paper ⬇️
For more on ACL rehab, click ⬇️
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I have put together a list of 22 ACL papers from the last 10 years (including full text links) that have shaped my clinical practice.
Click below to check it out
Do you have any other papers/references that have shaped yours? If so, share below 🙏
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Who has the strapping skills like
@juan_cuevas_atc
to take on all your athletes this weekend? 👏👏
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Quads matter! For every 1% increase in quads symmetry prior to RTS, a 3% reduction in knee reinjury risk in ACLR patients is seen. Simply, if you go from 80% quads symmetry to 90% quads symmetry, your risk of knee reinjury ⬇️ by 30% (Grindem et al, 2016)
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Reason
#114
why I love the Knee Extension Machine...
You can turn it into a seated calf raise and you can use it to hold down your feet & ankles to do Nordics.
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Return to running following ACLR is a key milestone for the patient. As it's usually at least 5-6 months before runs, running drills can be very helpful to help prepare the lower limb for regular running demands. Here are a few options for you 👍
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I recently shared this exercise as a compliment to knee extensions & squats to help people increase their quad function and decrease their knee pain following knee injury.
Here's a breakdown of the exercise in 4 simple steps:... 1/2
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The Side Hop Test is a new addition to the Melbourne ACL Rehabilitation Guide 2.0 - tests anaerobic capacity & has some nice norms for our ACLR pts to strive towards.
Have you got your copy of the Melbourne ACL Rehabilitation Guide yet? Simply click ⬇️⬇️
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Soleus strengthening; Neglect it at your peril! Soleus produces forces during running 8x BW vs Gastroc 3x BW. For more clinical info on the soleus, see
@Seth0Neill
blog below ⬇️
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Bulgarian Split Squats are one of my essential ACLR rehab exercises.
There's a couple of simple cues in this 2min video to get the most out of the exercise
Continue watching:
🟢 🟢
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ACLR Rehab: Intro to plyometrics
These 3 drills are my favourites when your ACL athlete is ready to start the process of adding plyometrics into their rehab plans.
💥 Tall to shorts
💥 Box Jumps
💥 Skipping rope
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💥 Side hop test 💥
This is one of my favourites to determine return to readiness to return to team training and eventual return to sport in ACLR athletes.
A 🧵
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Great rehab exercise for those that have injured themselves on the dancefloor and want to make their rehab "sport-specific" 🤣🤣
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Things you need to know to manage ACL injury.
Thanks to
@BrettBuist
, Jo Stannard, Con Boulinos and Zeb Kenny in helping putting this together for final LaTrobe Masters Sports Physio subject.
Patient & clinician infographics available. See also link ⬇️
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💥 Injury Prevention Programs 💥
Or Injury Risk Mitigation Programs if you will.
Or Performance Enhancing Programs if you're that way inclined.
What you prefer to call them - it's nice to have them back in the conversation again
A thread 🧵
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And here ladies and gentlemen, is the definition of PLYOMETRICS! Jump into your week with this mesmorising slow-mo video. Hoppy Monday! (Too many puns in one sentence? 🤣🤣)
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DYNAMIC BALANCE: Mix up your balance drills with these variations. Single leg stance challenges your balance & by adding in the figure 8 movements it changes your centre of mass; challengeing your trunk too! Perform 2-3x10 figure 8s - without losing your balance!!
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I've compiled a list of resources for medical & high perf. staff to ⬇️ injury risk in sport. Hope you find it useful
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If you're still using a 2x per day eccentric protocol to manage patella tendinopathy you really need to read the papers below on isometrics & isotonics
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67% of non-contact ACL injuries in females can be prevented with implementation of ACL injury prev programs. However it's not as easy as saying "just do them".
@Knee_Howells
covers this complex topic in
@LearnPhysio
new ACL Masterclass. Comment YES ⬇️ & I'll send you a link 👍
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Lost your "spring" following lower limb injury? Give this exercise a try. I'm finding this to be really helpful in patients in the mid-late stages of lower limb rehab & quite hop confidently. Feedback I'm getting is that it's easier to push off a harder surface than soft
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2 systematic reviews, 1 evidence based guideline & 1 RCT showing restricted ROM OKC exercises don't increase graft laxity in ACLR pt. We shouldn't fear knee extensions!
References:
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There's something extremely satisfying in watching the ease of this athlete clear these hurdles.
Have a HOPPY weekend! 😊
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Massive moment tonight finishing my last Masters of Sports Physio assignment! Huge thanks to my ever supportive wife for the encouragement & helping me get through something I started 7 yrs ago! Here's to more time on my hands & hopefully a few extra letters after my name! 😊 👍
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Crossover Step-Up: ACLR rehab should make you feel uncomfortable; both mentally & physically. With a twisting motion & high levels of glut max/med activity, the Crossover Step-Up is one of my favourite exercises during ACLR rehab. For more, watch here ⬇️
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"Picking stuff up from the ground" = Deadlifts & "Standing up from sitting" = Squats. We need to stop creating fear around these exercises with our patients
#Physio
#NoSuchThingAsABadExercise
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70-85% of ACL injuries are non-contact in nature. Unfortunately for this athlete, this is a textbook non-contact mechanism.
The good news is that ACL injuries are largely preventable; 50% of all ACL injuries & 67% non-contacts in females (Webster & Hewett, 2018).
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Don't fear Squats & Deadlifts: When you take away the bar; Deadlifts are simply "picking s$&t up from the ground" and Squats are simply "standing from sitting". These exercises aren't bad for you, it's the rapid load progressions that are, +/- technique
#GetStrong
#Physio
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"If you let your patients walk, you should let your patients do open chain knee extensions" -
@doclsmack
If you care for ACLR patients, I encourage you to watch this 45min presentation on ACLR exercise selection by clicking on the link below
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