ACL Sprain Rehab

Greetings -

My 14 year old daughter recently sprained her ACL back on 5/28 stretching a double into a triple during a softball game. The orthopedic surgeon said it was a slight sprain, nothing too serious and he thought it would take somewhere in the 3-4 week range for her to get back to practice and all. I figured it would be a good idea to throw a post up here to get some feedback from the community concerning the rehab that she's going to be going through in physical therapy.

A little background on her: She's 5'7" and 170 lbs. and has been lifting with me both at home and at the powerlifting gym I'm a member of since around August of last year. I've had her doing a stretched out version of LP, mainly because of other activities and the crap diet that she eats. Since she is as stubborn as I am, I consider myself super lucky that she listens to me about lifting... so trying to get a kid that doesn't like meat to eat enough protein is probably not going to happen at this age. That said, before the injury she was squatting reps with something like 180 and was able to do a fairly easy single with 225 back in February. Roughly the same numbers for deadlifts.

Now to my question: She's going to a local PT place that both she and her older sister have gone to in the past for other injuries, but her prior visit was before she started lifting. During the first session on Friday they stated that their goal will be to strengthen the rest of the knee to help take the stress off of the ACL so she can return to her normal athletic activities. I'll be the first to admit that I'm not an expert, but my guess is that the unweighted lunges, the less than body weight squats on the Total Gym, and the one legged balance exercises are going to do much for the strength of the muscles around her knee. If she was an untrained individual, quite possible given the "novice effect," but probably not for someone with even her limited amount of lifting progress. However I am wondering if these very things will still be of value as they will give her previously strengthened muscles some stress to adapt to the extra effort that will be required of them to compensate for the weakened ACL?

Thoughts?

Do you see why we hold Physical Therapy in such utter contempt? A girl who is squatting 170 needs her knee "strengthened" with unweighted lunges (these are, of course, perfectly safe for an injured knee), any movement performed on their POS $75 Total Gym, and one-legged balance exercises (which are, of course, perfectly safe for an injured knee). You are about to waste a lot of time and money. I suggest you read more about this.

Is Physical Therapy Fraud? | Mark Rippetoe

Squats and Your Knees | Mark Rippetoe

Thanks for the links, I remember reading those in the past... one of the reasons I figured I should post something here.

It sounds like you are unfortunately in rather typical situation where the amount of stress that needs to be given to elicit an adaptation is being under-dosed by a physical therapist. You need to find a PT that understands implicitly that exercises must be difficult to be effective and how progressive overload works. Remember physical therapy is a service. Since you are familiar with the information on this site you can make a few phone calls and actually talk to the therapist to get a feel wether they could be a good fit for your daughter. A simple question such as do they regularly use barbell squats and deadlifts with their ACL rehab patients could go along way. If it were my daughter I would probably have her ramp sets of 5-8 reps on squats and deadlifts every 48-72 hours. I would be watching for something moderately difficult either in terms of effort or if she was noticeably stress shielding (shifting away from the injured knee) and cutting it at that top set. Somewhere around week 3 I would introduce some type of straight line jogging. Week 4 some type of change of direction in a controlled environment at about 70% effort. After week 4 she has permission from the ortho to return to practice so she should be good to go. I would just keep her strength training like you have after that with the possible addition of nordic hamstring curls as a regular exercise done at the end of training. The above is not medical advice but just a general picture of what you should be looking for and the gist of how I would treat my daughter in this situation. Good luck!

I had ACL reconstruction 18 months ago and listened to the PT for about 8 weeks. I then asked on here and stopped seeing the PT and started squatting and deadlifting. I made more progress in 2 weeks than I had with him. The exercises he was getting me to do were pathetic and they were of no benefit.
I then snapped my Distal Biceps tendon a few months later and didn't even bother with the PT, I used John Petrizzo and my rehab went great. I'm now lifting more weight than I ever have. Just start light and gradually build over time.

And after this, you posted that other question about your neck. Amazing.

I've re-read your comment and realised that I've misunderstood it.

The Chiro said that I've tweaked it at the top where it connects to the vertebrae, so I assumed that it wasn't a muscle tear, maybe I should've been clearer. I've watched ask rip 16 again and you clearly state it is for muscle belly tears. I'm not sure how it connects to the vertebrae and if it is muscle tear or something else.