A late stage ACL programme should be progressive, tailored to individual needs and should be split into resistance-based and field-based programmes. The athlete undergoing the programme should be supervised by a qualified physiotherapist.
The resistance based programme should focus on double and single leg strength progressing on from early stage rehab. The physiotherapist should choose 5-6 exercises to be performed 2-3 times per week. The exercises that are chosen should include two compound movements such as a squat or deadlift and the programme should allow for variety in the movements (front squat, split squat, single leg RDL etc.). The chosen exercises can progressed by increasing exercise load or depth of the movement. The resistance programme should also include single leg power exercises such as vertical jumps, bounds, lateral jumps and combined movements.
It is vital for the programme to address single muscle groups including the quadriceps, hamstrings and calf muscles. The importance of isolated quadriceps and hamstring movements is to prevent muscle strength deficits that may be masked in a squat or deadlift by high levels of hip strength. Finally, bonus exercises including core strengthening, hip and groin strengthening and higher level hops may also be incorporated.
The field-based programme should include a comprehensive warm up and light running drills, high speed running and sprinting which can be progressed to acceleration and deceleration movements, multidirectional movements and finally to sports-specific skills and drills.
Running drills and the warm up may mimic injury prevention programmes like the FIFA 11+ or GAA 15 programmes. This allows the athlete to return to light field-based training without compromising the ACL.
This programme can then be progressed to high speed running and sprinting. The distance and speed should be progressed over a number of weeks and should finish with the athlete reaching 100% of their pre-injury level pace. An example of an initial programme may look like:
- Week 1-2 – 60mx5
- Week 3 60mx5, x2 sets
- Week 5-7 60mx5, x3 sets
- Build 80%, 85%, 90%, 95%, 100%
Acceleration and deceleration may be introduced lightly by incorporating a walk-jog-run-jog-walk type drill.
- Walk 10-15m, jog 25m, run 60m at 80-100%, jog 25m, walk 10-15m of a 130-145m GAA pitch
This drill can be progressed by shortening the distance to reach top speed and then to include short acceleration and deceleration bursts between cones. When an athlete is comfortable with double leg acceleration to deceleration, this should be progressed to single leg. Multidirectional and change of direction movements should be included following successful implementation of straight-line activities.
Finally, sports-specific skills and drills should be implemented including kicking, tackling, falling and rolling. The athlete should then be subjected to inanimate stress 1vs0 (cone) or coach stress (respond to certain skill). They should then be exposed to player stress such as small sided games 1vs1 and progressed to small sides games 3vs3. The direction, speed, distance, combined drills and predictability of the drills should be manipulated to challenge the player. The athlete should be progressed through sport-specific drills/skills phases based on competence, confidence and volume.