ACL Rehab: Timeline vs Criteria Based Progressions
A long term rehabilitation process such as ACL rehab is going to have several factors that will dictate the progression of an individual. With ACL rehab, as with all injuries, we tend to have a general idea as to how long certain processes will take and when it is understood and expected for individuals to perform and return to certain tasks. What governs these expectations can be dependent on different criteria. We can often differentiate these into two different categories, timeline and criteria based rehab progressions.
Timeline Based
Timeline based progressions are often based upon healing and other expected biological principles. Different structures: muscle, tendon, bone, cartilage, etc, all have different rates of healing and factors which will influence their healing either positively or negatively. Oftentimes, protocols are divided into phases based off these principles, with the intent of inhibiting an individual from performing harmful activities that could place unnecessary stress and strain on these structures. This strain can come in the form of positional stress with particular ranges of motion, compressive or distractive forces to joint surface and capsule and exceeding the contractile or elastic capacity of muscle, tendon and ligaments. These timeline based progressions are often non-negotiable or provide little leniency. The consequences for breaking this threshold may deem catastrophic or cause a remarkable set back in progress.
Criteria Based
Criteria based progressions are often in reference to an athlete’s movement profile. This can be with respect to their available capacity and tolerance to ranges of motion, coordination of movement, force production and dissipation capabilities and aerobic and anaerobic abilities. Criteria based progressions are often associated with achieving certain benchmarks or standards that are commonly accepted or reproducible in literature for being suggestive of hitting relative norms of prerequisite skills for a given task. They can also be qualitative in nature. Maybe something as simple as trying to replicate certain demands of a task with a certain activity or exercise in the clinic or utilization of a more remedial task with regards to complexity or intensity prior to progression. With criteria based rehab, I often think of it as a “prove it to me” type progression. In other words, show me that you have what it takes to logically and safely progress to the next step.
Work Together
Timeline and criteria based rehab regimens can be found and utilized all across all injuries. In the ACL population, they often help to blend the phases of one stage of a protocol to another and often fill in the gaps where they may not be definitive benchmarks already established in a larger macrocyle of a program. Understanding the relevance of each, can equip a clinician to make more informed decisions and keep patient safety and progress moving forward in the same direction.
-Dr. Zach Baker, PT, DPT, SCS . Want to chat further? Engage and discuss with Zach on Instagram HERE!
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