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Beginners' Guide to ACL Injuries: Bridging the Gap

Bridging the Gap Between the End of Insurance PT and Full Return to Sport

If you went to physical therapy after surgery (which is what should have happened), what were you able to do when you were discharged? What did your physical therapist consider as reasons for you to be discharged? Did running out of insurance visits play a role in the end of PT for you?

(Please understand, this is not meant to criticize physical therapy or any local physical therapy clinic. This is intended to point out a gap that exists between the end of traditional post-op physical therapy care and your ability to return to sport.)

Traditional PT is more than capable of handling your rehab immediately after surgery. In fact, they may be excellent at it. ACL rehab is a huge part of a physical therapist’s education and the traditional clinic is well set up to meet your needs right after surgery. But when you consider how much work it takes to get all the way back to performing at high intensity levels, traditional PT often falls short. This is for many reasons.


One of the biggest reasons is that your insurance company only cares that you can walk, bend your leg, straighten your leg, and climb stairs. Therefore, once you can do these things, insurance (in most cases) is no longer willing to pay. Because of limitations set by insurance companies, many patients will stop going to PT when insurance cuts them off. Sometimes, this is really early in the rehab process, maybe only 2 months post-op, which limits how far you rehab can take you.

Another reason you may be discharged from PT is that you have demonstrated success, or even excellence, using all the equipment the clinic has to offer. Because most clinics primarily see conditions that affect elderly people, the equipment is limited to meet those needs. When you can effectively perform body weight squats, step ups, single leg balance, weighted leg raises while lying down, your PT may discharge you because they don’t have more advanced rehab to offer. All of these exercises are good to have in your rehab routine, but they are not advanced enough to bring you back onto the field safely.

Traditional PT is excellent at helping regain range of motion, gaining return of strength in your quad muscles, improving your balance, and helping you walk well. But unless you’ve trained your running, cutting, lifting, squatting, sliding, tackling, and agility skills, you will not be able to safely step back onto the field. If you only complete your rehab to traditional PT standards and then return to sport, you may be at a much higher risk for injury than you were right before you got injured.

When a PT is given a referral from your doctor, they are given a specific protocol to follow. That protocol typically only addresses the leg you injured. When rehab is completed on only the injured side you are at a 235% increased risk of injuring your other side. This is because you train your injured leg, make it stronger, faster, more balanced, but your uninjured side continues to rest. It doesn’t get the same level of training. Additionally, the mechanics that existed prior to you having the injury continue to exist after the injury. So unless you train both legs to work together more effectively and with better mechanics, you are setting yourself up to get injured again.

It is also important to consider how much you have rested since injury. You likely took some time off, maybe a few weeks, maybe a few months. If you had surgery, you needed more time off for healing. As rehab began, you were performing exercise at a low intensity: range of motion, weight bearing, gentle strengthening with body weight or Thera-Bands, practicing walking. All of these skills are essential to getting you back to walking and having full motion. But these exercises are not intense enough to be considered “sport.” So this time spent in early rehab, while essential, is also time off from your sport. You spent months not exercising at the level you used to which means you’ve had a lot of time to lose strength, lose cardiovascular conditioning, and lose your sport specific skills. If you go back to sport before retraining these skills you may not be able to keep up, you may not make the team, and you will be at a much higher risk for re-injury.

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Return To Play Elite is equipped to help you practice the skills you need to get back on the field confidently, safely, and with a decreased risk of re-injury. You need to get back onto the field, we intend to make sure you get there in the best condition possible. Because you can’t safely give 100% to your sport if your body is only able to give 75%.

Athletic minds treating athletic injuries.