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When is it safe for a player to return to the field after an ACL injury? | 90STRONG

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Josh Beaumont's picture

When is it safe for a player to return to the field after an ACL injury?

This is a very challenging question. Sometimes you hear about professional athletes that come back from ACL injuries in 4 months. But most of the time, physicians will clear players to return in the 6 to 9 month range. When physicians try and determine when you are safe to return to the field, they will usually only test the ligaments in your knee as opposed to testing your overall physical ability. They will usually leave this up to the physical therapist or certified athletic trainer to make sure the athlete has regained proper control of the knee prior to returning to soccer. The ability to properly control the knee is important in returning safely to the field (see video for proper knee control). Most non-contact knee injuries result because of this. When an athlete returns to play before re-establishing control of the knee they set themselves up for re-injury of that knee or worse the other knee. This can happen because the athlete is lacking competitive soccer for 6 months and the body has become deconditioned. Returning to soccer prior to re-establishing cardiovascular and muscular fitness can also put the player at risk for other muscle injuries such as a hamstring strains.

The most important question the athletic trainer or physical therapist asks is, “is the knee functional?” I attended a conference a few years ago where a doctor stated that their success rate at 6 months was 66% versus 90% at 9 months. By waiting an extra 3 months, the surgery will more likely be successful because the knee has had time to become more functional. Most people that have torn their ACL will tell you that it takes almost 2 years for the knee to feel the same as it did prior to the injury. I believe a lot of that feeling may be attributed to rushing the rehabilitative process and not properly re-integrating back into sports. 

The video below is an example of a single leg exercise you can do to help regain knee control.

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What An Athletic Trainer Does In Soccer | 90STRONG

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Elysia Tsai's picture

What An Athletic Trainer Does In Soccer

Have you received a phone call from somebody stating to be the athletic trainer working with your son or daughter?  Ever wonder what it is that an athletic trainer does?  Perhaps you only know them as the person who tapes up your child before practice and gives them an ice bag afterward. Or maybe one has worked closely with your child after an injury to return them to play.

The four founders of 90strong.com are athletic trainers and have worked in a variety of settings. From high schools, physical therapy clinics, amateur sports, professional sports, collegiate athletics, sports performance enhancement and for the US sports associations. We have a very diverse background and can adapt to many situations due to our educational and clinical training.

To become an Athletic Trainer you must hold a bachelor’s degree from a college or university that is specifically accredited for the athletic training curriculum. 

Basic and Applied Sciences include:

  • Human anatomy
  • Human physiology
  • Biology
  • Statistics and research design
  • Exercise physiology
  • Kinesiology/biomechanics
  • Chemistry *
  • Physics *
  • * Recommended but not required by some ATEP

Required Professional Content includes:

  • Risk management and injury prevention 
  • Pathology of injuries and illnesses
  • Orthopedic clinical examination and diagnosis 
  • Medical conditions and disabilities
  • Acute care of injuries and illnesses
  • Therapeutic modalities    
  • Conditioning, rehabilitative exercise and referral
  • Pharmacology
  • Psychosocial intervention and referral
  • Nutritional aspects of injuries and illnesses
  • Health care administration

After graduation from college and completion of clinical hours and rotation, you are allowed to apply for and take national board exams administered through an independent company named Board of Certification, Inc.  After you successfully pass the board exam you can distinguish yourself as a Certified Athletic Trainer (ATC).  We are also required to submit 75 continuing education hours every 3 years, maintain CPR for Professional Rescuers and AED certification and standards of practice to maintain our certification.

The National Athletic Trainers’ Association (NATA) has public service campaigns for ACL injuries, back pain, baby boomers, senior falls and youth sports.  Other areas of interest and position statements include topics on concussion, mrsa, sudden cardiac arrest, heat illness, skin disease and sports injuries. This information is free and can be found on the NATA website.

