PT Podcast Episode 7: Elevating Late-Stage ACL Rehab

7In his PT Podcast, University Orthopedics Physical Therapist Dan Bien discusses the role of therapy related to various orthopedic injuries and surgeries. In Episode 6, Dan Lorenz, DPT, PT, ATC, LAT, CSCS joins Dan to discuss late-stage ACL rehab. When it comes to post-operative knee rehabilitation, few voices bring the clarity and depth that Dan Lorenz offers. Drawing on decades of clinical and performance experience, Lorenz shares actionable insights on program design, exercise selection, and emerging rehab technologies. Below is a breakdown of critical takeaways from his recent talk, complete with timestamped topics and literature references. Podcast Timeline: ·       00:42 Intro/Dan Lorenz bio/background

•  04:14– Double LE vs. Single LE programming in post-op knees. Considerations using Vermeil’s Hierarchy of Athletic Development and Rob Panariello 

  ·       04:52  Building capacity

  ·       05:38 Early eccentric focus and referenced literature.

  ·       06:20 Reps scheme, volume, and progressions, Joe Kenn and Tier System

  ·       07:18 Determining appropriate loading intensity

  o  RPE

  o  Reps Range

  ·       09:00 Suggested allocation of double LE vs. single LE training and related modifications to facilitate involved LE loading

  ·       09:30 Rationale for double LE loading exercise selections and 3 core double LE lifts

  ·       10:18 Leg press implementation, modifications, and progressions.  Understanding eccentric control.

  ·       11:33 BFR use

  o  Online Course: Blood Flow Restriction Training

  o  Clinical commentary

  o  Importance of using BFR as adjunct/supplement and not primary treatment, and how to improve implementation results

  o  BFR Using 30% 1 RM vs. 20%  body weight, pushing to failure, titrating and timeframe to initiate

  o  When to discontinue based on quad girth, strength LSI, etc.

  o  BFR as recovery tool

  ·       20:28 ACLR graft differences- pros/cons of quad tendon autograft, addressing differences in rehab, common rehab principles across grafts

  ·       24:15 Return to Run

  o  Return to Run criteria: Full AROM, no effusion, 70% quads/hams strength LSI, Step Down Test (10 inch lateral step down over 30 secs) with 90% LSI.

  o  Prep for return to run: Retro Treadmill, Impact loading and regressions

  o  Plyos and neuromuscular training to transition into running and relative forces with various modifications

  ·       30:06 Plyo volume and rationale with foot contacts and weekly progressions

  o  Delaware Soreness Rules

  ·       32:06 Change of Direction

  o  Addressing performance criteria early in rehab

  o  Criteria to begin full speed change of direction

  ·       34:30 Neurocognitive Training

  ·       41:45 Rate of Force Development (RFD)

  o  Measurement and assessment difficulty

  o  Simplistic Assessment Proxy with limited equipment

  o  Importance of cuing and training with speed and intention

  ·       46:20 Suggestions for new PT’s and students

  ·       49:30 Personal improvement and development items for 2025

  o  Danny Larson

DAN LORENZ’ PEER-REVIEWED ARTICLES Lorenz DS, Bailey L, Wilk KE, Mangine RE, Head P, Grindstaff TL, Morrison S. Blood Flow Restriction Training. J Athl Train. 2021 Sep 1;56(9):937-944. doi: 10.4085/418-20. PMID: 34530434; PMCID: PMC8448465. Lorenz DS. Variable resistance training using elastic bands to enhance lower extremity strengthening. Int J Sports Phys Ther. 2014 May;9(3):410-4. PMID: 24944861; PMCID: PMC4060320. Lorenz DS, Reiman MP. Performance enhancement in the terminal phases of rehabilitation. Sports Health. 2011 Sep;3(5):470-80. doi: 10.1177/1941738111415039. PMID: 23016045; PMCID: PMC3445218. Lorenz DS, Reiman MP, Lehecka BJ, Naylor A. What performance characteristics determine elite versus nonelite athletes in the same sport? Sports Health. 2013 Nov;5(6):542-7. doi: 10.1177/1941738113479763. PMID: 24427430; PMCID: PMC3806174. Lorenz DS, Reiman MP, Walker JC. Periodization: current review and suggested implementation for athletic rehabilitation. Sports Health. 2010 Nov;2(6):509-18. doi: 10.1177/1941738110375910. PMID: 23015982; PMCID: PMC3438871

About Dan Bien

Dan Bien is a physical therapist at our Kettle Point Campus in East Providence. Dan has worked at University Orthopedics since 2006 and serves as the Coordinator of Clinical Education for the physical therapy department. Dan is currently recognized as an Orthopedic Certified Specialist by the American Board of Physical Therapy Specialties, a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association, and a Credentialed Clinical Instructor by the American Physical Therapy Association.