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This paper presents a four-stage plyometric program to be undertaken as part of criterion-based rehabilitation for athletes with anterior cruciate ligament reconstruction (ACLR). After ACLR, the patient experiences alterations of joint mobility, gait and movement patterns, neuromuscular function and general physical fitness. Plyometric training is an important component for neuromuscular and movement re-conditioning after ACLR. Effective use of plyometrics can support enhancements in explosive sporting performance, movement quality and lower risk of injury. Plyometric training, as a component of the ACL functional recovery process, can aid in restoring function and supporting timely return to sport. However, few patients undertake or complete a plyometric program prior to return-to-sport. To truly impact individual patients, a stronger focus on research implementation is needed from researchers to translate efficacious interventions into practice. In designing a plyometric program, it is important to match the specific plyometric tasks to the functional recovery status of the ACLR patient. To do this, it is important to understand the relative intensity of plyometrics tasks, align these tasks to the ACL functional recovery process and monitor the athlete as part of criterion based rehabilitation. Plyometric intensity is based on the intensity of efforts, the vertical and/or horizontal momentum prior to ground contact, the ground contact time and the surface or environment on which they are performed on/in. Furthermore, how the person technically performs the task will influence joint loading. There should be a gradual increase in task intensity and specificity throughout the program, with all tasks used for both neuromuscular and motor control re-conditioning. The aim of this paper is to provide recommendations to clinicians on how to design and implement plyometric training programs for the ACLR patient, as part of the functional recovery process., Level of Evidence: 5., Competing Interests: The authors report no conflict of interests relevant to the content of this review.

There is a need to improve patient outcomes after anterior cruciate ligament reconstruction (ACLR). To do this likely involves a strong focus on optimizing rehabilitation processes and practices. Movement re-training is considered an important element of rehabilitation after ACLR, but there is a lack of knowledge on the 'how' and 'what' movement re-training should occur after ACLR. In its basic form, movement re-training after ACLR is about progressing a patient through gradually more demanding tasks from the point of being able to walk to being able to perform highly complex sports movements. However, there is a lack of guidance on when to implement certain tasks (e.g. when to begin running) and how to transition between tasks. This paper presents a 10 task progressions system which can form an important aspect of the movement-based re-training process, providing structure and patient autonomy. Monitoring knee function and movement and neuromuscular status to safely transition between these tasks is important. Although this task-based progression is designed for patients following a rehabilitation program after ACLR, it may have generalizability for all major lower limb injuries. The task-based progression was formed by combining theory, the best available evidence, and significant practice experience applied to movement re-training after ACLR. This approach supports patient autonomy, medical team communication and collaboration and can provide structure to the movement re-training process., (© 2020 by the Sports Physical Therapy Section.)

Outcomes after long-term injuries such as anterior cruciate ligament reconstruction (ACLR) need improving. One area which has received limited research attention is the use of aquatic therapy to optimize the functional recovery process after injury. There is still limited understanding of what the benefits of the pool can bring for rehabilitation and particularly what and when can be done in the pool after injury. This clinical commentary describes how the application of the properties of water can support the functional recovery process after ACLR. Here it is proposed that the main properties (density, hydrostatic pressure, buoyancy and viscosity) of aquatic therapy, if applied correctly to rehabilitation practices, can be used to achieve six primary goals after ACLR : 1) assist in the reduction of pain and swelling; 2) support the recovery of gait; 3) support the maintenance and/ or development of cardiovascular fitness; 4) help accelerate and optimize motor pattern retraining; 5) allow for earlier introduction of plyometrics and power training and 6) support the between session recovery and optimal load management, particularly in the later phases of rehabilitation. If implemented correctly, the presented phased protocol can support practitioners in implementing or delivering aquatic therapy rehabilitation services to their injured athletes. To support implementation, the authors have provided a specific protocol and supplementary videos for the use of aquatic therapy after ACLR., Level of Evidence: 5., Competing Interests: Conflict of interest: There were no funding sources for the paper. The authors report no conflict of interest., (© 2019 by the Sports Physical Therapy Section.)

The Gluteus Maximus (GM) muscle is the largest and most powerful in the human body. It plays an important role in optimal functioning of the human movement system as well as athletic performance. It is however, prone to inhibition and weakness which contributes to chronic pain, injury and athletic under-performance. As such, understanding how to assess and treat GM dysfunction is an important aspect of sports science and medicine, as it has relevance for injury prevention, rehabilitation and performance enhancement. Despite GMs considerable importance there is little research attempting to translate evidence into practice to support practitioners when faced with 'sleepy glutes'. This clinical commentary discusses the importance of GM for athletic performance and injury risk; factors which contribute to GM dysfunction and then provides evidenced informed approaches to assess and treat GM dysfunction. This can be used as part of rehabilitation or injury prevention practices as well as athletic performance training., Level of Evidence: 5.

One of the main priorities of rehabilitation after anterior cruciate ligament reconstruction (ACLR) surgery is the restoration of knee extensor muscle strength. Residual deficits in knee extensor muscle size and strength after injury are linked to poor biomechanics, reduced knee function, increased knee osteoarthritis risk, as well as heightened risk of re-injury upon return to sport. Most studies indicate that knee extensor muscle strength is typically not resolved prior to return to sport. This clinical commentary discusses strategies to optimize and accelerate the recovery of knee extensor strength post-surgery, with the purpose to support the clinician with evidence-based strategies to implement into clinical practice. Principally, two strategies exist to normalize quadriceps strength after surgery, 1) limiting strength loss after injury and surgery and 2) maximizing and accelerating the recovery of strength after surgery. Optimal preparation for surgery and a focused attempt to resolve arthrogenic muscle inhibition are essential in the pre and post-operative period prior to the inclusion of a periodized strength training program. Often voluntary strengthening alone is insufficient to fully restore knee extensor muscle strength and the use of electrical stimulation and where necessary the use of blood flow restriction training with low loads can support strength recovery, particularly in patients who are significantly load compromised and experience pain during exercise. Resistance training should employ all contraction modes, utilize open and closed kinetic chain exercise of both limbs, and progress from isolated to functional strength training, as part of a periodized approach to restoring neuromuscular function. Furthermore, thinking beyond the knee musculature and correcting core and hip dysfunction is also important to ensure an optimal knee extension strengthening program. The purpose of this clinical commentary is to provide a series of evidenced based strategies which can be implemented by clinicians responsible for the rehabilitation of patients after ACLR., Level of Evidence: 5.