ACL Rehab As rehabilitation professionals and personal trainers, the cornerstone to what we do is apply fundamental principles of exercise with the aim of producing optimal musculoskeletal adaptations, often on a remedial level and enhancement basis. An example of this would be the use of the SAID Principle (Specific Adaptations To Imposed Demands). With specific exercise parameters including intensity and rest intervals, for example, one is able to acquire gains reflective of the levels of the stimuli imposed. Heavy weights and low repetitions with high velocity movements, for example, are ideal to gain power (explosiveness), as lower intensities and velocities are ideal for strength and size.
Although simple in its concept, interesting is the carryover from fitness principles to that of rehabilitative ones. When a tendon has become degenerative or a muscle has been damaged through trauma, and consequently infiltrated with local scar tissue, the ultimate goal is to remodel the damaged tissue. We do this by placing a load to the tissue. Intuitively this doesn’t make sense to most as one would be inclined to think rest would be ideal, but the same way muscle is adaptive to load for strength and size gains, so is soft tissue that has been damaged, so as long as the imposed demand remains therapeutic. Generally we will start with light loads and slowly progress to heavier intensities – a lot similar to the way a novice exerciser would progress.
In rehabilitation science, we have learned to apply the R.I.C.E. Protocol after sustaining an injury. This stands for Rest, Ice, Compress and Elevate. In recent years this acronym has changed, and a newer model has become accepted. This paradigm is referred to as P.O.L.I.C.E, where the O.L stands for Optimal Loading.
What this means is that loading the injured tissue soon after the inflammatory stage (ending by 10 days) provides the stimulus so that the cellular groundwork is laid down properly, in a way that will allow for normal healing. An important part of facilitating rehabilitation is placing the patient in the right healing environment. Beyond eating well, ensuring adequate sleep and not smoking to mention a few, from the perspective of rehabilitation professionals, this means placing the patient in the right loading environment in order the proper stimulus spur on the healing process, all while taking into consideration tissue healing phases. The take home message should be that in order to get a desired result, whether it’s rehabilitating from an injury or becoming more fit, one must consider the demand that will facilitate the desired adaptation. A link between the two worlds is that we must operate at the edge of the client’s capability – we impose a demand on the client that requires skill and experience. That said, it is best to come to a professional who can gauge exercise readiness, acuity of condition, or the extent of a condition in order the right demand be prescribed.
Fortunately, I have partnered up with some of the finest personal trainers in Westchester County. This allows for easy communication and a means to rehabilitate a client and then have the personal trainer enhance their baseline beyond what their pre-injured status presented with.
This entry was written by Dr. Ivan Hernandez, PT, DPT, OCS, SCS. Adjunct at New York Medical College and Mentor for the Orthopedic Residency for NYU’s Physical Therapy Department, Touro College, and Fellowship Program through Evidence in Motion. He is board Certified Practitioner with distinctions as an Orthopedic Rehabilitation Professional and Sports Clinical Specialist.
Dr. Ivan Hernandez, PT, DPT, OCS, SCS, FMS
Executive Park Orthopedic & Sports Physical Therapy LLC