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ACL Injury - Do I need surgery?

Shane O'Sullivan • January 30, 2024

So, you have done your ACL.


You felt the pop, your knee collapsed and the pain was excruciating for the first 30 seconds.


You hobble off the field, and thoughts start rushing through your mind…


Oh no I'm going to need surgery!


How much will it cost me?


How long will I be out for?


Thankfully, we now have other options available that heal and rehabilitate an ACL injury without the need for surgery.


One promising approach gaining recognition is the ACL cross bracing protocol, a methodology rooted in the philosophy of facilitating the body's natural healing processes.


Let us delve into the key principles that guide this protocol and explore its significance in aiding the recovery of this crucial

ligament.


Reduce the Ligament: At the core of the ACL cross bracing protocol is the concept of reducing stress on the ligament. By providing external support in the form of a brace, the protocol aims to minimise the strain on the ACL during the healing process. This reduction in stress is crucial for allowing the ligament to recover without unnecessary interference, fostering an environment conducive to healing.


Brace Knee at 90 Degrees:  One of the fundamental aspects of the protocol involves bracing the knee at a 90-degree angle. This positioning not only ensures optimal support but also promotes stability during movement. The brace acts as a protective shield, limiting excessive movement that could potentially hinder the healing process of the ACL.


Brings Ends Closer Together: Another crucial principle is the idea of bringing the ends of the ligament closer together. The brace serves as a bridge, supporting the ligament and facilitating the natural process of reconnecting the torn ends. This proximity aids in the restoration of the ligament's structural integrity, a key component of successful ACL recovery.


Allow the Body to Do What It Wants to Do: The ACL cross bracing protocol emphasises working with the body's innate healing mechanisms. Instead of imposing rigid restrictions, the philosophy encourages allowing the body to

move naturally within the parameters set by the brace. This approach

respects the body's healing instincts while providing the necessary support for an optimal recovery.


Bracing Protocol: Now, let's take a closer look at the specific bracing protocol that accompanies the ACL cross bracing philosophy:


Weeks 1-4 - Locked at 90 degrees, Non-Weight Bearing:

In the initial stages, the knee is secured in a brace, maintaining a fixed angle of 90 degrees. During this time, weight-bearing is strictly prohibited, allowing the ligament to rest and minimising stress on the healing tissue.

Patients are provided a knee scooter to get around.


Weeks 5-6 Week 5: 60-90 degrees, Week 6: 45 -90, Non Weight Bearing:

As the healing progresses, the brace is adjusted to allow controlled movement within a reduced range. Weight-bearing is still restricted to promote a gradual reintroduction of stress on the ligament.



Weeks 7-8  Week 7: 30-full flexion, Week 8: 20-full flexion, Partial Weight Bearing:

Further modifications to the brace accommodate increased flexion of the knee. Weight-bearing is introduced in a partial manner, allowing the ligament to adapt to increased stress gradually.


Weeks 9-10 – Week 9: 10-full flexion, Week 10: full range, Wean crutches:

Continued adjustments to the brace support the progression towards a fuller range of motion. Crutches are gradually phased out as weight-bearing becomes more tolerable.


Weeks 11-12 – Full range, Full weight bearing:

By weeks 11-12, the brace supports the knee through a complete range of motion, and weight-bearing is fully restored. This phase marks the final stages of rehabilitation, as the ligament strengthens and adapts to normal activities.


Week 12 – Remove brace and re MRI:

At the culmination of the protocol, the brace is removed, and you will undergo a follow-up MRI to assess the ligament's integrity. This step ensures that the healing process has been successful, and the ligament was healed strong enough to restore normal activities. In combination, with the MRI, a barrage of other physical tests will be implemented to gauge whether you have the strength, capacity and power to resume higher level athletic activities.


A preliminary study in nearly 400 subjects, showed a healing rate of 90%. (Filbay et al, 2023).


During the 12 weeks of ligament healing, you will partake in a graduated rehab strength and power program.

At the end of the 12 weeks, the brace is removed and high end jumping, landing & sport specific drills will be undertaken.

Pending progress, competitive sport may resume at 9 months, similar to the low end of return to sport for ACL reconstruction. However, there is a leaning toward potentially getting back quicker than 9 months!


Some really exciting developments in the realm of ACL injury management!


Filbay SR, Dowsett M, Chaker Jomaa M, et alHealing of acute anterior cruciate ligament rupture on

MRI and outcomes following non-surgical management with the Cross Bracing ProtocolBritish Journal

of Sports Medicine 2023;57:1490-1497.


