ACL Rehab and Physical Therapy for Girls Soccer Players: Why It's Not Good Enough and the Re-Tear Rate is So High

25 Aug ACL Rehab and Physical Therapy for Girls Soccer Players: Why It’s Not Good Enough and the Re-Tear Rate is So High

Posted at 16:10h in ACL Injuries, ACL Rehab, Blog by erica 0 Comments

The research is clear: athletes who return to sport before 9 months post-op have a seven-fold higher rate of getting a second ACL tear compared to those who delayed their return.

Sadly, more and more girls soccer players return to full playing prior to the 9 month mark.

This is happening due to a few reasons:

1. Health insurance runs out: the patient and their parents use up all of their physical therapy visits around the 9 month mark, sometimes sooner, and do not want to pay out of pocket. More physical therapists are charging anywhere from $175-$200+ hour out of pocket, and at the 9 month mark when athletes are in the late stage of rehab, they should be doing 2-3x a week of sessions. I recommend hiring a certified strength and conditioning professional (whether a physical therapist OR strength coach who has a CSCS) in late stage for two reasons: it could be half the cost + strength and conditioning professionals are certified in the speed, agility, and conditioning required for sport return.

2. Lack of return to play knowledge from the physical therapist and/or surgeon: assessments in rehab are not reliable forms of testing return to sports, due to having no transfer to sport with volume and intensity. The single leg press for 1 rep, for example, tells me nothing about ability to handle over 40 changes of direction in soccer. Too, surgical clearance from the surgeon doesn’t mean cleared to play sport. I’ll go over this shortly on the demands girls soccer players must prepare for in order to go back to full playing.

3. Athlete and her parents are too eager to get back to playing: this is when families rush return to sport so the girl can play the game again as quickly as possible, despite not being fully prepared for sport demands. I can promise you, you don’t want to go through another year of rehab, so wait it out for a few more months. Don’t rush.

Surgically Cleared vs. Cleared to Play Soccer Again

The biggest misconception about “clearance” to play is that surgically cleared means the girl is ready to hit the soccer field again full speed. This is far, far from the truth. Don’t play as soon as your surgeon says you’re “cleared.” Surgeons have no understanding of sport demands and progression to be able to handle them.

Surgically cleared only means that the graft has healed. This is very different than cleared to play soccer again, as soccer is a game that has a plethora of physical demands:

– Changes of direction (hundreds in a game)
– Jumping and landing
– Sprints (around 30-40)
– Covering 4-5 miles a game on average

And these are just the physical demands. The cognitive demands are the hundreds of decisions made during these actions over the course of a game.

If girls soccer players aren’t built up to handle both these physical and cognitive demands = fatigue = re-injury.

This is why the re-tear rate is so high. Because ACL rehab is cut short.

The girl may do a few sets of cuts in the clinic, but oftentimes, I find these not even close to the hundreds of these movements that take place in the game.

Just like we progress strength training volume and intensity so the body adapts to high loads, the same must be done with soccer specific actions during ACL rehab.

Another disaster from most ACL rehab programs is not enough high speed running. This is due to the small amount of turf space in clinics. Most do not have over 30 yards of space for a girls soccer player to get used to running at top speeds then into a hard deceleration, so it begs the question, is her first game back after rehab the first time she is exposed to something this demanding?

And finally, the biggest disaster of all from ACL rehab programs is the lack of building strength relative to body weight. Too often, girls soccer players are not pushed enough on the big lifts like split squats, dead lifts, pistol squats, and they haven’t built up their muscles to handle forces of up to 8x body weight that cause ACL injuries.

Recently, I had a girl who was cleared by her physical therapist for FULL CONTACT before the 9 month post-op mark.

She came to me for a second opinion and I had to tell her to not move onto contact yet because she was wobbling like a tree during my single leg strength tests (a movement quality and mechanics issue that is a huge re-tear risk factor) + she never once dead lifted during rehab to build her hamstrings (a huge strength deficit that’s also a risk factor) + no build up of conditioning and change of direction work to prep for how many reps she will run and sprint in the game.

Adding on, there was no return plan communicated to her team soccer coach here in Tampa. She was just told to go back to practice with no gradual plan in place for small-sided game participation and slow ramp-up of game playing time. This type of negligence only puts her more at risk because she hasn’t been properly built up to handle soccer loads.

Back to strength…

Not only should girls be taught proper movement patterns before getting cleared, girls soccer players must also be pushed on these lifts, and usually this takes going through rehab all the way through to the 12 month mark to safely add heavy loads to the bar and gain some serious strength.

I’ll go more in depth in another blog on standards girls must meet before returning to play, but just realize that a few sets of side shuffles and cuts in the clinic, dead lifts under 100 pounds, and split squats at an itty bitty 40 lbs, do not prepare her muscles for the high forces in the game.

ABOUT THE AUTHOR

Erica Mulholland is a former college 3x All-American soccer player and now Hall of Famer from Johns Hopkins University. She holds a Master of Science in Exercise Science and has been helping female athletes of all sports with speed, agility, strength, power, and conditioning for over 13 years. She works with athletes who want to become stronger and faster, as well as ACL rehab girls soccer players in the later stages (over 6 month mark post-op) who want to return to sport better than they were prior to injury. Whether you’re a fully healthy athlete who wants to become resilient, or an ACL patient wanting to come back better than ever, Erica is here to help. She practices in-person in her gym in Tampa, Florida.

Train with Erica in Tampa Florida for speed and strength training, OR late stage ACL rehab: BOOK Assessment

Need more personalized help from Erica? BOOK A CONSULT HERE