The Biggest Mistakes Athletes in Petaluma Make After ACL Surgery

Youth sports in Petaluma and Sonoma County are growing fast.

With that growth comes a reality most families don't expect - serious injury. These injuries are happening more frequently, and earlier, than we've seen in the past. 

Chief among these injuries is the Anterior Cruciate Ligament (ACL) tear. This injury is among the most feared by all athletes, mostly due to the necessary surgical repair and lengthy rehabilitation process that follow. What starts out as a simple cut or change of direction can end with 12+ months before returning to sport. 

Perhaps even worse is the high likelihood for re-injury, injury to their other limb, or a failure to return to sport at all. 20-25% of athletes who have an ACL tear will re-tear that ACL, or injure their other ACL. Another 20% don't return to sport at all. And perhaps most staggering, up to 45% do not return to their preinjury competitive level. 

And here's the part most athletes miss. 

It's not usually the surgery that determines your outcome. It's the rehab. 

We've written a guide on what ACL rehab should look like. Check that out if you'd like more specifics on the rehab process. 

In this article, we will walk you through the most common mistakes we see in ACL rehab, and how you can avoid them. 

What Is An ACL Injury (and Why it Matters for Athletes in Petaluma) 

The ACL is the primary stabilizer of the knee for cutting and pivoting motions, such as changing direction or rapid deceleration. When it is torn, the knee loses stability, and the risk of injury to other structures of the knee (including the meniscus and other ligaments) becomes much more likely. 

When an ACL is torn, surgery almost always follows. A graft is taken from either a cadaver or the athlete themselves, and used to replace the existing torn ligament. 

Unfortunately, this is only the beginning of the road back to sport.

The ligament takes time to heal, and the athlete must work tirelessly to regain the strength, coordination, and explosiveness they had prior to their injury. In addition, they must overcome the mental setback that comes from such a life-altering injury. 

Without proper injury rehab, the Petaluma athlete isn't just limited in their ability to perform, but at a higher risk of future injury as well. 

Why ACL Rehab Is So Challenging for Athletes

As mentioned above, the ACL primarily stabilizes the knee during high-speed change of direction. This kind of force is a prerequisite for sports, especially field and court-related sports. 

The reality of ACL rehabilitation is that it isn't just about one thing, it's: 

1. Range of motion
2. Strength
3. Coordination
4. Balance
5. Power 
6. Conditioning

And so much more. This is similar to other injuries we see - miss one of these and you leave a gap. 

This is the only way to ensure an athlete is ready for returning to their sport at pre-injury levels of competition and performance. 

The number of factors makes it difficult to focus on everything. As a result, the focus often becomes pain-free and 'normal function', meaning the athlete can do most of their prior level activity, including running. However, higher-level items are often forgotten about, or simply time 'runs out' on the rehabilitation process, leaving the athlete unprepared for their return. 

This gap is where most mistakes happen. And most rehab programs? 

They stop too early. 

The Biggest ACL Rehab Mistakes Athletes in Petaluma Make 

Mistake #1: Skipping the Prehab Portion 

Prehab refers to rehab that is completed prior to the actual ACL surgery. This is a critical time period, where the athlete has sustained an ACL injury, but is not yet in the surgical suite for the repair.

This period can last days, weeks, or sometimes months, especially in the crowded orthopedic offices of Sonoma and Marin County. The longer the period of time between injury and repair, the more critical this time frame is for prehabilitation. 

In this time frame, the injured leg starts to atrophy, and often range of motion is lost. 

Done right, prehab helps to speed up the recovery process, giving the athlete an advantage following surgery in regaining control of their muscles, regaining strength, and normalizing gait/movement patterns.

The bottom line: the better you go into surgery, the faster and stronger you come out. 

Mistake #2: Progressing Based on Time Instead of Tests

Let's use 2 athletes as an example, both of whom are 3 months out from surgery. Conventionally, this is the time when we'd consider returning to run. 

