Our high-performance program is for new and old knee injuries. This program focuses on higher-level rehabilitation, using the latest science, exercises, manual therapy and technology to optimize movement and performance. In this program, general movement patterns and sport-specific movement patterns will be evaluated and specific exercises and therapy are designed to increase performance and prevent injury. At Physioactive, your therapist will look at the whole body, especially the foot, leg, pelvis and low back and integrating the full-body movement. Speed, hand-eye, and brain (nervous system) functions are integrated into your individualized program. Our therapists have backgrounds and experience in a variety of sports including hockey, soccer, baseball, tennis, runners/triathletes and more.
Physioactive’s Approach: Improving ACL outcomes
- Physioactive will bolster your confidence: Current research shows that this is the most important factor, beyond strength. The authors found that confidence related closely to motivation and accountability during rehab. Athletes are known to feel depressed or guilty after an injury for letting down the team. They may also sense that their body has failed them. Your therapist will reassure you that your body is healthy and capable of healing. We will help you to see the long-term picture of an entire athletic career and lifestyle, rather than a single season.
- We will assist with finding resources outside the clinic: An athlete’s access to places and personnel to perform their rehab beyond the physio gym varies wildly. Some have first-rate trainers with well-equipped school gyms while others struggle at home alone with a Theraband. The reality in today’s healthcare environment is that much of the burden of rehab falls on the athletes to do on their own. We will work with your time and money budget to create a successful program for you.
- We help our clients develop a support network: Athletes report feeling alone and often scared after an injury. Talking with someone who has been through it, especially one who has successfully returned to the sport, would go a long way toward boosting confidence and motivation.
- We offer connections to other athletes and clients at Physioactive. Our post-injury support group can act as a local hangout for our rehabilitation clients. Encourage socializing and guide sharing. Teens especially look to their peer group for information and validation.
- We will guide you and your family: Our clients look to their physio to be their guide through the rehab process. Often our clients do not even understand their injury or procedure until they come to PhysioActive.
- We take the time to review the entire process from the moment of injury through return to sport puts our patients at ease and gives them a stake in the process.
- We are your motivator: Sure, physios instruct, but the teaching goes beyond sets and reps. Sometimes your therapist will act as your coach and will figure out what motivates you. If ACL rehab were as simple as executing an exercise-based plan of care, then an artificial intelligence could do it. The fact is, it requires a physio who is in tune with the athlete and understands what drives them to endure the painful and challenging climb back to the playing field to successfully lead the patient through rehab.
- We will alleviate your fears: With goals attained and discharge around the corner, athletes may be at their most vulnerable. Like returning to the scene of a crime, the thought of getting back to real-life sports situations may fill the athlete with anxiety and fear. Assurance with a demonstration of targeted skills they achieved will help the athlete feel confident returning to play.
- We will coordinate your care: Our role as the lead physio on an ACL case is to manage the care of our athletes. This means we will communicate with the surgeon and other providers, such as athletic trainers, coaches, etc about the status of the patient. It also means understanding the patient’s benefits and helping the family make decisions as to the best utilization of those benefits. Advocating for the athlete assures they will receive the best possible care and improves their response to rehabilitation.
- Provide a discharge wellness package: We will rehabilitate you to optimal function. At Physioactive we go the extra mile and take the necessary extra steps to help coordinate care and be sure to send regular updates to the others on the team.
At Physioactive, our approach is to treat the whole client or athlete, looking at the local injury, but also looking at contributing factors of the whole patient will ensure maximal healing. Emerging research is supporting the Physioactive way. Traditional programs appear to be missing the full rehabilitation process. Researchers in Ohio have found what additional factors might influence the outcomes, including the return to sport rates for young adults and adolescents who suffer an ACL injury(1). They explored the patient and parent perceptions of the rehabilitation process and uncovered three significant aspects of the rehab process that impact outcomes.
(1) 2019 Aug;49(8):576Clin Orthop Relat Res.2012 Apr;470(4):979-85 Nurse Researcher. 2015 July 14;22(6):22-27
Here is one example of how PhysioActive will look beyond your injury to restore optimal function and performance.
Protecting the Knee Joint and Preventing Re-injury
Your therapist will evaluate a group of muscles that we need to activate for full knee function. Proper coordinated strength of the foot, hip, and back is needed to protect the knee joint. One example is posterolateral hip muscles.
Superior fibres of gluteus maximus – these hold the pelvis neutral and stop the pelvis from dropping (the Trendelenburg sign) and they also counteract femoral internal rotation.
Inferior fibres of gluteus maximus – these extend the hip and offload the quadriceps from doing too much in the extension phase of running, thus reducing patellofemoral compression.
The gluteus medius and minimus (posterior fibres) – these approximate the hip joint by locking the femoral head in the acetabulum to create a stable hip joint and they also work with the gluteus maximus to hold the pelvis neutral.
Piriformis – this is the major hip external rotator when the hip is going through its flexion to extension movement during the stance phase of running. It prevents the femur from internally rotating.
Deep hip rotators (gemellus, obturators, quadrutus femoris). This work both to approximate and lock the hip joint with the gluteus medius and also work with the piriformis to prevent hip internal rotation.
All of these muscles are important and function synergistically (together) to stabilize the hip and pelvis and reduce forces across the knee joint. Therefore, we should train the muscles in unison for the runner with knee pain as this is the way this group needs to work during the stance phase of running. This also requires good spinal stability.
Isolated exercises such as clams and bridges are great ways to isolate muscles, however we need to progress exercises that will make the muscles work in an integrative way and in a functional way. Therefore, let me suggest a few options for exercises that do this well for the runner.
Suggested Physiotherapy Exercises:
Isolated exercises such as clams and bridges are great ways to isolate muscles, however, we need to progress exercises that will make the muscles work in an integrative way and in a functional way. Therefore, let me suggest a few options for exercises that do this well for the runner.
1. Standing iso-integration of the hip muscles.
With the patient in standing, wrap a band or tube around the top of the thigh and apply a posterolateral force.
The force of the tubing is attempting to pull the client out “through the back pocket”.
This creates an internal rotation/flexion/adduction force on the hip.
This needs to be balanced by an internal muscle force that will externally rotate/extend/abduct the hip. The muscles that do this are all the muscles listed above.
The amount of pull is about 20% of the maximum.
This can be performed as an isometric hold as the patient stands on the affected leg or they can add opposite leg swing to imitate a running action.
2. Triple extension drill
The triple extension drill is an exercise that works to strengthen the hip/knee muscles in the actions they perform during gait, particularly running. The triple extension relates to the three-way action of the calves to plantarflex the ankle, the quadriceps to knee extends and the gluteals and other hip extensors to hip extend.
3. Stand on a step with the affected leg on the step.
Step up in an upward and forward direction using a combination of plantarflexion, knee extension, and hip extension.
The hands need to be placed on a wall for stabilizing balance as well as keeping the forward body lean that will accentuate the hip extension component of the drill.
Once the descent, the focus is on light foot touch of the non-affected leg – almost like you are stepping back onto thin ice. The load and tension should be kept on the affected working leg.
To increase the difficulty and to promote more gluteus medius activation, wrap a theraband around the upper thigh and have a partner hold the band attempting to pull your hip backward and sideways – out the back pocket.
Working on sets of 10 repetitions should be sufficient to fatigue the quadriceps and gluteals.