December 18, 2024
New year, new you! The new year is a chance to rest, reset and create some resolutions (if that’s your thing). Whilst we’re big advocates for creating rehab goals all year round at Life Performance Sports Medicine, this might be the opportunity for you to create your own rehab goals. Have you been putting up with a niggle, pain, or problem for weeks, months, or even years? Is it something you are just attributing to old age, ‘wear and tear’ or a previous injury? It can be exhausting and frustrating putting up with pain, and it is easy to lose hope that it may not improve. We see many people who put up with pain for far too long before they do something about it. If this is you, keep reading! Conditions such as osteoarthritis are commonly seen as issues that will simply run their course, and there isn’t much you can do to stop them aside from wait for a joint replacement. This simply isn’t true. Whilst it may be extremely frustrating to put up with a sore shoulder or knee for years, or not be able to do the things you love, there is always something we can do to get your pain and level of function heading in the right direction. Whether it be seeing our dietician, Meagan, to help you eat and feel better Seeing one of our physiotherapists to come up with a targeted exercise program for you Having one of our podiatrists review the role that your footwear is playing in your condition. Whichever option it is, there are many avenues you can explore to improve your pain, all under the one roof . When it comes to exercise, we have a number of dedicated programs to meet your needs and improve your pain. We offer the GLA:D program, a proven exercise program aimed at knee and hip osteoarthritis. It has been rolled out across the globe and has been shown to reduce pain by an average of 36%! We also offer our very own Bones and Brawn program, which is aimed at individuals with Osteoporosis or Osteopenia. It focuses on improving the strength of your bones, boosting your mobility and assisting you with functional, day to day activities.  So, use this festive season to relax, spend time with family and enjoy the sun, but I’d also encourage you to reflect on how your body is feeling, and more importantly, if it is holding you back from achieving your goals. Let 2025 be the year you get your body feeling like it used to!
December 10, 2024
Low back pain (LBP) is often dismissed as just a sore back that will go away on its own. But for many people, LBP can become a persistent, life-altering condition that goes far beyond a simple ache. The reality of chronic LBP is complex. It’s not just about the physical pain—it’s the ripple effects it creates across all areas of life. Tasks that used to be second nature, like picking up groceries or playing with the kids, suddenly feel monumental. Sleep becomes a nightly battle, with pain waking you at every turn. Over time, the frustration of dealing with constant discomfort can wear down even the most resilient people, leading to anxiety, depression, or a sense of helplessness. And the challenge doesn’t stop there. For many, LBP brings the fear of movement—an instinctive worry that bending or lifting could make things worse. Ironically, this avoidance often leads to stiffness, muscle weakness, and even more pain in the long run. It’s a vicious cycle that can feel impossible to break. So what’s the solution? Thankfully there is light at the end of the tunnel if managed correctly. The key is to treat LBP holistically . This means more than just pain relief—it’s about addressing the root causes, improving mobility, and rebuilding strength and confidence. Physiotherapy plays a vital role here, with targeted exercises and strategies that empower you to move safely and effectively. Education is another powerful tool, helping you understand your pain and how to manage it. Remember, LBP isn’t just a “bad back.” It’s an individual experience that affects different people in different ways. What works for one person, will not work for the next. Knowing which lever to pull at which time, is something that Life Performance clinicians know too well. Which exercise, how much and how often? Does the patient need psychological support? Do we need to empower the patient with confidence to move again? Are there fears and anxieties that must be faced & overcome? All of these questions are front of mind during a low back pain initial consult with our all star clinical team at Life performance. With the right support, you can break free from pain and get back to living life on your terms. Let’s work together to make that happen.
October 22, 2024
You’ve probably heard of Osteoporosis . It’s a relatively common condition affecting up to 1 in 4 women and 1 in 16 men over the age of 50. Osteoporosis is characterised by poor bone quality, making them more prone to breaking . Whilst nutrition and supplements such as vitamin D, protein and calcium are super important in improving health for people with osteoporosis, the importance of exercise is often overlooked. If you have osteoporosis, pause and reflect for a minute: what exercise do you do? How often do you exercise? When was the last time you lifted weights? When it comes to osteoporosis, unfortunately, walking your dog around the block won’t cut it. There are two forms of exercise which are really effective at improving bone health: Heavy Strength Training Jump Training / Plyometrics Heavy Strength Training involves lifting or moving weight, whether that be our own bodyweight (e.g. squat), or external weight, (e.g. a dumbbell bicep curl). Whilst this seems easy enough, the keys are how much weight we move, and how often strength training is completed. Bones and muscles get stronger when