Why ACL Rehab Fails (Part 1 of 2)
Whether you’ve torn your ACL or had surgery to repair damage, there are numerous ACL rehab protocols out there that look promising. However, there are still so many incidences of ACL re-injuries, even after getting an ACL repair and going through a whole program that was supposed to get your knees back to being strong and unbreakable.
So why does this happen? And what’s missing?
The answer to this question is that many protocols are NOT LOADING THE KNEES ENOUGH in order for them to really be strong enough to tolerate the demands that you ultimately want to put on them.
Understanding Knee Valgus
Many ACL rehab programs do a good job of training the body to protect the knee from getting into what’s called valgus collapse. During valgus collapse, your knee is bent and twisted inward (internally rotated and adducted). Getting your knee forced into this position is considered to be the main cause of most ACL injuries. With that in mind, many ACL protocols focus on training your body to AVOID getting into this position.
This type of protocol will emphasize strengthening your hip abductors and external rotations (your glutes) to help you resist being pushed into that valgus (adduction + internal rotation at the hip) position. It is true that training your hip abductors and external rotators as well as other body parts such as your core/torso to resist valgus collapse can help you protect your knee in many situations. Ultimately though, there is a big problem with programs that only focus on this one thing.
Knee valgus is unavoidable!
It is impossible to avoid moving into knee valgus in dynamic events.
If you could, you wouldn’t see so many torn ACLs in athletes of all ages and levels in the first place. The fact that athletes keep damaging their ACL is proof in itself that completely keeping the knee out of that position is impossible.
In some instances in sports or other dynamic activities, your can’t avoid being in that valgus position because it is the position your knee NEEDS to be in because it is the best position to effectively accomplish the task you are asking it to do. One example is when you push off your leg when it’s stretched out to the side ( i.e. football player weaving in and out, or a Euro-step in basketball).
Or what happens when you are pushed by another player? Or if you have to plant and turn quickly?
A well trained hip/knee/ankle complex should be able to withstand these forces and allow for good transfer of energy that doesn’t blow out the knee!
Progressive Adaptation
Progressive adaption is the meat and potatoes of how training works. Per the principle of progressive adaptation, tissues need to be stimulated in order to produce new healthy tissues. In the case of an ACL rupture, the ACL and the surrounding structures that are damaged need to be stimulated with the right amount of load for it to grow back stronger. Just like any other healthy tissues in your body (muscles, tendons, ligaments), in order to gain strength, they need to be exposed to adequate and progressive load to adapt and develop resiliency.
So in an ACL rehab protocol that avoids putting load to the knee in the valgus position altogether out of fear of re-injury, the knee will never get the chance to grow back stronger in this dynamic position!
The solution…
We need to strengthen the knee in and through the valgus position to prevent re-injury! Or in other words, we need to expose the hip/knee/ankle complex to moving well and controlling motion in ALL planes of movement and through all the available range that it has.
No matter how much you train other body parts to protect your knee, in dynamic sporting activities (and sometimes just in life) there will be times where your knee (or other body part) will be forced into a vulnerable position. So it is crucial to incorporate exercises that will stimulate the injured tissue itself to give it a chance to grow back strong. That way, when the knee does get exposed, your body will have the strength and control and your tissues will be resilient enough to protect itself!
We’ll be going into more detail about the types of exercises we do at Victory that can help bullet-proof your knee.