One athlete has a 60% difference in their hamstring strength between their surgical limb and non-surgical limb. One has a 8% difference. Which do you think is ready for starting a running program? 

This is the nuance that is needed when looking at the complex rehab of an ACL repair.

If you aren't testing, you're simply guessing that an athlete is ready based on their timeline from surgery.

We believe objective return-to-sport testing is required, not simply a luxury of performance rehab.

In our experience, this is a gross oversight that can lead to setbacks, delays in recovery, frustration, and rehab burnout. 

Mistake #3: Skipping Strength Benchmarks

We know exactly how strong and powerful an athlete needs to be before progressing to running, sprinting, and cutting. 

And with the progression of technology, the ability to confidently and accurately measure strength is possible now outside of just clinical research settings. We can do this in the clinic with remarkable accuracy, allowing us to get precise insights into where a patient is at regarding strength symmetry. 

Again, basing decisions on activity readiness solely on timeline or rough strength estimates is no longer acceptable. At best, you miss the mark, and at worst, you end up putting an athlete back under the knife. 

Mistake #4: Ignoring Power and Explosiveness

Regaining strength and function after an ACL is relatively straightforward, albeit time consuming.

Getting back to a place where the athlete can confidently strength train and run isn't the finish line. It's the starting point to performance. 

Yet, this is where many clinics in Sonoma County and Marin County discharge their athletes following ACL repair. It's not due to a lack of knowledge, but rather a failure for insurance companies to reimburse care beyond these stages. The insurance company views its role to return an athlete to daily function, not to the highest levels of sport.

As a result, power and explosiveness gets swept under the rug, or kicked down the road to someone else. The challenge is that few athletes receive this help before getting back into sport.

As a result, they aren't prepared for the demands, and the sharp increase in the stress sport places on their body puts them at high risk for injury. 

Mistake #5: Returning to Running Too Early

This mistake aligns with the above mistake of failing to accurately test strength. Without knowing if an athlete is ready to run, therapists often start an athlete back to running around the 12-week mark. 

This isn't an issue when strength asymmetry is less than 10-15% between sides. But, without testing to know if an athlete is ready, we might have the athlete with the 60% asymmetry under our watch.

Running carries with it it's own injury risks. And returning to run with this level of asymmetry will certainly cause irritation of the knee, leading to swelling, pain, and delayed progress. 

This setback creates frustration for the athlete and therapist, as they continue to battle the healing of the knee and the timeline of returning to other activities.

As frustration grows, the athlete often begins to feel burnout from the length of the rehab process and the lack of progress being made. 

This can be a slippery slope  - and to avoid it, we must know the athlete's strength/power symmetry rather than using timelines alone. 

Mistake #6: No Structured Return-To-Sport Program

The return to sport should be handled with the same level of precision as the entire rehab process. Too often, once an athlete is capable of returning to practice, therapy ends. The patient is discharged and both parties cross their fingers that the athlete won't end up back in the rehab clinic.

A proper return to sport program should include steps for:  

1. Practice participation
2. Controlled contact drills
3. Limited scrimmages
4. Minutes-restricted competition 

Prior to returning to full competition. 

This step-by-step approach helps to prepare the body for the cumulative demand of sport, but also to help prepare them mentally. 

This last piece is incredibly important during the rehab process, and without a structured return to sport plan, the athlete often ends up tentative and fearful of reinjury.

This changes their mechanics on the field, and increases their risk of injury to their non-surgical knee. 

Mistake #7: Not Having A Clear Plan For ACL Rehab

This one primarily falls on the therapy team. As we alluded to above, the ACL rehab process is a long one. While the therapist may have a clear idea of where the athlete is at in the program, the overall plan is not communicated clearly to the athlete. 

This creates a nebulous structure for the rehab, and can leave the athlete without a clear goal or expectation of the next step in their rehab. Burnout is a huge problem in ACL rehab, and one that must be avoided for a successful and prompt return to sport. 

Clear communication of the stages of care, the criteria for entering and exiting these stages, and the expectations placed on both the therapist and the athlete allows for them to work as a team in the pursuit of returning the athlete to sport at their highest level. 

