I Tore My ACL…Now What?

By: Nicole Skipper, ATC

Partial ACL TearFor most athletes, one of the injuries they fear sustaining is a tear of the anterior cruciate ligament (ACL).  Their season is likely over, and they worry their career could be too.  With a rehabilitation process of 6 months to a year, athletes must decide quickly how they want recover.  Listed below are options available to discuss with your physician for surgical and nonsurgical ACL tear repair.

Nonsurgical Treatment:

You do not have to have surgery.  Athletes and non-athletes can live an active lifestyle with a torn ACL.  The deciding factors to determine if it’s safe or to not fix the tear include the amount of instability and surrounding tissue damage.  Partial ACL tears, physical activity with low demand for cutting and twisting, low instability, and no tears or fractures of structures in the knee joint may be reasons to not have surgery.  You will still go through physical therapy with a goal of obtaining pre-injury strength and function.

Surgical Treatment:

Surgery is a common treatment for ACL tears.  “Active patients involved in sports or jobs that require pivoting, turning or hard-cutting as well as heavy manual work are encouraged to consider surgical treatment.”  Lifestyle and activities of daily living are important deciding factors to determine if you should have surgical intervention, not your age.

Once you have decided to have surgery, you need to discuss the best type of repair for your injury, lifestyle, and body.  The first decision is allograft verse autograft repair.  Allograft repair means tissue from another source, such as a cadaver.  ACL grafts from cadaver patellar, hamstring, and achilles tendons can be used in surgery in the same ways as autograft tissues. Autograft repair means using tissues from your own body to replace the torn ACL.  The four most common autograft tissues are the quadriceps, hamstring, patellar tendon, and combination of semitendinosous and gracilis tendons – a technique known as double bundle.

Athletes need to discuss the pros and cons to their surgical or nonsurgical repair of their torn ACL.  They should be prepared to ask questions and understand what their decision means for their recovery process.  An ACL tear isn’t the end of the world, just another challenge to overcome.




Posted in General, Athlete, ACL | Tagged , , , , | Leave a comment

Investing In Recovery

By: Jonathan Starcke, ATC, VATL

Yesterday, an athlete came into the training room while I sat at the desk finishing some paperwork. Not saying a word, he flopped down face-first onto the nearest treatment table and immediately closed his eyes. A few moments passed in silence. I waited. Finally, I asked him if he needed anything. He stirred and sat up. His shoulders slumped and his eyelids drooped. “I’m so tired,” he said, “I never used to feel this tired.” He proceeded to tell me about all of the activities (in addition to sports) that he participated in at school. By the end of his narrative, I was feeling tired too!

“I know you’ve probably heard this before,” I said, “But you need to start blocking off some time for recovery or you will get burned out.” We spent the next few minutes discussing simple strategies he could use to improve his performance without sacrificing his sanity.

1. Prioritize sleep. Morgenthaler et al. (2006) found that “Chronic insomnia is associated with a reduced quality of life, impaired daytime functioning, increased loss of time from work and higher health costs”. An athlete who cannot sleep cannot perform. The Mayo Clinic Staff (2014) recommends using a sleep schedule, limiting alcohol, caffeine, and nicotine consumption, and exercising regularly as methods to improve quality of sleep.

2. Stay hydrated. The International Olympic Committee (2010) recommended that “Athletes should be well hydrated before exercise and drink sufficient fluid during exercise to limit dehydration to less than about 2% of body mass.” This means that an athlete who weighs 150 lbs should consume enough fluids during exercise so that their post-exercise weight loss is less than 3 lbs. Dehydration can adversely affect performance.

3. Eat plenty of food. The IOC Consensus Statement on Sports Nutrition (2010) states that “Dieting in young athletes should be discouraged. Robust immunity and reduced risk of infection can be achieved by consuming a varied diet adequate in energy and micronutrients.” Young athletes have growing bodies that require a variety of nutrients to support not only their athletic performance but also their overall health. An athlete needs nutrients to perform.

Although the advice is simple, it is often neglected. School is a demanding environment. Coupled with athletic participation and other activities it can be difficult for athletes to meet the overwhelming demands on their time and energy. Prioritizing sleep, staying hydrated, and eating plenty of food can help busy athletes continue to perform at their best while maintaining some semblance of sanity.


International Olympic Committee. (2010). IOC consensus statement on sports nutrition 2010. Lausanne, CH: International Olympic Committee.

Mayo Clinic Staff. (2014). Sleep tips: 7 steps to better sleep.

Morgenthaler T; Kramer M; Alessi C et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. SLEEP 2006;29(11): 1415-1419.

Posted in Athlete, Hydration, Recovery, Sleep, Sports Performance, Student Athlete | Tagged , , | Leave a comment

Sleep: An Essential Ingredient to Maximize Sports Performance

By: Sara Rau, DPT

Sleep1When athletes think about ways to improve their athletic performance, they usually think of training, diet and maybe even supplements.  But many don’t realize that sleep is just as important to their performance.  It is recommended that athletes get at least 1 hour of extra sleep than what is recommended of their non-athlete peers.  This can be achieved by going to bed earlier or even taking a nap.

Studies have shown that adults require 7 to 9 hours of sleep/night to reach their peak performance.  However, more sleep is essential for cognitive and physical development of children.  School-aged children ages 6-13 years old require 9-11 hours and teens require 8-10 hours of sleep per night.  This is because the human growth hormone is only secreted during sleep.  This hormone repairs the body as well as is a key factor for growth and development both cognitively and physically.

Sleep2Some studies have looked specifically at the effect of sleep on athletic performance.  They found that an increase in sleep improved speed, reaction time, accuracy of skills, mood, vigor and decreased fatigue.  On the flip side, a lack of sleep can cause slower reaction time, mood disturbances and fatigue.

