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Post surgical rehab for athletes at Ryan Monaco Physical Therapy

Why is following a protocol not enough?

Here are three tips while working with athletes in post surgical rehab.

Post surgical rehab for athletes: Why following a protocol is not enough.

If you have ever been trusted with the aftercare of an athlete, most Surgeons will give you their specific rules to follow while treating their patient. These recommendations are based on personal preference, experience, stage of healing for the tissue that was repaired or what the Surgeon saw while performing the surgery.

(On a side note): That is why getting the operative report can be helpful for the therapist to understand why their athlete is presenting the way they are.

Rehabbing an athlete is much different than rehabbing someone from the general public, especially if it’s the athlete’s goal to return to competition. A common misconception when working with athletes is that they are easier to work with because “they can do anything”. That could not be further from the truth.

Let’s get back to the title, why just following a protocol is not enough. Fortunately, but unfortunately at the same time, I have seen many athletes who come to SPI Fitness following their “rehab” that have been discharged by PT but are not ready to return to competition. One reason why we decided to start SPI Fitness was the common trend of athletes returning to sport too soon, getting reinjured or just not performing as they previously did. So how can we improve on this as a profession?

Here are three tips while working with athletes:

1) Treat them like athletes and not like patients.

They are used to being pushed to their limits, they are used to sweating. The regular “3 sets of 10” approach is not enough, push them to fatigue if it’s appropriate, have an understanding of proper rep and set scheme with the appropriate weight or manual resistance to match their goals. As I said before, treating an athlete is much more difficult than someone in the general population.

2) Regardless of what the script says, you are treating the whole body.

I get a lot of post surgical athletes who have undergone ACL repair. Some are multi sport athletes who injure themselves playing football and need to be ready for baseball season. Implementing upper body exercises into their program is imperative for them to return to their sport at pre-injury level. An example of some of the exercises I implement are performing med ball rotational slams, sure you are using the trunk and arms but you are also preparing the knee for any rotational forces they might encounter while playing sports.

3) Gaining confidence is key.

For an athlete, gaining confidence is the most important part of the rehab process. To piggy back on recommendation #2 treating the whole body, you have to treat the mental part of an athlete almost as much as the physical part. For some athletes this may be the first injury they have ever had, couple that with a required surgery, they are missing a significant amount of playing time. From day one my job is to reassure them that they are going to come back better than ever. For an athlete returning from ACL repair, as soon as they are allowed to bear weight on their affected leg, I am pushing them to perform single leg activities, sometimes within the first 4 weeks! Do this and by 9 months they will have no problem “trusting” that knee.

There are literally thousands of recommendations that I could give based on everything that I have learned from working with athletes. These three stick out to me as pretty important pieces of the puzzle and I have never seen them included in any of the protocols that I have gotten in the past 5 years as a Physical Therapist. Start implementing these into your practice and you will start to see better results for your athletes. To schedule an appointment with SPI Physical Therapy or for post rehab training with SPI Fitness contact Ryan Monaco at or call (315) 292-4032.

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