Sports Physical Therapy

Sports Physical Therapy and Rehabilitation are paramount in the successful return of athletes and recreational participants to their activities of daily living or sports after injury or surgical intervention.  While PT has many specialties including cardiopulmonary, geriatrics, neurologic, orthopedic and pediatrics and many settings in which it is practiced from inpatient to outpatient facilities, this website will specifically address Sports Orthopedics Rehabilitation, PT protocols, Case Studies, Education and Research.  While these practices are most often practiced in Outpatient PT Settings, they may also be included with patient care in the industrial work place, fitness centers, sports training centers and athletic training rooms.  Sports physical therapy is relevant for patient care in all of these areas. 

Sports Physical Therapy and Certification

Sports physical therapy includes certifications and credentials from several associations and agencies.  A physical therapist can receive a Sports Certified Specialist credential through the American Physical Therapy Association(APTA) .  Athletic Trainers,  see National Athletic Trainers’ Association(NATA) ,while skilled and experienced in rehabilitation, work typically only with athletes in Athletic Training Job Settings .   They may, however, be supervised as aids in sports physical therapy settings; see the job classification at Bureau of Labor Statistics Physical Therapists.

Sports Physical TherapyWorking  in sports physical therapy as an Athletic Trainer and Certified Pedorthist, I have had the pleasure of working with several world class Orthopedic Surgeons that specialize in Sports Medicine and Sports Injury, including James R. Andrews, MD .  Dr. Andrews is a strong advocate of sports physical therapy for his patients, and has worked with Champion Sports Medicine Birmingham lead therapist, Kevin Wilk, PT, DPT for many years.  It is quite gratifying to work with such exceptional sports physical therapy and sports medicine professionals.  Regarding sports physical therapy, I’ve learned much from Kevin.  My first Knee Course with him was in 1996, and although I thought I had a handle on Ligaments and Muscles, I had an epiphany when Kevin spoke about “Static Restraints and Dynamic Restraints”.  Wow, it all came together.  Since then I have a much better sense of “End Feel”, Range of Motion, especially in the Overhead Athlete and “Low load long duration stretching“!  Kevin is quite a speaker and lectures to physicians, athletic trainers and PTs specializing in sports physical therapy on almost a weekly basis.

Sports Physical Therapy and Common Injuries

Sports Physical TherapyThe most common injuries addressed by sports physical therapy are finger sprains and ankle sprains.  Among the most severe injuries are head and neck injuries and heat stroke.  By far, the most commonly severe is the Anterior Cruciate Ligament Tear (ACL) of the Knee.  The ACL, located in the front of the knee, controls the movement of the knee joint. It limits side-to-side motion and prevents the knee from straightening beyond its normal range of motion.  So there is no better place to start a discussion about rehabilitation than with ACL Post Op Rehabilitation, Recovery After ACL Reconstruction.  The rehab protocol for an ACL reconstruction is usually measured in days post op initially, then weeks post op, and finally in months post op.  Complete rehabilitation will require six months to one year.  The skill of the athletic trainer and the commitment of the patient determine the success of the rehabilitation.  Here is a detailed sports physical therapy protocol for an ACL rehabilitation for the six months following reconstruction.

 The Immediate Post-Op Phase should focus on:

    • Wound Care
    • Ice and Elevation
    • Diminish Inflammation
    • Pain and Swelling
    • maintaining Knee Extension at Zero
    • Passive ROM to 90 degrees
    • E-Stim
    • Quad Sets
    • SLR’s
    • Ankle Pumps
    • Hamstring Stretching
    • Use of crutches
    • Weight bearing as tolerated

Sports Physical TherapyHere is the sports physical therapy protocol for ACL rehabilitation for the first six months post surgery:

  • Week 1
    • Isometric Knee Extensions
    • Mini Squats
    • Weight shifts
    • Standing Hamstring Curls may be incorporated as tolerated. 
    • It’s also most important to continue to monitor the wound and perform Patella Mobilization
  • Week 2 – Week 4
    • Literature supports that the Maximum Protective Phase is 2 – 4 weeks post op ACL Protocols
    • While the progression of exercise is minimal, the repetitive nature of PROM to AROM, Quad Sets, SLR’s, Standing, Mini Squats, Weight Shifts and Hamstring Curls prepare the patient for sophisticated work.
    • Bike can be introduced at Week 3, the patient should be off crutches and full weight-bearing prior to Week 4 as well. 
    • The goal of 0-115 degrees AROM around Week 4 is appropriate. 
    • Pool walking may begin with the physician’s approval at Weeks 3 – 4, but only if the patient’s wound is appropriately healed.
  • Weeks 4 – 8
  • Weeks 8 – 12
    • Eccentric Quad Work may be incorporated along with increased Biking for Endurance and Pool Running. 
    • Stair Master is an appropriate Closed Chain Exercise, along with Calf Raises as appropriate for Quads, Gluts, and Gastrocnemius. 
    • It’s important to incorporate ABD and ADD Hip Exercises as well. 
    • Isokinetic Testing maybe performed at 12 weeks.
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  • 3 – 4 Months
    • Light Activity may be performed. Continue to perform strengthening Quads, Hamstrings, ABD, ADD, Flexion and Ext. Hip, Plyometrics
  • 4 – 6 Months
    • Rehabilitation should focus on Return to Activity Drills. Setting Goals for Isokinetic, Functional and Proprioceptive Test Scores of 85% or Better!  This should be achieved by continued increased intensity of Strengthening, Plyometeric, Running and Agility Drills.
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    • Clinicians should remember that it is well documented that the ACL – PTG Graft is weakest from 3 – 6 Months.  By 9 months, the graft should be completely revascularised and should look and function like a new ligament.

Sports physical therapy is all about returning the athlete or recreational sports participant to a healthy lifestyle.