I had a consultation a while back about my knee issues. I had another read of some of the stuff that Dr. Ray sent me. That conversation made me feel relieved about a lot of things training wise.
I would probably classify myself as a coper who can squat, deadlift, lunge and now I can pistol squat without any pain. I have also managed light jogging.
I started browsing some literature about copers vs. Non-copers. The things that I could gauge where people in the literature have tried ways to distinguish between copers and non-copers.
The main things that I could pick out was that there seemed to be a difference in strength levels and muscle activation in quadriceps and hamstrings between copers vs. Non-copers. The other thing that I saw is that non-copers seem to be less willing to flex the knee.
So my question to you guys. Are there any reliable papers or meta-analysis about this? I am guessing you guys have worked with both copers and non-copers with ACDL, have you ever noticed any common differences between the two groups?
One was a soccer player that sustained a contact knee injury during a game. Went to the ortho with low pain levels, underwent a physical examination and referred to PT with a knee sprain. No imaging taken. Went to a PT, who performed the same clinic based laxity tests.All perceived as unremarkable. Rehab progressed well. I started seeing patient late in the rehab progression. Returned to full practice and games. Late in the season noticed the knee felt “funny” when trying to cut at high speeds. Finished the season and followed up with ortho again. Clinic testing unremarkable. MRI taken just to cover all bases. Absent ACL. Had been playing varsity soccer for a full season without an ACL. The decision was made to pursue surgery since high level soccer was the goal. I saw them pre-surgery for several weeks and you’d never know anything was wrong. After surgery, did well, but noticeable changes in gait and running abilities.
The other “copers” were middle aged folks without sport participation. Just typical household and yard work activities. They did just fine.
I’ve seen a number of others referred for PT status post ACL tear. The non-copers, for whatever reason, really struggled with the feeling of instability (proprioception loss?) with twisting, lateral and unlevel ground tasks. It was never a pain issue or weakness issue so much as a feeling the knee wasn’t their own.
The idea of identifying copers vs non-copers doesn’t interest me much as a clinician. Researchers are interested. To me, the real world application: tear an ACL, send them to physical therapy. If it doesn’t go well, you can always get surgery. At least they got PT prior to surgery. The copers will progress and the non-copers will move on.
The nuanced answer would suggest we can’t rule out a psychological component to recovery from any injury, illness, surgery etc. How much or how little would require very specific research. There has been some literature looking at “kinesiophobia” in copers and non-copers pre and post-reconstruction, but that doesn’t answer your question. In time I suspect researchers may look deeper into the “psychosocial factors” when all “tissue specific” tests and measures have been exhausted.