Physical therapy, strength and conditioning, and injury prevention are tightly connected in my mind.  It is hard to separate them within my practice because therapy often blends into the other two.   

Individuals with an anterior cruciate ligament (ACL) injury are a great example.   The ACL injury has been heavily researched because of the cost and time required for a full recovery.   Further, the incidence of ACL injury continues to rise despite the efforts of researchers and health professionals.  I have seen athletes recover from surgery and return to play within 6 months but sometimes take up to 2 years (if they return at all).  During that time, it can be hard to tell when the return will happen or when physical therapy is over. 

Is it after full range of motion is achieved or a normal hop test? 

What is there a regression in control and strength on the injured limb?

These questions highlight the fact the tearing the surgically repaired ACL and other injury should be addressed in an ongoing fashion with long term monitoring and management.  No clear endpoint or separation is present that tells us you should be doing therapy, or strength training or focused on injury prevention. 

Numerous factors for individuals that want to remain active should be monitored.  Here is a list (it can vary depending on what you like to be doing):
  1. walking gait
  2. running gait
  3. range of motion
  4. strength
  5. injury history
  6. pain
  7. pain tolerance
  8. fatigue
  9. jumping performance
  10. age
  11. sport
  12. shoes/playing surface
It is hard to monitor all this stuff.  But there should be an effort to understand why you had your injury or what injury is most likely to stop you.  If you are basketball player with poor balance, it is critical you simple balance exercises prior to practice or a game.  Just 5 minutes of this in your warm up can reduce the likelihood of the non-contact ankle sprain. 

If you are a runner, your hip strength is an important factor to constantly monitor.   A simple activation exercise for the glutes can mean the difference between an irritated knee or a good run.

My goal is to work with people over a long period of time.  It reduces injury and corrects problems before they get serious.  This blend of physical therapy, strength and conditioning, and injury prevention may take more effort, but it’s worth it.

Until next time,

Craig Allen Smith

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