Late-Stage ACL Rehab - Sub in the S&C

Here is a summary of the presentation “Late-Stage ACL Rehab: Sub in the S&C Coach”:

🎯 Purpose

To highlight key gaps in late-stage ACL rehab and propose strength & conditioning (S&C) solutions to optimize return-to-play (RTP) outcomes—especially in athletes who fail to regain full function post-ACL reconstruction.

⚠️ The Problem

• Up to 25% of elite athletes fail to return to sport (RTS) successfully.

• Young athletes face a 30–40x higher risk of re-injury within two years.

• Current rehab often misses critical physical qualities—particularly in the late stage—because S&C professionals are not integrated early enough.

🧍‍♂️ Case Study: Johnny

• 17-year-old top level athlete, 8.5 months post-op.

• No S&C support; rehab lacked objective data or early-stage exit criteria.

• Jump testing showed:

  • Asymmetry (CMJ: 19.7%; SLJ: 33%)

  • Poor reactive strength (only 4% difference between CMJ and SJ)

  • Low jump heights (CMJ: 28cm; SLJ: 8.15cm)

  • Poor movement quality (forward trunk lean, poor landing strategy)

✅ Late-Stage Entrance Criteria

Before late-stage training begins, athletes should meet criteria for:

• Full ROM and no swelling

• Adequate strength and glute/lower leg capacity

• Proper squat mechanics

• Not based solely on LSI (% limb symmetry index)

🧩 Identified Gaps in Late-Stage ACL Rehab

1. General Strength Gap

   • Lack of sufficient max strength limits explosiveness and resilience.

   • ✅ Solution: Heavy strength training, isometrics, perturbations.

2. Explosive Strength (Rate of Force Development) Gap

   • RFD is often impaired despite adequate max strength.

   • ✅ Solution: Mixed methods—ballistics, Olympic lifts, burst isos.

3. Reactive Strength Gap

   • Poor SSC function & high asymmetries persist.

   • ✅ Solution: RSI-based training, start with low-intensity plyos.

4. Movement Quality Gap

   • Poor motor control and biomechanics not addressed.

   • ✅ Solution: More coaching, supervised reps, technical exposure.

📈 Key Metrics to Monitor

• Jump height

• RSI (Reactive Strength Index) = Jump Height ÷ Ground Contact Time

• GCT (aim <250ms for fast SSC)

• Asymmetry levels (aim <10%)

🧠 Takeaways

• Rehab must go beyond healing and basic function.

• S&C coaches are essential to address neuromuscular deficits.

• Objective metrics, tailored strength, and movement coaching must be included in late-stage ACL rehab.

• Use structured criteria—not time alone—to progress athletes.