ACL Rehab Case Study - Part 1

Who: Emmett Andrews, 18 year old Senior at South Eugene High School

Sport: Ultimate Frisbee 

Injury: Non contact full ACL tear of left leg, partial left MCL tear, without Meniscus tear

Emmett Andrews is a phenomenal ultimate frisbee athlete who unfortunately tore his left ACL playing Ultimate in mid July 2023. He initially had some swelling, with limited straightening and bending of the knee. We had our first appointment the first week of August to set him up for some “pre-hab” physical therapy.

What is "Pre-hab"?

“Pre-hab” stands for Pre-Rehabilitation aka rehab before you undergo a surgery. Having full range of motion, reduced swelling and improved strength of the injured leg can lead to improved outcomes and a speedier recovery after surgery! In a lot of cases of ACL reconstruction, surgeons will prefer there to be no swelling and full range of motion before undergoing the repair surgery, and physical therapy is an excellent intervention to achieve this!

In Emmett’s case he had been strength training 2x/week with his ultimate team prior to the injury and came into our first session with a good strength training background. He had been doing the necessary things at home to get his swelling down and range of motion improved. In our first session we did some tissue work to continue to improve this range of motion, as well as started a 4 week strengthening routine to improve quadriceps, hamstring and glute strength going into the surgery. 

Some examples of leg and core exercises

we were doing 3x/week included:

Trap Bar Deadlift

Barbell Squats

Single Leg Squats

Wall Sits

Rear Foot Elevated Split Squats

Plank variations (forearm, side, adductor)

Hamstring Slide outs

Single Leg Romanian Deadlifts

Single Leg Calf Raises

Tib Raises

We also made sure to include some upper body exercises to keep his core and general strength up to par. These exercises included:

Dumbbell chest presses

Dumbbell rows

Pull ups

Pallof presses

On his “off” days of strength training we made sure to sprinkle in some balance training (very important for this to be addressed post op!), and stationary biking to help control his swelling in his knee and to get the joint moving on a regular basis. 

Blood Flow Restriction Training

We also used Blood Flow Restriction training (BFRT) in our “prehab” phases with Emmett. Blood flow restriction training works to induce a ‘hypoxic state’ in your muscles, meaning they are operating with less oxygen. While this seems like it would be dangerous, it actually primes the muscle tissue itself to adapt more quickly, having to work harder and therefore grow stronger with less work! BFRT uses a strength training repetition structure of 30-15-15-15 (75 total) for 6-8 minutes of work! It is a great bang for your buck, allowing you to get more for less. Read more about BFRT and how we use it here.

Emmett was able to work up to multiple 6 minute rounds of BFR during his training days, building both strength and endurance of his quads and hamstrings to help really prepare his system for surgery!

We were able to do a solid 4 weeks of consistent strength training, balance work, cardio and BFR and Emmett went into his surgery stronger than before he even tore his ACL! With all of that hard work and consistency Emmett was really able to set himself up for a successful surgery, so we could hit the ground running post operatively!

Follow along as we update you through his journey back to the field! We will be updating these blog posts at least monthly. Subscribe to our website for notifications when new blog posts go up, and follow us on instagram (@zenith_pnw) to watch this amazing athlete crush his rehab!

Written by Dr. Mariel Hammond, DPT