The athletic training profession has come a long way since the days of smelling salts and throwing water bottles. We prep athletes for practice, oversee any injuries that occur and make assessments for further care, create return to play protocols and carry out rehabilitation or corrective exercises for injuries. Most are involved in pre-participation physicals and keep documents on our athletes. Because we are required to maintain continuing education, we keep up to date on the latest treatments, gadgets and advancements in the profession.

 As the parent of an athlete, your interaction with the school or club ATC may be limited. Some schools cannot afford a full time ATC and some clubs operate without one. If you do have access to an athletic trainer, introduce yourself. Find out if the ATC will be present for games, traveling with the team for away games, present during practices, and available after practice hours for any injuries or rehabilitation needed.  We are there to help keep your child safe so they can excel at their game.

Quick facts about athletic trainers:

The National Athletic Trainers Association was started in 1950.

There are more than 30,000 athletic training members, with 26,000 being ATC and the remainder are AT students. 

Currently regulation/licensure for athletic trainers is present in 46 states.

Almost 70% of athletic trainers have a master’s or doctoral degree.

85% of ATC’s practice in the United States.

50% of ATC’s work outside of the school athletic setting.  We can be found in physician offices, hospitals, physical therapy clinics, the military and government branches, commercial settings and professional sports teams.

Athletic trainers are assigned National Provider Identification numbers and have designated Current Procedural Terminology (CPT) codes and Uniform Billing (UB) codes.

Athletic trainers are not personal trainers. We practice under the direction of a physician and recognized as health care professionals by the American Medical Association.

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Using Single Leg Box Squats for ACL Injuries | 90STRONG

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Chris Phillips's picture

Using Single Leg Box Squats for ACL Injuries

Single leg squat exercises serve as a tremendous asset for soccer players that are returning from an ACL injury. This is because the exercise involves a combination of strength, mobility, and stability of both the hip and knee. However, in order to do the exercise correctly, the load placed on the body must be appropriate. Starting off with a modified version such as incorporating a box or chair to sit on can serve as a safe way to start implementing the exercise. Here’s how you do it:

  1. First, find a bench, a box or any stable seat to sit on.
  2. Start the exercise in a seated position such that the injured knee is bent approximately 45-60 degrees with the foot on the ground and the other leg elevated and set your footing in order to stand up using one leg. You can also use the uninjured leg as support by placing the heel on the ground while keeping it straight. As you get more comfortable with the exercise, you should slowly start from a more difficult position- that being to start from a lower position and have your uninjured leg completed elevated.
  3. To execute the exercise, use your glutes and quadricep muscles to lean forward slightly to position your body weight into your working leg/foot and then stand up tall . S
  4. Slowly return to the starting position. Sit your hips back and control the lowering versus crashing down onto the seat.

Perform this exercise on both legs for about 3 sets of 10-15 reps focusing on being balanced and stable. A clear sign that you have to dial it back is if you notice your knees buckling inward or if you are unable to control the descent back into the chair. If this is the case, you may want to start with a higher chair or box or return to a more fundamental exercise such as squats or lunges.

We will discuss how to progress this exercise and modify it in later posts.

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Use this Ladder Drill to Improve Stability and Reduce ACL Injuries | 90STRONG

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Chris Phillips's picture

Use this Ladder Drill to Improve Stability and Reduce ACL Injuries

By modifying the Ickey Shuffle ladder drill, you can improve your knee stability, reducing the chance of injuring your ACL. The athlete will begin on the side of the ladder stepping in with one foot, then the other and transitioning out of the ladder landing on the outside foot. You want to move quickly through the ladder, stabilize and pause on the outside foot. To do this, keep the plant leg beneath you so that the shoulder, knee and foot are aligned one under the other. Repeat to the other side and continue for the length of the ladder. Another important point is to flex the hip, knee and ankle joints so the muscles can shock absorb, protecting the joints, while allowing the athlete to become more balanced. To make the drill more complex, repeat the drill moving backwards.

 

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