♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the Internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the Internet.
- In our opinion of course, Bob.
- Torn ACL surgery, want best success,
you must see this.
Listen to us now and we'll tell you later.
Something like that.
- Well, yeah, there's some good information (laughs)
here from science, recent science on when to start
certain parts of the protocol and when not to if you
want to have long-term success.
- Lotta studies.
- Right.
- Lot of things have been referenced here.
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- Oh yeah!
- Brad, go to work here.
- Yeah.
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If you go to our channel, our website, bobandbrad.
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- Right.
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- Easy to sign up for and we definitely,
people get this stuff!
- That's right.
We're very generous.
- Okay!
- With other people's products!
(laughing)
- Yeah.
ACL.
First of all we're gonna start from ground zero.
Kinda go, ACL ligament, there's a lot of people
that really aren't familiar with it unless you injure it.
Even then you may not know.
It stands for anterior cruciate ligament.
- Right.
- So it's in the knee.
Anterior means front of the knee.
- Right.
- The ligament itself isn't in the front of the knee,
but it prevents the tibia from moving forward.
- Yeah, that's this bone right here.
This bone right here. - Yep.
- It prevents it from translating this way.
- Right.
In the forward direction.
Cruciate.
You know what cruciate stands for?
- Cross, right?
- Yeah, two ligaments that cross.
- Yep.
- So the ACL and the PCL cross, make a cross
in the middle of your knee
so to speak, so there ya go.
And of course ligament is a structure.
Now along with this, so we know where it is.
Like here you have to lift up, get the patella.
- [Bob] Out of the way.
- Out of the way.
And then we got meniscus in there.
And actually there you have the ACL,
they do have it in there.
- [Bob] Oh yeah, sure.
- [Brad] In that little sam, huh?
We didn't even know it was in there.
- [Bob] Yup.
Can you see right there, and right there, the cross?
- [Brad] Can you zoom?
Oh yeah, she's got it.
I wish they had that in a different color.
- Did you see that, just as an aside,
it's usually kind of a devastating injury.
- Right.
- Yeah.
- Well I wouldn't say devastating.
- Well it's devastating if you're an athlete.
(laughing)
It takes a long time to rehab.
- Right.
It does in that way for sure.
- Yeah.
- But you know people can live without an ACL.
- Right.
- Your knee is not as stable.
It's not desirable.
- It could lead to like premature osteoarthritis.
- We don't even wanna go there.
- Yeah.
- But how do they figure out if it is torn?
There's couple ways.
First of all they'll do some manual testing.
The therapist and the doctor, the orthopedic doctor,
they'll do the anterior drawer test.
- Right.
- Anterior drawer?
- Anterior drawer test.
- Yup and there's two or three tests.
And it depends, I've been to a doctor, you know I thought
he was gonna test my knee and he only did one.
I was kinda disappointed.
- Oh sure.
- He said, go get an MRI. (laughs)
- Oh really.
- Yeah.
So the MRI was probably the big one that
they're gonna look at so they can see that soft tissue
and confirm that that ACL is torn.
- And to see what other structures because often
if the ACL is torn something else may have been tore
along with it. - Right.
- Medial collateral. - Right.
- Or the meniscus may have been damaged too.
- Right.
- And the terrible triad as they call it.
- There ya go.
So the MRI is typically the preferred scan.
And then once you confirm you got an ACL tear,
you're gonna go talk to the surgeon.
Don't start talking to other people who had theirs done.
- Right.
- You know to go to someone who looked at your MRI and
is familiar with it.
And if they say they recommend an MRI they may give ya
a couple options of how to repair it.
They may replace that with an autograft.
So that means your hamstring tendon.
There's a hamstring repair.
Or they take the tendon below the patella, your kneecap,
and your tibia, they cut a third of that out and they
may use that method.
- Auto meaning again you're using
your own body parts basically.
- Precisely. - Yeah.
- Or you could use the allograft which is a cadaver.
- Sure.
- In other words they harvest the tendon from a cadaver.
- Right.
- Someone who's died.
They take that part of their body.
- Yeah.
- So that can be a psychological thing for someone.
But you'd talk that over with your surgeon and decide
what's gonna be the best for you.
- Sounds good.
- Now once the surgery is done then you got a number
of months ahead of you to get ready to get back
into your activity.
First of all there's a part in time where after surgery
you're gonna work on range of motion with therapy.
You're gonna eventually work on strength beginning
after a number of weeks.
But there's a point in time where that tendon,
that new tissue actually starts to die off a little bit.
And after about, between six and 12 weeks, there's a point
where it's very weak and what has to happen,
is it has to get revascularized which takes weeks.
- Has to create its' own blood supply, yeah.
- Right.
And then once you get blood supply to tissue then it
can start to become stronger and respond
to therapy much better.
- It's that critical point. - Right.
- Where you don't wanna damage the tendon.
