The ATP Training Methodology EXPLAINED

ACL rehab is a hot topic these days.

Annually we are seeing between 100,000 - 200,000 ACL injuries every year in the US alone.

Of these athletes, nearly half (45%¹ ) will never return to their previous level of sport. Of the ones that do, between 20 - 25% of them will re-injure their knee or injure the opposite knee within 2 years⁽²⁾ .

In response to these less than encouraging statistics there are more opinions and protocols out there than ever before leaving more and more athletes left unsure what to believe and who to trust.

This article is simply intended to share what we do differently from more conventional protocols, why we do things differently, and the results of these protocols so far.

Again that’s not to say we’re perfect and that we never will, that’s just our track record so far.

It’s also worth mentioning that the athletes we work with are rarely your typical or ‘ideal’ case. Because our methods are somewhat unconventional, we are rarely the first stop in an athlete’s recovery process but, as I tell parents and athletes on day 1: we are often the last.

Some of our most notable cases include a skiier who has had 9 knee surgeries combined between her two legs. Needless to say she had tried a whole host of different doctors and physical therapists and training protocols and yet season after season she kept going down with injuries.

I never thought I would be talking to someone about trying to keep her surgical count to single-digits, but that was the conversation we were faced with when we started.

After 6 months of training together she is back skiing, mountain biking, squatting full range of motion, and taking full advantage of all the fun outdoor activities the mid-west has to offer.

Again I highlight this case just to show that our training formula doesn’t just work with the ‘perfect’ client who is reaching all their benchmarks exactly according to schedule. It works with the athlete who has tried everything, failed, and is still determined not to give up and get back to the sport they love.

Our formula we follow can be broken into 3 stages:

1. Maximize Circulation

2. Build Local Muscle Tissue

3. Strengthen the Joint Internally

Maximizing Circulation

In this phase we are bringing as much blood flow and circulation to the knee as we possibly can. We are not improving circulation. We are maximizing circulation.

The reasoning behind this is simple.

The body needs circulation and blood flow in order to heal. In order to rebuild new tissue, remove dead tissue, and return to full functionality. We want to work with and facilitate this natural healing response as much as possible.

It’s important to remember we are talking about ligaments and connective tissue here. These structures have little to no direct blood supply which is part of why they are so hard and slow to heal. Even bones have more of a blood supply and is part of why they heal faster than ligaments.

Moving the joint (notice the emphasis on movement not load at this stage) is kind of like gently stirring that soup keeping it fresh rather than stale and stagnant to maximize the flow and transfer of nutrients.

This will do a few things:

1. It will help the joint move more freely, not be so stiff and achy

2. Helps hydrate the ligaments and soft tissue

3. Help prepare the muscles and joint for loading

This is the feel good stage of the recovery process. It’s not easy by any means, but every session should really leave your legs and knees feeling warm, feeling loose, and just plain good.

This training style works both as a full training phase to prep for later phases, and as a warmup in those later stages to prep for more direct loading of the joint and muscles.

The main tools we use to accomplish this task are:

• Backwards sled: Absolute king of all tools for accomplishing this task

• Backwards treadmill: An effective substitute for the sled if you don’t have one

• Backwards walking: Outside, barefoot, in the grass

Building Local Muscle Tissue

The next goal of our training is to rebuild and strengthen the local muscle tissue around the joint.

In English let’s get your legs the same size again!

If you’ve gone through a surgery or period of immobilization you probably had a noticeable shrinkage in your quad on the injured side, particularly the area on the inside of the quad right next to your knee.

This specific muscle is called the Vastus Medialis Oblique and is one of the four muscles that make up the quad (hence the name).

This particular piece of the quadricep tends to atrophy (shrink) the most after surgery and, interestingly enough, plays the largest role of any muscle in the strength and stability of the knee (yes, more than the glute medius!).

This makes it a high priority for us as we look to rebuild back to our previous levels of strength and beyond.

Now, in my opinion many of the exercises commonly used in PT — box squats, single leg squats, leg presses, etc. — place more of an emphasis on the glutes and hips than the knee.

So even though the athlete is getting ‘stronger’ in reality they are just compensating and using the hips to accomplish the task, and making the gap in strength between their hip and their knee even larger!

Instead we have very specific knee exercises, such as the Poliquin Step Up, which put all of the load on the knee and VMO without allowing cheating with the hips.

This way, when the athlete gets stronger, we know the knee is getting stronger as well.

Interestingly we see this exercise have the most direct carryover to running ability of any other exercise (look at how similar the joint angles are).

Strengthening the Joint Internally

This, in my opinion, is the big separator that explains why we are able to have success with athletes that have struggled with other programs.

By strengthening the joint itself, getting stronger internally as well as externally, we build strength much more holistically and greatly improve the quality of our athletes’ outcomes.

The main way we do this is by training the joint through its full range of motion.

This is where the slantboard squats and deep split squats come into play and become some of the most powerful exercises for long-term bulletproofing.

Working through these deeper ranges of motion has two profound benefits:

1. Circulates synovial fluid

   Remember the benefits of moving and hydrating the tissue we talked about in phase 1? Bending the joint all the way does this to an even greater degree. It’s like changing the oil in your car, allowing it to run more smoothly and remove the gunk that builds up over time especially after the trauma inflicted from surgery.

2. Strengthens the connective tissue itself

   The deeper we take a joint through its full range of motion, the more load we put on the joint and the connective tissue compared to the muscles. While this can sound like a bad thing, by starting at a safe, controlled level and slowly building up (just like we do with every other form of exercise) we can improve our joint and connective tissue’s ability to handle force!

The trick with this phase, and why many PT’s avoid this, is our ability to scale the intensity so that it can be gentle and healing rather than aggravating.

By starting gently and not working through pain we are able to get the stiffest, most locked up joints to slowly release and be able to move again.

This is how we were able to get Caleb, a high school soccer player who couldn’t get past 90 degrees of flexion after three months of normal rehab to regain full range of motion and get back on the field a month earlier than originally predicted to help his team win the 7A State Championship.

This formula is our secret sauce. It is how we structure our daily workouts and our long term progression.

It scales to any level and addresses every aspect of joint health and performance not just the basic criteria most PT’s use to clear an athlete to return to sport.

Our mission with every athlete is to help them get back to a level greater than they were before getting injured.

How else can you move forward with confidence without having the fear of injury linger in the back of your mind?

This is our goal for every athlete we work with.

If you have specific questions about this process Instagram @zakwoodwardatp is the best place to reach me.

If you are interested in learning more about how we work with athletes check out our training application here:

There are only 5 spots left in our big promotion we have going on right now so if you’ve been thinking about training with me for a while there’s never been a better time!

This is not a commitment or a guarantee of getting a spot just an entry point to see if you’d be a good for our program.

If you found this article helpful, do me a favor and share it with a friend.

Otherwise I’ll see you in next week’s newsletter.

Till then, bye ✌🏼

Sources:

1. Returning Athletes to Sports Following Anterior Cruciate Ligament Tears

2. Return to sports after ACL injury 5 years from now: 10 things we must do

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