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ACL tears account for 350,000 surgeries each year.
ACL tears account for 350,000 surgeries each year. (photo: Hannah McCaughey)

Everything We Know About Treating ACL and Tendon Injuries Is Wrong

After most MCL and ACL surgeries, doctors focus on treating and rehabbing the soft-tissue, while almost completely ignoring motor patterns and biomechanics

Published: 
ACL tears account for 350,000 surgeries each year.
(photo: Hannah McCaughey)

New perk: Easily find new routes and hidden gems, upcoming running events, and more near you. Your weekly Local Running Newsletter has everything you need to lace up! .

In the opening minutes of the 2006 AFC championship game between the Cincinnati Bengals and the Pittsburgh Steelers, Bengals quarterback Carson Palmer hurled a 66-yard pass to wide receiver Chris Henry. As Palmer released the ball, 299-pound Steelers tackle Kimo von Oelhoffen corralled Palmer鈥檚 left leg with his right arm, . The instant replay revealed a nausea-stirring inward collapse of the knee, which tore Palmer鈥檚 ACL.听

In the off-season, Dustin Grooms, an intern trainer with the Bengals, watched as the team frantically tried to rehab Palmer鈥檚 shredded ligaments and cartilage. Grooms was baffled by their approach, which included ice, elevation, soft颅-tissue treatment, and strength work. They had millions of dollars at their disposal, yet the techniques they were using, says Grooms, 鈥渨eren鈥檛 any different than what I鈥檇 seen done with college soccer players.鈥 What鈥檚 more, the standard rehab protocol rarely seemed to restore complete stability to the knee. Reinjury was common. Palmer, for instance, .听

Over the past few years, Grooms, now a 32-year-old , has published a series of studies suggesting that for all joint injuries, standard physical therapy isn鈥檛 enough because it fails to address neuroplasticity, the process by which the brain rewires damaged neural connections. If rehabilitation doesn鈥檛 address weak spots left by that rewiring process, returning to the field can be risky. Following typical therapy, the best many athletes can hope for is a joint that鈥檚 weaker than it was before the injury; at worst, it will eventually require more time under the knife鈥.

The key to smooth and effective rewiring, says Grooms, is to apply a stress to brain pathways, which can improve a patient鈥檚 biomechanics. This involves things like sight-restricted lunges and targeted foam rolling, treatments you鈥檙e unlikely to get from most physical therapists.

Following typical therapy, the best many athletes can hope for is a joint that鈥檚 weaker than it was before the injury; at worst, it will eventually require more time under the knife.

鈥淲e鈥檝e become tissue-ists,鈥 says , a physical therapist whose clientele includes the New Orleans Saints, the U.S. Army鈥檚 Special Forces, Tour de France cyclists, and the San Francisco Ballet. 鈥淲e鈥檙e really good at knee surgery and managing tissues after surgery.鈥 Addressing motor patterns, Starrett argues, is just as important, but 鈥渋nsurance doesn鈥檛 incentivize a physical therapist to look at that.鈥 The result, he says, is that the bad mechanics of healing tissues are never corrected, and they remain that way despite rehabilitation, degrading per颅formance and making another injury likely.

There are a few clinical early adopters of the neuroplastic approach. Brad Cox heads the clinic outside Boston and works with runners, triathletes, and Spartan Race competitors. This year, Cox used a custom foam roller to fix the running mechanics of after a back injury. 鈥淚n the science literature it鈥檚 called neuromuscular repatterning,鈥 Cox says. This involves stunningly painful exercises in which you tense up your quadriceps while plunging a lacrosse ball deep into a hip flexor. 鈥淚t increases tension in larger muscle groups and along fascial lines,鈥 Cox says. The upside is that smaller, unused muscles get reactivated. The downside is enduring a program that can feel like torture.

Grooms is experimenting with less painful approaches, including disrupting vision to reactivate latent sensory pathways. In an article in the Journal of Orthopedic and Sports Performance Therapy, Grooms and his colleagues elaborate on how the brain inefficiently relies on eyesight to stabilize an injured joint and how the process of confusing this loop with strobe glasses while rehabbing with drills, jumps, and exercises forces adaptation. 鈥淵our brain lets go of using vision to stabilize the joint and ramps up input from the remaining sensors,鈥 Grooms says. As a result, the body relearns how to use muscles and tendons for stability.

It鈥檚 unlikely that insurance companies will cover this sort of rehab regimen anytime soon; the science on neuroplasticity is too new. But there鈥檚 interest from athletes鈥擥rooms鈥檚 calendar is filling up with presentations at sports-medicine conferences, and Starrett鈥檚 book, , is a bestseller. Perhaps clinics like Acumobility will eventually lead physical therapy out of the RICE dark ages. Below are some tools to aid your recovery.听


Foam Roller聽

础肠耻尘辞产颈濒颈迟测鈥檚听聽begins the rewiring process by assessing where the restriction is. In the case of a torn ACL, this could mean foam-rolling quads with full body weight. From that rather uncomfortable position, a patient flexes and extends the leg for two minutes with the surrounding muscles tensed. Sounds easy, but this is where you enter the pain cave. After two minutes, pay attention to any differences in how it feels to move and any range of motion you may have recovered.

Strobe Glasses聽

聽and his colleagues have produced good results by compounding movement therapies, such as聽multiplanar聽lunges, with the use of strobe glasses like those sold by聽聽($325). The intermittent visuals can decrease feedback to the nervous system, forcing the brain to 鈥渦pregulate鈥 the joint鈥檚 remaining聽mechanoreceptors, essentially bringing the nerve endings back online.

厂辩耻补迟蝉听

聽advocates a lower-tech approach. As soon as healing allows, he recommends daily body-weight squats, with a focus on perfect technique. 鈥淵ou can disrupt your vision鈥檚 involvement by doing one-legged squats with your eyes closed,鈥 he says. 鈥淥r do them while you wash dishes.鈥

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