- Right.
- And then you wanna make sure you promote vascularization.
- Right.
And they're kinda vague on this.
But between six and 12 weeks is definitely that.
- That crucial period.
- Right.
That's where you want a therapist to follow your symptoms
and guide you through this particular right manner so you
have successful rehab.
- Exactly.
- So then, once you get,
typically after 12 weeks is when you're gonna start
strengthening and you're gonna start doing some activities,
but in a real structured, regimental manner.
- Yeah, they generally have like a protocol
that we just follow. - Precisely.
- It goes right along and obviously some physicians have
they sorta just have their own protocol, I mean.
- Yeah.
- You need to follow what they're suggesting.
- Right.
The surgeon and the therapist are working together.
They communicate in one form or another.
- Right.
- So they keep you at that precise levels
so you don't injure it.
Now they can go up to, after you get the revascularization.
- Revascularization.
- I need that speech therapist.
(laughing)
There's that remodeling phase and
then the maturation phase.
In other words, when is it complete?
And studies show up to two years, 24 months.
- Wow.
- Before it's completely healed.
- Wow.
Ligament takes a long time to heal.
- Right.
- It's a tough fibrous material so it takes longer.
- Right.
And so the biggest mistake and they mention a study.
Now when I say they I took a continuing ed course
through a gentleman at Stanford, and he was just
labeling off the studies after study after study
to support all this information.
- So he did all the background work on this.
- Right.
- I mean he did.
He looked all the studies which there are hundreds
probably, right?
- Right.
He narrowed it down to some.
- More, more.
- The more recent. - Right.
- And then the more prominent researchers.
And one of the biggest mistakes that someone with an ACL
can do and happen is when they reinjure it is they
go back to the sport too early.
- Sure.
- And the number that they picked was never to go back
to the sport before is nine months.
If you're not at least nine months out,
don't go back.
- And you'll see that on the pro NFL players.
They're never back before nine months.
- Right.
- I mean they're always talking about a year in time.
- Right.
- In fact sometimes it's less than a year but.
So I think that obviously where money's on the line
they're being extra careful and they wanna make sure
you can tolerate.
- Right.
On the other hand they wanna get them back
as soon as possible.
- I know they do.
(laughing)
but they don't wanna reinjure.
- Yep.
And that's the same with most anybody.
You wanna get back to your activity as soon as possible.
And usually by nine months you're feeling pretty good.
You're walkin' pretty good.
But they talked about quadricep strength.
And he said quad is king.
You wanna have a really strong quadricep.
And after an ACL the quadricep will atrophy.
- Oh, atrophy, sure.
- And it will shrink right up.
And then it takes time and a lot of dedicated exercise.
- It's funny I have a patient right now and he really
has had difficulty with his quadricep.
- Sure.
- I mean we are just focused on it.
- Yup.
- Just had done like you said Brad.
It atrophied to the point where you know he could hardly
even sit down without it collapsing you know.
- Sure, yeah.
- So.
- So that's it.
And hamstring strength which does help to support
the ACL. - Sure.
- So you wanna get that going.
So this is something.
- So the biggest point you're taking away here Brad,
is one, don't go back to the sport too soon.
- Right.
- Nine months.
And two you really gotta get that quadricep strength
under control and I'd say three, is there's that critical
period between six and 12 weeks where you really wanna
be careful with the knee and that because revascularization
is taking place.
- Wow, you are an excellent student! (laughs)
- I've just paying attention.
I've been paying attention, so.
(laughing)
- So again this is something you're not gonna do
on your own.
- Right.
- You've gotta.
- You've gotta be guided.
- Yep, you gotta go to a therapist.
Take your time and just be prepared for this time
to go through before you.
- And then the therapist at the end,
he's gonna do functional testing that you have
to pass before you can go back to your sport.
- Exactly, right.
- So that they know that you're gonna feel confident.
- Right.
- That's part of the problem with an injury like this,
you don't trust the knee anymore.
- Right.
- It's gone.
- And you gotta get that guidance.
You know there's a number of tests to go through.
There's the jump test, the hop test.
The LEFT test.
Are you familiar with that one?
- LEFT.
- It's very aggressive.
- No I don't know that one.
- Lower extremity functional test.
George Davies actually made that up.
- Oh he did?
- Yeah, he's very big in the knee in the therapy world.
- Brad studied under George Davies, right?
- Yeah, he was one of my professors.
- Your instructor.
- My instructor for a couple years.
- Notable therapist in the field, so.
- Right.
He's known all the way across the, worldwide actually.
- Sure.
- So take your time with the ACL.
Do more homework and listen to your doctor.
Listen to your therapist and you're gonna have good success.
- Alright remember Brad and I can fix just about anything.
- Except for.
- A broken heart!
- There ya go Bob.
But we're gonna work on that.
- We're gonna work on it day and night.
Thanks for watching.