posts FROM PROFESSIONALS - OCTOBER 24, 2018
An interview with the ACL Queen: Dr. Steph Allen, PT, DPT, OCS
Dr. Steph Allen earned her doctorate of physical therapy from Ithaca College in 2013. She stuck around Ithaca and completed an orthopaedic residency the following year, then decided to give travel PT a try. After almost 2 years of travel PT, she settled in Boston, MA at Boston PT & Wellness. She is now focusing on ACL risk reduction (and educating on the subject wherever possible), as well as strength and conditioning and movement pattern training in youth athletes.
CONNECT WITH DR. ALLEN on social media / book an appointment with her!
Instagram: @stephallen.dpt and @bostonptwellness
Facebook: Steph Allen
If you’re from Boston, you can find her at her clinic:
Boston PT and Wellness www.bostonptwellness.com
(1) Many athletes in the XCLevation community have torn their ACL and are now interested in pursuing a career in sports medicine. What led you to the field of physical therapy and how did you develop a passion for ACL rehabilitation in particular?
Both what led me into PT and what eventually sparked my greater interest in ACL rehab was my own ACL injury and surgery in high school. I had always wanted to do something in the healthcare field, but the journey from injury to return to activity/sport was impactful enough that it took my internal dialogue from “I think I could see myself doing this” to “This is what I am going to do.”
The laser focus interest in ACL did not come until years later. I began to realize how my own post-op rehab had been sub-par, and how that seemed to be the common experience amongst other high level athletes. I kept seeing (and continue to see) the injury rates increase, and how there doesn’t seem to be enough urgency to raise the bar in return to high level sport or in implementing risk reduction programs. These realizations are what have truly ignited my passion for making a change.
(2) What advice would you share with athletes who are eager to return to the playing field after ACL injury, but are worried about re-injury?
The return to sport/end stages of rehab are crucial for sure, but do your homework, find a PT who works a lot with return to sport athletes, and put in the work. The body is SO adaptable and SO strong - with good rehab and good mental preparation, you will be over-prepared for whatever it is you want to get back to. We also have sufficient research that shows how fear of re-injury and anxiety surrounding that can alter movement patterns and potentially increase risk too. Therefore, have faith in the work you have put in, and “do you” out there on the field, court, track, wherever. You deserve to participate worry free and feeling strong!
(3) What are the top three things that athletes need to keep in mind during the recovery season?
First, patience - respect healing times and recognize that there may be times, at different points during rehab, that you have some pain/swelling or that you feel like you are struggling a bit. That is NORMAL. Trust the process.
Second, DO NOT compare your journey to others’. Every human responds differently to injury and surgery and you will only set yourself back if you dwell on where you “think you should be.”
Third, ask questions and learn during the process. This will not only help you by creating clear expectations and attainable goals, but it can potentially help others down the road, as you will now be able to explain the process to others who have injured themselves. You will then be able to confidently share your journey and instill hope and positivity in someone who is recently injured and facing the recovery road ahead.
(4) What advice do you have for parents of young athletes who want their children back on the playing field as soon as possible?
THINK LONG GAME. The ACL is continuing to heal for up to 2 years post-op. If you want to reduce your child’s risk of re-injury as much as possible, respect that. Return-to-sport (RTS) can safely resume as early as 9-10 months in some individuals, but is recommended to be 1 year at this time.
Avoid saying things like “If you return too soon you might lose your college scholarship if you re-tear it.” Or “The team really needs you for playoffs.” These things, well-intentioned or not, only add more anxiety to the situation and contribute to potential fear of return (which we know can in and of itself increase risk).
(5) What are some ways that athletes can build confidence on their journey towards a comeback?
Repetition with tasks that are hard: jump and land, cutting, sprinting, squatting, etc.
Measure your progress! Via keeping a spreadsheet for lifts, videos of jump and land and cutting tasks, times for sprint drills, etc.
Talk about things that are worrying you! With your physiotherapist, doctor, family/friends. Address lingering fears prior to return to play.
Spend some time participating in “soft return” to play via practicing with the team.
Visualize yourself performing sports specific tasks.
(6) What are some common misconceptions/myths when it comes to ACL recovery?
As long as you pass the single-leg squat, triple jump, and strength tests, you’re fine to return to sport
Females tear their ACL because they have weak hips and their knees go inward when they jump
Everyone can run at 8-10 weeks
End stage rehab can be undertaken by any physiotherapist
Everyone who tears their ACL has to get surgery
(7) How is recovery different for athletes who use a patellar tendon autograft, hamstring autograft, vs. cadaver allograft?
Not hugely different:
Hamstring graft: delayed active hamstring loading, and may require slower return to higher level hamstring loading/eccentrics
Patellar-tendon graft: somewhat more conservative with open-chain quad and knees over toes, and potentially slower progression with running if patellar tendon irritation occurs.
(8) What are a few ways that ACL rehab is different for children vs. adults?
1. Potentially different surgical procedures to avoid compromising growth plates
2. Rehab focus is more on neuromuscular control and movement pattern quality than on high-level strength (proactive to reduce risk of non-contact injury in the future)
3. Supervision: potentially higher frequency of physiotherapy visits for children, as they cannot be expected to perform exercises with good form on their own.
Thank you Dr. Allen for sharing your knowledge and insights with the XCLevation community!