Phase IV ACL Recovery: Returning to Play After ACL Surgery

Reading Time: 4 minutes
  • Why the phase IV of ACL rehab involves sport-specific activities, plyometrics, and agility drills to build confidence and prepare for returning to the field.
  • How to gradually reintroduce non-contact drills and full-contact practice to avoid ACL re-injury and safely progress towards playing in a full game.
  • What are the things that need to be checked with the physical therapist to have an excellent healing process during the final stage of ACL recovery.

Congratulations – you’ve made it to the end of your ACL rehab! Phase IV is the last stage before you officially get back on the field, and most would consider it to be the best part of the process. Not only is this stage full of sport-specific activities, but it’s also a great confidence booster to make you feel more at ease as you approach the end of your ACL recovery.

Before we dive into the events of Phase IV, take a moment to remember how far you’ve come. From a simple straight leg raise to a weight-based strengthening program to a running program; the past 20 weeks have prepared you for the upcoming sport-specific program. You’ve come a long way, and that’s something to celebrate.

Some things to remember as you progress into Phase IV:

  • Wear your knee brace – that’s a no-brainer.
  • Continue strengthening that knee – yes, you still need to do single-leg raises.
  • Keep working on your balance – you’re all too familiar with those single-leg balancing exercises by now.
  • Maintain the hamstring-to-quad ratio (around 70%) – no shock here, either.

ACL Recovery and Rehabilitation: Let’s Talk About Sport-Specific Movements

Whether you play football, hockey, soccer, or basketball, every sport has specific movements that define it. For soccer, those movements are kicking, cutting, dribbling, and dodging defenders. In volleyball, sport-specific movements include planting and jumping, leaping, and serving. The most crucial part of Phase IV during ACL recovery and rehabilitation is finding a way to incorporate those aspects of your sport into your ACL rehab.

Fortunately, there is a safe way to do this while avoiding injury to the healing ACL reconstruction. To help you understand these concepts, we’ll use soccer as an example.

If you successfully completed your running program from Phase III and achieved other criteria in Phase III, then you’re cleared to do more complex plyometric and agility drills during Phase IV. As with all other phases of ACL rehab, reintroduction to soccer plyometrics and agility drills begins incrementally with low-intensity drills. For example, use a soccer ball to slowly work on your touches and passing skills. Once you’re comfortable with that, progress to shooting drills and dribbling laterally with light cutting.

Your plyometric exercises should be sport-specific as well. Add a passing drill or a dribbling exercise to multidirectional jumps. You can also practice catching balls thrown by your coach or athletic trainer after jumping on top of a plyometric box (this one is particularly fun for a goalkeeper).

How to Return to Practice After ACL Surgery

Non-contact drills play a big part in the progression of Phase IV ACL rehab. Once you’ve gained some confidence from your sport-specific agility and plyometrics activities, you can enter into non-contact drills at practice. The definition of non-contact can vary from sport to sport, but it typically means that you should avoid contact with a teammate, the ground, or objects.

When it comes time to participate in full-contact drills at practice, do so lightly and slowly ease your way into it. Rushing back into a full-contact practice like you never left is extremely dangerous and places you at high risk for ACL re-injury, which is something you definitely want to avoid.

Once you can safely participate in a full practice, celebrate this milestone. This is a huge part of what you’ve been working toward. The next step is your final goal – to play in a full game.

How to Return To Play After ACL Surgery

Just like with every other exercise or drill you’ve encountered throughout your ACL rehab, returning to play after ACL surgery should be done gradually. Just because you’ve been able to complete a full practice without restrictions doesn’t mean you can play all 60 minutes during the next soccer game.

Because game situations can’t always be simulated in practice, start with a scrimmage with your teammates. For your first scrimmage, play for 10 minutes in each half. This is a safe starting point from a physical and mental standpoint. Increase your time on the field with each scrimmage played so long as you don’t experience any discomfort along the way.

Use the same progression when it’s time to play a refereed game. Start with 10 minutes during each half and increase as you feel comfortable. Keep in mind that you’re going against athletes on the opposing team, which heightens the intensity (and risk) of game situations.

The most important thing to do in this stage is to advocate for yourself. If you don’t feel right, tell a coach, teammate, or your trainer. Find the courage to pull yourself from the scrimmage (or the game) if something feels off. Keeping pain or discomfort to yourself is detrimental to getting back to 100%.

What Happens Now?

Now that you’re more active, it’s likely that your knee will be tired at the end of practice. That is usually a good sign since it means you’re getting stronger and steadier on your feet. However, watch out for swelling and pain since those are signs that indicate you overdid it.

You should be feeling pretty confident about where you’re at now. Don’t forget to check in with your physical therapist throughout this phase of your rehab. Although you’re back at practice and not in one-on-one treatment sessions with your PT, you should be touching base every 2 weeks or so as you progress.

Remember – you’re not going to be in the same shape as you were prior to your ACL surgery. Don’t let this discourage you, though. Give yourself grace as you recondition your body to return to your peak athletic shape. As stated earlier, you’ve come a long way, and this is the home stretch.

Once you’ve completed a full game, you have achieved every goal and milestone of your ACL recovery, and there are no additional criteria to move on. It’s been a long nine months, but you did it. You have reached the finish line, and you deserve to celebrate that win. Well done!

Are you or your loved one near the end of ACL recovery? Check out the Return-to-Play program at Myokinetix, part of their comprehensive ACL rehabilitation package. Put your trust in experts who have the expertise and experience to safely get you back on the field after ACL reconstruction surgery. Contact Myokinetix for more information.

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