ACL Rehab, Soccer player considerations

Training Q&A [Moderated]
1

Hello,

First of all thanks for all the content you provide us in your podcasts and articles, it has been a huge inspiration for me this last year.
I’m working as a Physical Therapist in a Sports Rehab facility where I mainly rehab ACL injuries in an athletic population. I have been for 3 years now (I’m 25) and the first 2 years I was doing most of the rehab things I learned at University, which is BS, it actually embarasses me.
Currently, I’m more efficient with the concept of SRA (still learning) and applying it to the wide spectrum of my patients. I’m also training myself and currently following The Bridge and learning about RPE.
It’s taking me a while to incorporate all the training modalities available with the barbells, because my colleagues see barbell as “DANGER” and I have to cope with them and some patients we are sharing together (schedule thing). But I’m getting there…

The thing is, the current “evidence-based clinical practice” for ACL rehab that I also try to follow, says something like this : progress from bilateral squat 0-60° to 0-90°, then on unstable surface, then with perturbation (lightly pushing the patient) and then throwing a ball at them. If the ball is a basketball and your patient turns out to be playing basketball, Sports Specificity is at its best, right there.

I try to follow as much as I can on Evidence Based Stuff, but as you know, in PT world, it can be quiet disturbing to read this kind of things. I tried to debate with my colleagues that a patient Low Bar Squatting 100 kilos with perfect form is giving me much more confidence then seeing him perform a BW BOSU Squat.
Also, recently, one of my soccer patients told my colleague he couldn’t fit his pants now that he is squatting 2 times a week, which he never did before in his S&C programs.
“Aren’t you afraid he’s gonna be slower with this gain of muscle mass” my colleague, and chief of service, asked.
Now that he’s entering the late phase of ACL rehab 5 months post-op, I’m throwing some sprints in a progressive manner and he feels pretty good already about his speed (but I don’t have the data to support his claim). I also have him perform jumps weekly, BW most of the time, to get some RFD training alongside sprinting.

So my question is, as performance goes after such a rehab, should I be worried about a soccer player gaining some weight?
I often respond that in the US some big guys in the NFL have ridiculously high Vertical Jump and Sprint times but it doesn’t do the job of convincing them. I don’t have data either to show them that 3-4 kilos more on a soccer player didn’t make them slower, after a solid RT program (not just from getting fat after a long rehab).
The only downside that I see of gaining some weight as a soccer player, is to lose some Conditioning and Work Capacity on the field, because obviously you have some more weight to carry around, especially atfer 6-9 months of rehab. But Conditioning is easily trainable and my soccer patients usually feel better one month after Returned to Play, since they mostly needed that specific conditioning “on the field” that I cannot provide them as efficiently.

Thanks for your time, I hope it’s not too long to read!

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Hi there,

Welcome to the forum, we’re glad to have you.

You pose some good questions. I think there’s a lot of room for individual variation here, primarily related to where the player is STARTING from, from a strength standpoint, versus where they’re ending up. In other words, if you have a player who is really weak, the strength benefits may outweigh a small amount of weight gain. Conversely, if you have a player who already possesses sufficient strength for their needs, piling on the weight is indeed likely to set them back.

The bottom line is that, regardless of context, if you stop doing conditioning, your conditioning will get worse. This is not a fault of strength training, in the same way that strength training alone does not make you gain weight – caloric surpluses do.

1 Like
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Thanks for your reply!

I understand what you mean and indeed, it’s a tough call, especially when you have to start them from the bottom-up in ACL rehab (BWBoxSquats then GobletSquats then LowBarSquats 30-50kg) and can’t go first session to the point where the barbell starts to slow down, which usually gives you a good idea of the strength level of the athlete.

The good thing is, 99% of the soccer players that I encounter in rehab never ever had a squat in their S&C routine, even if some of them are professionnals… There seems to have a huge potential in this novice population to the barbells.
Some of them can tolerate 5 kilo jumps for some time and land somewhere between 100 and 130 kilos. But usually after that, they’re back on the field already and the surgeon is telling them they don’t need to rehab anymore. Which means that I often don’t see the end of their customised LP, and they hardly never gain any significant amount of body mass. Most of the strength gains comes from neural drive enhancement and I see it as an important point to make when debating with my colleagues.

As far as prevention to re-injury goes, I read plenty of times that athletes should be able to squat 1.5 to 2.5 times their BW. I’m aware that it comes from early European literature where athletes had to tolerate 1 meter+ drop jumps workouts. But I’m trying to make them reach at least 1 time BW squats before throwing back some plyometric workout after this kind of surgery.
As far as perfomance goes, many of my soccer patients told me they felt like jumping higher and felt more stable on their feet than prior to ACL-injury, which is very nice to hear, but again, I don’t have data to support their claim.

In the end, I think I’ll stick to what I’m doing, and if the weight gain is becoming a problem to the point where it’s setting them back, I’ll adjust their conditioning and worry more about their caloric intake.