IN THIS MONTHS MEDICAL DETECTIVE SERIES PREMIER THERAPY SOLUTIONS WILL DISCUSS THE ADVANTAGES AND PRACTICE FOR AQUATIC THERAPY DURING REHAB AFTER ACL (ANTERIOR CRUCIATE LIGAMENT) RECONSTRUCTION. A CLINICAL COMMENTARY CITING Buckthorpe M, Pirotti E, Villa FD. 2019;14(6):978-993.
ACL (Anterior Cruciate Ligament) is a prevalent rehab topic because of how common athletes, workers, and even the layperson will experience an ACL injury. The ACL is a key ligament that controls the stabilization of the knee which blocks an anterior translation of the tibia on the femur. After any ligament injury, reconstructive surgery is paramount, however, the results of the reconstruction are not always flawless. Reinjury can begin and some athletes are not able to resume to the same level of competition they once enjoyed. Leading medical institutions and studies show that only thirty-five to forty-five percent return to the sport.
Knee osteoarthritis can occur at an accelerated rate after an ACL injury. Employing aquatic therapy has started to gain ground in recent years in receiving an optimal outcome with rehab after an anterior cruciate ligament reconstruction. Essentially, rehabilitation through aquatic therapy is a form of rehab that uses a water-based environment for therapeutic purposes. A water environment is highly advantageous after any sports injury because of the properties of water surrounding hydrodynamics, such as buoyancy, viscosity, hydrostatic pressure, gravity, and density. Aside from these properties, another critical benefit is the ability to achieve exercise or activities much earlier in the functional recovery phase than land-based therapy.
Aquatic therapy has the capability to fast-track the ACL recovery process and lessen the recovery time. In-depth and lengthy research was done by Buckthorpe et al. where they studied the benefits and application of aquatics therapy to the functional recovery process during the rehab phase of an ACL reconstruction through a clinical commentary. They closely studied 6 benefits of aquatics therapy which include the reduction of swelling and pain along with restoring the joint range of motion, early introduction of plyometric training, movement pattern/ coordination training, maintenance and or development of the cardiovascular system, recovery of the normal gait cycle, and between-session recovery and optimal load management.
The researchers found that the functional recovery process for anterior cruciate ligament reconstruction, which consists of four phases, is implemented in conjunction with the aquatic therapy program and should be well aligned. The four phases include early-stage rehabilitation which concentrates on resolving the swelling and pain, gaining a better range of motion among other things, the mid-stage rehabilitations focal point is on regaining strength imbalance, late-stage rehabilitation which focuses on movement performance and neuromuscular training, lastly, sport-specific retraining for an eventual return to competitive sports. Based on this, Buckthorn et al concluded a four-stage aquatic therapy program to complement the existing land exercises based on the functional recovery program. They include postoperative pool, movement, and CV conditioning, intense conditioning and field preparation, and recovery pool.
BOTTOM LINE: In my practice I see so many ACL grafts fail as a result of a poor evidence-based return to play rehab algorithms. Patients return to play more often sooner than they are ready and are at high risk of a retear! I ALWAYS pre and post-test my athletes to ensure they are neuromuscularly ready to get back in the game!! Prevention and Applying the research is key to the success of your patients.