exercises are challenging , and when we experience significant fatigue. Strength training should also be completed at least 2-3x per week to maximise strength gains. Plyometrics, or jump training, involves rapid movements such as jumping, hopping or moving things quickly and powerfully . These kinds of exercises might seem a little optimistic or even dangerous, particularly if you are someone who struggles with your balance or mobility. Don’t worry, when completed under the guidance of one of our physiotherapists, they are a perfectly safe and effective exercise to improve your bone strength. Plyometrics are great to stimulate new bone growth, which is exactly what someone with osteoporosis needs! So where do you start? Our Bones and Brawn Exercise Program may be the solution you’re looking for. It’s been specifically designed by our physiotherapists to focus on key movements and areas that are prone to osteoporosis. See here to register your interest: Bones and Brawn Exercise Program If nutrition such as a Vitamin D, Calcium or Protein deficiency are part of the problem, we have just added a Dietician to our team! Meagan can help ensure your diet is ticking all the boxes to keep your bones in tip top shape.
October 22, 2024
Running success isn’t just about clocking miles—it’s a balancing act between pushing your body to its limits and staying injury-free. The secret? Tuning into both your internal environment —muscle strength, tendon elasticity, and explosiveness—and the external environment of footwear, surfaces, and recovery strategies. Internal Factors: Building Resilience Your body’s internal strength determines how well you absorb the impact of running. Muscle strength powers your stride, while tendons act like springs, releasing energy. Proper stiffness and ground contact times boost efficiency, while explosiveness (muscle power) enables quick acceleration. A strong aerobic system and good bone health are essential to keep your body resilient against the constant demands of running. While an element of internal resilience stems from genetics, a large part of how healthy and robust our body tissues are, is determined by physics! Forces that we put on our body - whether it be lifting weights, jumping rope or doing sprints, play a major role in how strong our tissues are. The classic example of a 30 year old who takes up running for the first time after being a competitive swimmer their whole life, can encounter issues with weaker bones and might be at a greater risk of developing a stress fracture. External Factors: The Environment Around You Your running environment is just as important. The right footwear supports your foot type and stride, while different surfaces (e.g., trail vs. pavement) impact joint stress. In fact, its variability in surfaces that wreaks the most havoc with causing injury. Lesson here is to keep a consistent surface. Smart programming —including rest days—helps you push yourself without going too far. Proper recovery , including time for your body to recover after a long or strenuous run, is crucial to let your body heal and adapt. Running Mechanics: The Cadence Sweet Spot Running mechanics play a major role in keeping you injury-free. Key adjustments like reducing stride length and increasing cadence (steps per minute) to around 160-180 can improve efficiency and minimize joint strain. Using a metronome or BPM music can help you lock into this rhythm and avoid overstriding, which commonly leads to overuse injuries. This tweak not only protects your joints but also helps optimize energy use for faster, smoother running. Finding the Perfect Balance There’s no one-size-fits-all when it comes to running technique. However, if you’ve struggled with injury or are currently dealing with one, analysing and adjusting your running mechanics is essential. Consulting with an expert clinician at Life Performance is crucial. Running is all about balance, and with the right combination of internal strength and external support, every step you take counts.
By Shane O'Sullivan August 21, 2024
The Melbourne Marathon is just around the corner. For our running die-hards out there, Christmas has indeed come early. Whether this is your 15th consecutive marathon, or you’ve made a last minute decision with your friend to join in the fun, your preparation in the lead up is equally as important. Marathons can be a truly taxing experience on the body . Cramps, blisters and general soreness are almost a given, however, more serious injuries like a stress fracture or Achilles tendinitis / tendinopathy can be significantly reduced with a well- designed training program. As physios, our role is often dealing with the aftermath of these injuries to help you get back out onto the track. However, as the old age goes, prevention is better than cure! That is the main purpose of this article, so continue reading to learn how you can avoid coming to see us in the first place! Acute: Chronic Workload Ratio You may have heard of the Acute: Chronic Workload Ratio (ACWR) . It sounds complicated, but it is relatively simple. Think of it as how much running you are doing in the short term (normally the past week), compared to how much running you have done in the long term (normally the past month). For example, if you normally run 10km a week, and suddenly you run 20km a week, your ACWR will be quite high. If you normally run 10km, and then next week you run 12km, your ACWR will be much lower. So why is this important? Monitoring our ACWR and keeping it at a consistent level is really important to reduce the risk of injury . Our bodies don’t tend to react well to spikes in training, and many injuries we see as physios result from an error in the athlete’s ACWR . To keep on top of this, use technology like Strava or a fitness watch to keep an eye on any big spikes in your training load. Planning out your running in advance (e.g. creating a running schedule) can also structure your training program so that the lead up to the big day is as smooth as possible. The importance of strength and link to performance Strength training and runners used to be treated as polar opposites. Strength training makes you really big, strong and heavy, whereas runners need to be quick, nimble and light on their feet – why on earth would they lift weights in a gym? We have fortunately moved on from this old dogma and come to realise that the message is really clear: Lifting weights significantly reduces your injury risk, whilst also boosting your performance. It’s a double whammy of the highest order! If you are someone who is repeatedly injured, or you feel that your running program is top notch, but your times have plateaued, strength training may be the answer for you. If you are new to strength training and don’t have access to much equipment, perhaps start with 2 sessions a week focussing on key movements like calf raises, lunges and squats. If you really want to maximise the benefits of strength training, aim for 2-3x per week of legs and abdominal work. I’d also do a combination of lifting really heavy (eg 3 sets of 4-6 reps) and endurance training (eg 3 sets of 12-15 reps, using a lower weight) across the week. So, there you have it. If you would like some guidance with preparation for your marathon, or don’t quite know what to focus on in your gym program, our team is here to help. Happy running!
By Shane O'Sullivan May 17, 2024
The thrill of competitive sport. A physical outlet for most to expel their built up energy. Engaging in contact sports like football, soccer, or hockey can be exhilarating, but it also comes with risks , especially regarding head injuries like concussions . Knowing the signs & symptoms of a concussion is crucial for players, coaches, and parents alike. Signs to Watch Out For: Headache: Persistent or worsening headache post-impact. Nausea or Vomiting: Feeling sick to the stomach or vomiting. Confusion: Disorientation, difficulty focusing, or feeling mentally foggy. Dizziness or Balance Problems: Trouble standing or walking steadily.  Sensitivity to Light or Noise: Irritation or discomfort in response to light or sound. Memory Problems: Difficulty remembering events before or after the hit. Changes in Behaviour: Unusual irritability, mood swings, or personality changes.
By john March 18, 2024
Picture this : you're walking in the sunshine, whistling dixie and having the best day. All of a sudden you step wrong, and your ankle twists. Ouch! You've got yourself a ‘ simple ’ ankle sprain, right? Well, not so fast. What might seem like a minor injury can sometimes turn into a bigger problem than you'd expect. Here's the lowdown: An ankle sprain happens when the bands of tissue (ligaments) that hold your ankle bones together get stretched or torn. You might think r est , ice , and a bit of elevation will sort it out – and sometimes they do. But other times, there's more going on under the surface. Amazingly, Once you have injured your ankle for the first time, you have a whopping 47% chance of re-injuring that same ankle in the future! Not to mention 40% of first time ankle sprainers, go on to develop Chronic Ankle Instability (CAI)!
By Shane O'Sullivan February 26, 2024
Do you get pain at the front of your knee? Walking downstairs? Sometimes you feel like you have to go down sideways ! When you’re hiking…… Especially when you have to go downhill? Playing sport…. Especially when you have to do a lot of short stop and start type movements?
By Jacob Jewson October 24, 2023
Adhesive capsulitis , or frozen shoulder , is a condition that affects the capsule/lining of the shoulder joint. It occurs most commonly in people aged 40-60 and while it can result from an injury or surgery to the shoulder, in the majority of cases there is no obvious cause. The condition involves inflammation and scarring of the shoulder joint capsule. The inflammation causes pain, particularly at night, while the scarring results in reduced range of motion in the shoulder joint as the capsule tightens. Then if the shoulder is pushed into extreme positions, the scar tissue becomes irritated, causing more discomfort. While there is often no cause, adhesive capsulitis occurs more commonly in people with diabetes and other systemic inflammatory diseases, so it may be worth performing some blood tests if these haven’t been done previously. Imaging with an X-ray and ultrasound (or sometimes an MRI) is not always essential as adhesive capsulitis can be diagnosed based on symptoms and clinical tests, but may be performed to ensure there is not another diagnosis to explain the symptoms. Adhesive capsulitis has a natural history of resolution after typically 12-24 months. It is characterised by 3 phases: freezing, frozen and thawing phase. The freezing phase is often the most painful, as the inflammation causes progressive pain and loss of range of motion. The duration of symptoms is often unchanged by treatments, however the goal of management strategies is to reduce pain and improve function during the course of the condition.
By Shane O'Sullivan September 19, 2023
Whether you're training for the Melbourne marathon, a dedicated athlete or just someone who enjoys staying active, the guidance of a sports physician can be a game-changer! Our very own Dr Jacob Jewson offers a unique set of skills and insights that can enhance your performance, prevent injuries, and keep you in peak condition. 
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