What is Return to Sport Testing Post ACL like?

Ryan, our 2019 Summer intern, put his legs to the test by going through an abbreviated Return to Sport test by Dr. John Snyder. Continue reading to hear what the test was like with his candid remarks!

Why Return to Sport Testing?

Did you know that ACL injuries account for 50% of all knee injuries? If the ACL is torn it usually requires surgery to return to pre-injury activity level (Joseph et al. 2013). Return to Sport Testing allows the athlete to be led by a Physical Therapist with objective testing to determine their readiness.

What composed of Ryan’s Return to Sport Test?

  • 5 minute warm-up on the Assault Bike
  • Single-leg Squats
  • Lateral Step Downs
  • Single-leg hop for distance
  • Single-leg triple hop for distance
  • Single-leg crossover hop for distance

Note: All hops for distance consisted of 2 warm-up jumps per leg and 3 measured jumps per leg. The best distance was kept.

Single-Leg Squats

Method:  Balanced on one leg with the other leg out in front, slowly squatted all the way down until my butt touched my heel, came back up. Repeated with other leg.

Goal: Complete 5 reps with each leg with no knee valgus or difference in squat depth, and ability to maintain balance throughout the movement.

Reality: I had never single-leg squatted that deep pre or post injury, so it was a little weird. I was able to complete the 5 reps for each leg with no valgus, but with difficulty for both.

Lateral Step Downs

Method: Stood on a ~20 cm step with one leg hanging off, slowly squatted down until the heel of my hanging leg touched the ground, came back up. Repeated with other leg.

Goal: Complete a set of 5 reps with each leg with no knee valgus or difference in strength, no major pelvic tilt or rotation, maintain balance throughout movement.

Reality: This was not that hard for me, I completed them with relative ease.

Single-Leg Hop for Distance

Method: I started on one leg and jumped forward as far as I could, only counts if you maintain your balance on the landing. Repeated with other leg. 

Goal: Jump just as far on one leg as you do the other to demonstrate equal quadricep strength and knee stability, maintain balance on the landing.

Reality: I jumped a little farther on my left (uninjured) leg compared to my right (prev. injured) leg. The difference was about 10-15% in distance. Maintaining balance after the jump was the hardest part.

Single-leg Triple Hop for Distance

Method: I started on one leg and jumped as far as I could three times in a row. I was not allowed to pause in between, and I had to maintain balance on the landing. Repeated with the other leg. Best of my three tries was recorded.

Goal: Jump just as far on one leg as you do the other to demonstrate equal quadricep strength and knee stability, maintain balance on the landing.

Reality: I had never triple jumped before, so it was a weird start. Still, my right leg only got to about 90% of the distance as my left. Maintaining balance was even more difficult on this jump.

Single-leg Crossover Hop for Distance

Method: We laid down a straight line in front of me, I then hopped of one foot to the right, left, and then back to right side if I was starting on my left foot. I was not allowed to pause in between and I had to maintain balance on the landing.

Goal: Jump just as far on one leg as you do the other to demonstrate equal quadricep strength and knee stability, maintain balance on the landing.

Reality: It was another weird exercise for me, but quickly got the hang of it. My legs actually had an even distance on this one, I felt confident executing these simple cuts on my right knee.

Why is Return to Sport Testing important?

  • ACL re-injury occurs 3%-37% of the time (depending on age, competition level, demands) (Losciale et al. 2019)
  • Reduced quadricep strength in the injured leg is a major culprit of ACL re-injury, RTS can help test this
  • RTS allows for a “standardized” test for ACLR patients, rather than strictly recovery time (Snyder 2013)
  • RTS not only good for body, but also your mind

Interested in giving the Return to Sport test a try? Give us a call at 614-850-0500 and schedule at one of our clinics!

References:

  1. Snyder, John, et al. “ACL Reconstruction: When Can I Play Again?” John Snyder, DPT, 5 Jan. 2019, johnsnyderdpt.com/2013/07/29/acl-reconstruction-when-can-i-play-again/
  2. Losciale, Justin M., et al. “The Association Between Passing Return-to-Sport Criteria and Second Anterior Cruciate Ligament Injury Risk: A Systematic Review With Meta-Analysis.” Journal of Orthopaedic & Sports Physical Therapy, vol. 49, no. 2, 2019, pp. 43–54., doi:10.2519/jospt.2019.8190.
  3. Joseph, Allan M., et al. “A Multisport Epidemiologic Comparison of Anterior Cruciate Ligament Injuries in High School Athletics.” Journal of Athletic Training, vol. 48, no. 6, 2013, pp. 810–817., doi:10.4085/1062-6050-48.6.03.
  4. Mcgovern, Ryan P., et al. “Evidence-Based Procedures For Performing The Single Leg Squat And Step-Down Tests In Evaluation Of Non-Arthritic Hip Pain: A Literature Review.” International Journal of Sports Physical Therapy, vol. 13, no. 3, 2018, pp. 526–536., doi:10.26603/ijspt20180526.
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