A TEN TASK-BASED PROGRESSION IN REHABILITATION AFTER ACL RECONSTRUCTION: FROM POST-SURGERY TO RETURN TO PLAY – A CLINICAL COMMENTARY
Movement re-training is considered an important element of rehabilitation after ACLR, but there is a lack of knowledge on the ‘how’ and ‘what’ movement re-training should occur after ACLR.
In its basic form, movement re-training after ACLR is about progressing a patient through gradually more demanding tasks from the point of being able to walk to being able to perform highly complex sports movements. However, there is a lack of guidance on when to implement certain tasks (e.g. when to begin running) and how to transition between tasks. This paper presents a 10 task progressions system which can form an important aspect of the movement-based re-training process, providing structure and patient autonomy. Monitoring knee function and movement and neuromuscular status to safely transition between these tasks is important.
1. Normal walking gait
2. Bilateral squat
3. Unilateral foundation exercises – Single leg squat4. Bilateral landing5. Running6. Bilateral plyometrics – Bilateral drop jump
7. Unilateral landing/ deceleration –Single leg deceleration8. Unilateral plyometrics –Single leg drop jump
9. Change of direction ability/coordination – 90º cut maneuver10. Sport-specific movements – Movement control under sport specific change of direction
SUMMARY Establishing clear task-based progressions can provide structure to a rehabilitation approach and give autonomy and motivation to a patient after ACLR. This clinical commentary presents 10 task-based progression which can be used by clinicians for their patients who intend to return to sporting activity after ACLR. Progression through a task and between tasks is based on respecting the joint, strength, movement quality and muscle soreness.
The presented task-based framework is evidence informed and based on applying theory into practice.
