or Connect
EpicSki › The Barking Bear Forums › Ski Training and Pro Forums › Fitness, Health, Nutrition, Injury, and Recovery › Protocol for ACL injury prevention & Rehab
New Posts  All Forums:Forum Nav:

Protocol for ACL injury prevention & Rehab

post #1 of 8
Thread Starter 
The Stone Clinic in San Francisco is recognized as one of the most cutting edge PT clinics in the US. Their site has some excellent information about ACL injury prevention and rehab. http://WWW.STONECLINIC.COM

Click on the link for ACL injuries

THese words from their site explain it best:

"Protection against ligament injury and early return to athletics after ligament surgery can best be achieved by strengthening the muscles around the knee that act as shock absorbers and joint stabilizers. Specifically, hamstring strength protects the tibia from the anterior translocation that can rupture the cruciate. For instance, when a skier 'catches an edge," the muscular ability to recall the deviant ski is based on the strength of the medial hamstrings. If they are weak, the knee goes into hyperextension, the skier falls, and the "pop and swell" scenario can begin. On the other leg, when the skier "catches an edge," stability is often dependent on the quadriceps and hamstring power for balance on one ski while attempting to reign in the wayward leg. If the quadricep muscles are weak, the leg wobbles under the unexpected load, twists as the skier falls, and "pop and swell" occurs.
Dramatic decreases in knee injuries have occurred after specific knee strengthening exercises have been initiated. The program concentrates on a single stance one-third knee bend performed by bending one leg behind the body and standing on one leg. A series of flexions and extensions from approximately 30 degrees to 80 degrees is performed at a steady rate for three minutes, working up to five minutes on each leg. No specific exercise machines are required, though resistance may be added by using an elastic cord after the initial levels are achieved. Specific hamstring and side to side exercises should be added as a preseason and intra-season workout. A program of 20 minutes a day concentrating on the knee musculature can dramatically increase strength, improve performance, and diminish injuries."

This page explains their rehab protocol, and can answer some of the questions that have been asked in the various ACL threads on this board. http://www.stoneclinic.com/aclrep_rehab.htm

<FONT COLOR="#800080" SIZE="1">[ January 20, 2002 02:18 PM: Message edited 2 times, by Lisamarie ]</font>
post #2 of 8
Lisamarie brings a very important topic up.

Skiers everywhere should be taught how to fall. And, they should be taught how poor technique leads to ACL injuries.

Ski instruction should include ACL awareness. I am going to suggest to HH that he includes falling lessons on his website, in his books and videos. Also, that he point out how technique is not only important for skiing, but for injury prevention during all camps and private sessions.

The video from Vermont Safety Research is a must have for all skiers. I know it changed my life. Then, here's some sure signs of poor technique -- that your risk of injuring your ACL is higher than it should be.

1) Your hands fall behind you.
2) Your hands fall to your side.
3) Your uphill hand falls behind.
4) You turn by dragging your heel over to your new, downhill ski.
5) You find yourself in the backseat.
6) Your pole basket falls behind you.

If anyone of these signs are familiar, your technique is weak and your are dramatically increasing your chance of ACL injury.
post #3 of 8
LM, I thought the only way to avoid skiing-related ACL injuries was to quit skiing!

I agree with what you and SCSA posted. Once you learn the lever action that causes most ACL injuries, you will teach yourself to fall correctly. I usually know when I'm about to lose it, and if I can't recover safely (without over-levering the ACL), I try to fall forward and down. This increases the chance of collarbone/shoulder injury, but I'd much rather injure those two body parts. As a bilateral ACL recon victim, I know exactly how badly an ACL injury can ruin one's fun, not only in skiing but in most any athletic activity.

Hear, hear!
post #4 of 8
Thread Starter 
SCSA, thanks for reposting the Vermont Ski Safety info. I know we did this in a thread awhile back, but with new members coming in, its important to bring these ideas "back to life".

I put in the link to the Stone Clinic's rehab procedure because of something Gonzo said in some thread about making sure that your PT knows something about skiing. These guys do a good deal of work with ski teams.
Although its not important that a PT does EXACTLY the same rehab program, if you look at the Stone Clinic program, you will see an emphasis on balance and proprioception exercise. So, if god forbid you do need PT, this can give someone an idea of what ski specific physical therapy should be like.
If all these injuries keep up, we are going to need an EpicSki directory of Physical Therapists!

I would prefer, however, to make that unecessary!
post #5 of 8
Hi Uncle Crud,
I need your help to guide how to get back safely after 2 nd acl recon.
Both knees reconstructed in only just 16 months.
I had a hamstring autograft. And it is my 6th wk of rehab.
I need to know the sport specific drills, and the best way to improve technique.
Last time I was on Copper Colorado, anybody there to go to for advice when I am back next season?
post #6 of 8
Uncle Crud has been gone from this site for quite some time. Find a great physical therapist for rehab.
post #7 of 8



It's not a surprise that 12 years after Lisa Marie started this thread, the link she's provided has gone stale. However, her advice is still spot on:


Here's an updated link for the Stone Clinic's ACL Reconstruction Rehab Protocol. Their ACL Repair Rehab Protocol is different. While you are at their site I'd also recommend that you read this blog post about visualization skills helping speed recovery. Their info is light on ski specific drills, but this should really depend on your level of ability and is more in the realm of what a Physical Therapist should be working with you to develop. Your PT should develop a custom program for you. If your PT is not a skier, then either they should be consulting with a PT who is or you should be looking for a new PT. When it comes to developing ski specific drills for you, there are tons of threads in this subforum for general ski fitness that are examples of things a PT could focus on.


