Knee Injuries Need Extensive Rehabilitation

There have been tremendous advances in the repair and treatment of torn knee ligaments over the years. Knee injuries to Illini football players 50 years ago sometimes ended their careers. Now, most if not all surgically-repaired knees recover fully and return to action. Illini athletic trainer Nick Richey plays an important role in recovery from knee surgery.

The dreaded ACL (anterior cruciate ligament) tear used to scare athletes and fans alike, but not anymore. Improvements in surgical technique and therapy have made these injuries manageable.

Now, fans grow impatient to see their favorite players return to action quickly. They become frustrated when they hear surgery might not take place for a few weeks after the injury. But Illinois athletic trainer Nick Richey explains recovery is enhanced with proper preparation before surgery.

"We call it prehab. Basically, the idea is if we can get them pain-free, if we can get them strong and to the point that they have as much motion as they can possibly get, the idea is the recovery takes a little less time to get back to that point once the surgery takes place."

Once surgery is performed, it is up to the athletic trainer to assist the recovery process.

"The first month post surgery, we're really working hard at getting full motion. Full motion in the first 3-4 weeks is big for us. We want to make sure the knee doesn't get inflamed or infected. We get as much of the swelling out of there as possible, and that the knee is really in great shape at the end of that first month.

"At the end of that first month, we can start to introduce some strengthening activities. We start on a very basic level with table-based knee extensions, calf push-downs, ankle therapy, hip therapy. We try to incorporate everything from the abs down to the ankle, so that at the 8 week post surgery mark, we can introduce more flex strength motions.

"Really, that second and third month, about halfway through the third month, we can start to introduce some strength and balance activities as well. So that by the end of the third month going into the fourth month, we can start some gait cycle stuff. Walking steps, knee steps, backward walking, walking on a treadmill, uphill walking, all that kind of stuff."

Up to this point, there has been no running.

"By about 4 and one half months, we can start to run them a little bit. There are other people that do it sooner. If you interviewed ten different people about ACL rehab, they follow the same path, but there will be different tweaks, twists and turns along the way. I feel like, for the most part, the general protocol is pretty standard."

The knee is healed by this time, but the leg must regain its strength and endurance before it can perform any football-related work. It takes time to rebuild what was lost during the recovery process.

"Between months five and six, you're working on a sport-specific rehab. Put a guy through basic position-simulated drills, different agility exercises, change of direction, speed work. And I think the most important thing is general endurance cardio therapy kinds of stuff. That way, we're really building muscle endurance.

"At this point, a lot of them are really strong, and can essentially do anything asked of them, however, many still lack the endurance to complete a 2 and one half hour practice. They may be able to sustain a 40-45 minute strength workout, but if you put them back out onto a field, their endurance level isn't there."

While protocols have become reliable over time, trainers still look for ways to improve recovery. Richey explains one recent modification to the regimen.

"We start the endurance a little bit sooner now. One guy that we had recently that did very well, we did a knee extension-leg press program with him. His recovery was phenomenal; he did extremely well.

"I think that's something we're going evaluate and continue to do because of the benefits this particular person had from a strength and endurance standpoint. He may not have been a guy who was going out and squatting 500 pounds, but he was leg pressing 300 pounds for 4 sets of 25."

The recovery period varies depending on the individual. The goal is to get them back into their normal workouts with the Strength and Conditioning staff in preparation to resume practicing with the team.

"Once they get really built up, we do a release to the weight room so that they can get back into their normal routine. Somewhere in that same area, as long as their strength numbers are the same, compared on both the involved and uninvolved sides, then we feel pretty good releasing them to practice some of their specific sport and position movements.

"If you look at how well they can do their job, how well they can protect themselves, then you can look at letting them get back to practice."

It is a long process, and some athletes are more dedicated to recovery than others. But most if not all athletes now return to full activity. It may take another few months or even a year for them to feel completely confident in their surgically repaired knees, but they will get there.

Illini football players may spend as much time with Richey and his assistants than they do their coaches. As he explains in part 7 of this 8-part report, he must be empathetic but consistent with them to provide the best care.

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