So in order to help maximize your athletic performance, try these tips:

  • Try to increase your sleep time either with going to bed earlier or taking a nap in the afternoon. Be careful not to take a nap that is too long or too close to bed time to affect your night-time sleep.
  • Try to keep a consistent sleep schedule during the week and keep as close to the same schedule as possible during the weekend.
  • Get yourself in the habit of doing the same routine before you go to bed. This will teach your body that it’s bedtime and get ready to sleep.
  • Avoid caffeine later in the day to avoid affecting your sleep at night.
  • Don’t eat, drink or exercise within a few hours of going to bed. Avoid procrastination and try to finish your homework early to give yourself time to rest your brain before going to sleep.  Try to do calm, quiet activities before bed.
  • Keep a sleep journal or to-do list near your bed. Write down things that are on your mind so that you will have a greater ability to stop worrying or stressing to enable sleep.



Blumert PA, Crum AJ, Ernsting M, Volek JS, Hollander DB, Haff EE, Haff GG.  The acute effects of twenty-four hours of sleep loss on the performance of national-caliber male collegiate weightlifters.  J Strength & Cond Res. 2007;21(4):1146-1154

Mah CD, Mah KE, Kezirian EJ, Dement WC.  The effects of sleep extension on the athletic performance of collegiate basketball players.  SLEEP.  2011;34(7):943-950.

Scott JPR, McNaughton LR, Polman RCJ.  Effects of sleep deprivation and exercise on cognitive, motor performance and mood.  Physiology & Behavior. 2006;87:396-408.

Posted in General | Leave a comment

Pilates Program: 6-Week Program for Athletes

Pilates ProgramFor young athletes, a well-rounded strength and conditioning program can improve sports performance and reduce the risk of injury.  The benefits of Pilates include: improved posture, relaxation and stress management, injury prevention, increased core strength, increased body awareness, and improved recovery after injury. At CHKD, we know that cross-training and exposing children to various types of training can lead to lifelong changes.

This class meets twice a week on Mondays and Wednesdays for six weeks.

Register at www.chkd.org/classes

Posted in ; Athletes, Pilates | Tagged , | Leave a comment

Exercises for a Strong Dancer

By: Erica Walters, DPT

Psoas Isolations – Have the dancer in long-sitting with upright posture.  The dancer turns one leg into attitude.  While having the dancer palpate the psoas, the dancer lifts the leg off the table.  The dancer then holds for a count of 3 seconds before returning to start position.  Repeat 10-15 reps on both sides.

**Performed every day for 6 weeks has been shown to increase developpé height by 6 inches

Psoas Isolation

End position of the leg


Long-sit Turnout – Have the dancer in long-sitting with upright posture.  The dancer places TheraBand around both ankles and abducts legs until resistance is placed through the band.  The dancer then externally rotates legs and returns to parallel.  Repeat for 20-30 reps.

Long-sit Turnout

End position without Theraband


Hip Flexion Holds – Have the dancer in single leg stance.  The dancer grabs one knee with both hands and brings it up to chest.  The dancer then releases the knee without letting it drop.  Begin with a hold time of 15 seconds for 2-3 reps.  Repeat on other side.

**Can also be performed as attitude holds.

Attitude Hold

Attitude Hold


Grand plié – Have the dancer perform a grand plié in 1st position.  Once 1st position is easy and painfree progress to 5th position.  Have the dancer begin on the floor.  Once technique looks good, change the surface to an Airex or foam pad.  Repeat 15-20 times.

2nd Position

5th Position

1st Position

1st Position


Airplanes – Have the dancer begin in single leg stance.  The dancer then places non-stance leg into arabesque with both arms out to the side in a “T” position.  The dancer then rotates in one direction to reach the floor, returns to center, and then rotates in the opposite direction.  A rotation to each side counts as 1 rep.  Repeat 6-8 reps on each leg.

Start position

Start position


Side gait in relevé – Have the dancer in standing with a TheraBand around both ankles.  Patient then raises into relevé (up on both toes) and proceeds to walk sideways.  Have the dancer walk from one end of the room to the other and back for 1 rep.  Repeat 2-3 times.

Start position without Theraband

Start position without Theraband


Relevé with ball squeeze – Have the dancer in double leg stance.  Place a tennis ball between both ankles and have the dancer turn out into a modified 1st position.  The dancer then squeezes the ball between the ankles while raising up into relevé.  Return to start position and repeat for 20-30 reps.

Releve with Ball Squeeze

Relevé with Ball Squeeze


The exercises listed above are just a few of the exercises used for strengthening the dancer patient.  Proper technique must be achieved with all exercises in order for the patient to see a benefit.  If any exercise cannot be performed with proper technique, do not have the dancer continue with that exercise.



Grossman G. Dance medicine: Strategies for the prevention and care of injuries to dancers: The dancer’s hip: Anatomic, biomechanical, and rehabilitation considerations. APTA; 2008.

Liederbach M. Dance medicine: Strategies for the prevention and care of injuries to dancers: Common knee injuries in dance. APTA; 2008.

Molnar M, Bornstein R, Hartog M, et al. Dance medicine: Strategies for the prevention and care of injuries to dancers: Foot and ankle injuries in the dancer: Examination and treatment strategies. APTA; 2008.

Wilmerding V, Krasnow D. Turnout for dancers: Hip anatomy and factors affecting turnout. IADMS. 2011; 1-7. http://www.iadms.org/associations/2991/files/info/turnout_for_dancers_anatomy.pdf

Posted in Dance | Tagged , , | 1 Comment