I am not a PT, but here is what I would be personally be looking for in general. First to consider is a mix of focus on improving aerobic capacity, strength, balance and flexibility. For aerobic development do activities that are fun for you. Personally, I golf at a hilly golf course (walking and carrying), play racquetball and rollerblade. For strength I would look for exercises that work adductors/abductors, quad and hamstring exercises that focus on optimizing the strength ratio (I use hammies 50% as strong as quads, but others recommend up to 75% as strong), hip, core and shoulder exercises (shoulder exercises also work the core and hips). I use free weights to do specific exercises given to me by a personal trainer so that I learned the correct methods. I use machines for general exercises that I've chosen for myself. I love Wall Sits (for 2 minutes), but check with your PT and consider doing a combo of a wall sit and a squat. Squats are great strength building exercises for skiers. For balance focus on single leg exercises with eyes open and closed and use fitness ball exercises. My favorite fitness ball drill is just sitting on the ball with your feet off the floor. A balance drill I use is the yoga warrior pose. For flexibility (beyond the knee flexibility the surgeon is watching) I would focus on ankle range of motion and hips. For ankle rom and balance, I personally use a balance board like the one shown here using single leg and both feet side by side drills to rock fore and aft and side by side with a pause in the middle (balanced position) with eyes open and closed. For hip ROM I use a medicine ball drill like the Russian twist shown on this list of medicine ball drills, but I hold the ball to the chest (make sure not to overturn the shoulders). I also do a drill laying on my back with one leg raised vertically and twist one foot from side to side to rotate my femur. An exercise series that I used during my own knee rehab (but is now replaced by playing racquetball) involves a series of cross over steps or hops forward, backward and side to side (e.g. box drill). When my gym had a slide board, I loved this thing and worked up to using hand weights while I slid. This is a cheaper version of using a machine like a Skier's Edge, Look for a mix of exercises on equipment you need to go to the gym to do and exercises you can do at home with a minimal investment in resistance bands, kettle bells, foam rollers, fitness balls, medicine balls, balance boards etc.


On snow considerations

Vermont Ski Safety has tips for knee friendly skiing. I highly recommend watching their ACL awareness video ($45). A lot of ACL injuries happen because of skiers caught "in the back seat". You can improve your fore/aft balance with drills like 1000 steps, 1000 shuffles (shuffling your feet instead of stepping), skating on flat ground, skate to shape (start skating downhill and slowly transition from skating to turning) and drills to keep your shoulders parallel to the snow surface. I love doing a stretch with skis on where you slide forward on one leg and touch one knee to the ground so that the top of the tip of one ski is touching the snow and the top of the tail of the ski is touching your shoulder (ouch!). Despite all of the work I did for my own knee rehab, moguls were the last step in the process. I felt great when I first got back in them but took it easy, quit after only a few runs and still was completely "knee exhausted" later on in the day.


Hope this is what you were looking for. It should give you lots of ideas you can pick and choose from.

post #8 of 8
Thanks, this excercise list is impressive.
I will definitely check the Vermont site.

I have done most of them at PT after first acl reconstruction, what I have not continued after that was 1 legged jumps, or agility drills.
After completing 6 months of PT, I asked what should I be doing to keep the knee in good shape?
Agility vs strength? Or both? I was told to pay attention to strength.
So after that I kept my routine of:

aerobic warm up: rope jumping or elliptical

Strength: leg presses for quads, prone curls for hamstring, abductors and adductors machines, core exercises, wall sits, different forms of 1 legged squats with weight, step-ups with weight, 1 legged chair stand up, lunges etc

Proprioception : 1 legged squats on inverted bosu ball, balance board squats, 1 legged balance board ball throws.
Agility: none
I have not done jumping at all after PT except for rope jumping. But no single leg hops.

So I have been trying to keep this routine 2-3 x week. I have become stronger, but it still did not prevent my second acl injury on the other knee.
I was skiing in donjoy brace on my reconstructed leg,

Even though I had some minor aches over both knees when skiing, but it never occurred to me to take a break and rest it.
Or watch out to correct myself or call it a day.

Is there acl injury prevention awareness that tells you to stop and rest and go back to square 1 ?
If I look back the only indication of fatigue I had both times was
that I was getting annoyed that my hubby was disappearing far ahead of me, and I couldn't follow closely behind.
And that was becoming irritating.
So if fun is gone I should be gone from slopes, maybe this is my advice for myself for the next time. Brilliant. Still hope to keep both knees in good shape.
By the way.
PT question ? Rehab after acl recon with hamstring autograft.
last time my rehab was delayed, and AROM and strength as I had too much fluid in the knee, after2- 4 weeks I had it drained and since then. I was getting consistently better and better. But that time also they trimmed lateral meniscus.
This time my recovery was faster, but at 6 weeks I went through intense PT, and noticed since 4 days knee became stiffer, more difficulty getting the same ROM, and more pain, now there seem more bulging over side of the knee, may be more swelling, so I started icing more.
Some skiers posted they have a bulge after skiing even 10 years after surgery. It is scary and I hope it gets better and heals altogether. I got advice from my OS PA not overdo it, and slow down if pain is getting worse.
Also I read that the most important predictors of long term good results is terminal knee extension matching the other leg within 2 degrees, and full range of motion (ROM). So I am pushing that heel back into the butt, even if it became more painful. I hope that is still good thing to do. I am at 140-160 range.
Will be back at PT in few days, just getting back to gym before then.
Thanks a lot for your post.
New Posts  All Forums:Forum Nav:
EpicSki › The Barking Bear Forums › Ski Training and Pro Forums › Fitness, Health, Nutrition, Injury, and Recovery › Protocol for ACL injury prevention & Rehab