Mick Hughes:
Sports & Exercise Physiotherapist
M. Sports Physio, B. Physio, B.Ex. Sci.

In a recent survey of 304 non-professional ACLR patients (90% of respondents Australian, nearly 60% female and at the time of surgery average age 25yrs) the authors reported some very interesting findings: - 21% reported a 2nd ACL injury - Contralateral 2nd injury was 2x more likely as 2nd ipsilateral graft injury (67% vs 32%). - Prior to surgery, 87% aimed to return to the pre-injury level of sport; however only 43% of respondents did. - 41% expected to be back at sport betw

I know I bang on A LOT about how important the quads are for ACL rehab (and this won't change anytime soon), but another muscle we need to make sure we don't overlook in ACL injury prevention & rehab is the soleus! Maniar et al (2020) published data on muscle activity contributing to shear & rotational forces across the knee joint during single leg landing. The most interesting finding was that they found the soleus generated the greatest amount of posterior shear force durin

A great study looking at the reliability and normative values of a heel raise test This was a single legged heel raise test to fatigue done on a 10 degree incline at a cadence of 60 beats/min via metronome. 566 participants of a variety of age groups were instructed to lift the heel as high as possible for each heel rise until no further repetitions could be performed, keeping knee and trunk straight Failure was achieved when the subject could no longer lift the heel from the

Usually between months 3-4 post-op ACLR rehab, I'll notice patients getting SICK or SORE; and it's usually a sign that they're cooked and are in need of a temporary break from rehab. There's only so much progressive overload that the body can take, and although it may seem counter-intuitive; having a week off from structured ACL rehab every 6-8 weeks will do you the world of good - both physically and mentally. ACLR rehab is a massive 9-12 month commitment (at least), and it'

After a great "bang for buck" exercise to reduce the risk of adductor-related groin problems in your athletes/patients? Look no further than the Copenhagen Adductor exercise! Haroy et al (2019) showed that the addition of this exercise to "usual" weekly preparation during the pre-season resulted in 41% less adductor-related groin complaints throughout the season vs those who didn't do Copenhagen's. See below to see the programming and dosage. I cover this paper in more detail

Yes, it can. But it's a highly debated topic. Historically, it's believed that ACL healing is impeded by 2 main biological factors: 1) Inability of blood clots to form during the initial phase of healing that results in a lack of scaffolding between the 2 ruptured end-points 2) Layer of synovial tissue forming over the ruptured ACL end points impeding tissue healing. However these 2 full text papers are showing the potential for the ACL to spontaneously heal (in some people)

Do you measure vertical jump/hop ability? This recent paper by Ebert et al (2021) on commonly used hop tests following ACL reconstruction, found that the common horizontal hop tests used for discharge testing may not be sensitive enough to detect residual impairments following ACL reconstruction that often lead to 2nd ACL injury. Considering that the ability to produce (and absorb) vertical force is an important part of most team and individual sports, a single leg vertical h

The phenomenon of maintaining strength by training your UNINJURED limb when your INJURED limb is immobilised is called Cross Education. And it potentially has a powerful effect on overall rehab outcome; especially ACLR rehab. In a recent study by Harput et al (2018), a group of ACL injured patients were divided into 3 groups who all performed the same standardised ACL rehab. However, one group did 3x extra sessions per week of concentric knee extensions on their uninjured leg

For the vast majority of ACLR athletes I manage, this will be the first time ever working with them. For that reason I won't have a database of their previous best strength and performance tests (eg. hop, jump, sprint, fitness tests). And neither will they.. So what Ive been using a lot lately during late stage rehab, and to help me guide return to full training and sport, are normative values from existing research to see what their current performance standards are. It's fa

Pollock et al just published a brilliant piece of research in British Journal of Sports Medicine (BJSM) highlighting that injuries to the intramuscular tendon result in a much slower return to full training in British Athletics athletes. Those injuries classified via MRI as 2C or 3C (as per BAMIC injury classification) resulted in a median return to full training of 35 days and 51.5 days respectively. In contrast, tears in myofascial tissue or at the musculotendinous junction