ACL tears are on an all time high. They have increased by 77% for women and 19% for men in the last 12 years. Many athletes believe this to be a death sentence to their athletic career. We also see a staggering 20-30% re-tear rate. These are unprecedented rates among other sports injuries. Physical therapy likely plays the largest factor in the recovery and re-tear rate of ACL patients. So what isn't working?
PT school is a 3 year doctorate level degree. We learn a WIDE variety of things from acute care rehab, sports medicine, neurological rehab, pediatric rehab, manual therapy, pharmacology etc. It allows for us to cover a lot of information but on a surface level. One of the most neglected areas in PT school is sports rehab, exercise prescription, and ACL rehab. A simple 3 hour lecture is not enough time to learn even the basics of ACL rehab. Unless there has been a strong effort made to learn outside of the PT school curriculum such as becoming a Certified Strength & Conditioning Specialist, most PT's are not well prepared to prescribe exercise for athletes. They tend to be better suited for the geriatric patients and doing manual therapy. What this often looks like is a PT reading off a generic "knee" packet of exercises.
In order to change, we need challenge. ACL tears wreck havoc not only to the muscles and ligaments but to the central nervous system as well (see ACL Tears Are Brain Injury's). Yet, we think 3x10 heel slides will make the changes we need to bounce back from this injury. We need dosages that actually illicit changes. We need challenge if we are going to rewire the brain and restore function. Screw 3x10. How about 3x500? Or 2x1000?
Even in the early stages. We need to be stressing the system enough to actually illicit the changes we are desiring. PT should push you.
ACL injuries are not super straight forward injuries. There is nuance and a certain level of specialization required to be good at it. Most PT patients are too busy to really research and get really good at ACL rehab or sports rehab. 90% of their schedule is older folks with chronic back pain so that is what they will focus on getting better.
Most PT clinics are a mill. One PT for every 2-3 patients 15-30 minutes of one on one attention, generic exercises, passed off to an aide, same boring exercises. If you are lucky to be one on one often times the sessions are shorter or the large portion of the session is spent warming up on the bike or hooked up to a ice/e-stim machine. This is just simply not enough time or attention to kick start your recovery.
Insurance companies and PT clinics are designed to get you back to baseline, or your previous level of function. Once you have achieved that "functional" status you not longer get your visits approved. Baseline is clearly not good enough. Baseline = torn ACL. So not only do we need to get you back to baseline, but we need to surpass baseline and help you level up.
Most PT clinics are best equipped to serve their most frequent customer - the geriatric population. Athletes need athlete rehab. No pink weights, BOSU balls, ice packs and balance boards. We need real turf, real weights, real sports medicine. PT clinics do not have the space or equipment to effectively rehab ACL patients.
Insurance coverage for physical therapy is variable. Often times they offer 20-30 visits a year. ACL rehab is a 9-12 month process. If you do the math you burn visits pretty fast. The "fix" has been to stretch visits. Start going frequently, then gradually decrease to 1x per 2-3 weeks, trusting the patient to "rehab" on their own. This is disastrous to their ACL rehab and often results in ACL patients being months behind. There is nuance to ACL rehab. It is not as simple as "just go get strong on your own".
Bottom line, the physical therapy is by and large not prepared to help ACL patients in the best ways possible. The system has failed these patients and continues to do so. It is no wonder the re-tear rate is so high when you really take a look at the standards of practice among traditional PT clinics. I recommend finding a provider who specializes in ACL/sport rehab to really be sure your recovery is in the right hands. I highly recommend looking into Team ACL to find an ACL provider.
Hope that makes sense! Don't be afraid to ask questions during your rehab process.