Failure to do so often derails therapy too early, leading to several of the other mistakes above. 

Clarity drives consistency. Consistency drives outcomes. 

How Performance Rehab Solves This

The biggest difference in performance rehab?

It's the last 30%.

This is the difference between feeling ready and actually being ready. 

Performance rehabilitation focuses on helping athletes prepare for the unique demands of their sport, not just in returning to daily function. As a result, the entire rehab process looks different than the traditional ACL rehab. 

Performance rehab starts off by educating the athlete on the importance of the prehab portion of care. This tees the athlete up to succeed well immediately following surgery, by helping them gain range of motion, strength, and coordination of both the injured and non-injured limbs.

Following surgery, a clear plan is laid out for expectations, with benchmarks included. The athlete is educated on the importance of objective testing, and such technology is made available to them as soon as possible. 

Throughout the rehab program, the athlete is tested before progression is made to higher impact activities, such as running, sprinting, and change of direction. 

During this portion, the athlete is battle tested to ensure that all weaknesses are addressed, including in their upper body and core. Conditioning is used to ensure the athlete is prepared for the unique demands of their sport. Sport-specific power and agility drills are implemented.

Overall, the athlete completes the rehab process stronger and more durable than they were prior to their ACL injury. 

This is where most athletes either become resilient, or become a statistic for repeat injuries.  

How BaseCamp Performance Co. Approaches ACL Rehab

At BaseCamp Performance Co., ACL rehab isn't just about recovery, it's about transformation. 

The first phase of care is about getting back to their baseline.

The second phase is about building a stronger, faster, and more resilient athlete than before. 

Our system for ACL rehab is built on 4 things: 

1. Objective testing
2. Clear progression benchmarks
3. Performance-based training
4. The athlete as a whole 

This is the same framework we use when rehabbing any injury. 

Throughout their care at BaseCamp, athletes receive frequent testing through our VALD technology - the same tech used to assess readiness in professional sport. 

All of our decisions for preparedness are made with the use of this technology, allowing us to ensure that the athlete is ready to run, sprint, change direction, or any other key area within the return to sport framework. 

During our evaluation, we share these benchmarks with our athlete. Specifically, we discuss our framework and goals for each of the following phases: 

1. Gaining back pre-surgery range of motion
2. Gaining back pre-surgery strength
3. Returning to running
4. Returning to change of direction
5. Returning to sprinting
6. Returning to reactive agility
7. Return to practice
8. Return to sport 

By sharing these objectives, we ensure that the athlete understands what's ahead of them, and how we'll work together to make sure with absolute certainty that they are ready to return. 

Our protocols are robust and multi-faceted, ensuring that athletes are physically and mentally prepared for the explosive and unpredictable nature of sport. 

In addition, our athletes transition on to our in-house Strength & Conditioning coach for performance training to become fully prepared to exceed their previous athletic levels. 

Our goal is simple: you won't just return to sport, you'll be better than before. 

We've helped athletes from Petaluma, Rohnert Park, Novato, Santa Rosa, and beyond to help them successfully return to sport and avoid subsequent injury. 

When Should You Seek Professional Help? 

If you're in an ACL rehab program right now, and nearing the end, and you: 

1. Still feel unstable
2. Don't feel 100% confident in your return to sport 
3. Haven't had objective testing done to determine how ready you are to return 
4. Still have pain or fear when running, sprinting, or changing direction
5. Or, you're in the midst of ACL rehab but unsure if you're on track or not

Then it's time for help. If your goal is to return to competitive sport, you need to be tested and pushed to the highest levels. 

Because 'cleared' doesn't always mean 'ready'. 

If you're uncertain on whether you're ready, we can help. During our evaluation, we can test exactly where you're at with your strength and power, and determine if you're on track in your rehab or not. 

If this resonates with you, the next step is simple. Book a Discovery Call with our team. We'll help you understand:

Where you're at

What's missing.

And what it will take to get back to sport safely.