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» ACL rupture – Why I decided to go conservative?

ACL rupture – Why I decided to go conservative?

My conservative ACL management journey

The decision

After I completely tore my ACL playing field hockey in November 2018, I was almost immediately booking my
surgery to get it over with as soon as possible. After an interesting conversation with a colleague in
Australia, we started discussing ACL conservative management. This sparked interest as it is becoming
more popular due to the rate of ACL tears increasing annually. Most of the research studies I read were
based on ACL tears alone, they did not include meniscus or MCL tears (of which I had both). After
gathering all the information I needed with regards to the two approaches, I decided to try the
conservative treatment first. Many people were concerned seeing as I play a pivotal sport and the lack
of an ACL might lead to further damage of my knee. I knew that this was what I needed to do though, so
off I went.

 

The journey

I spent 5 weeks non-weight bearing (crutches) and restricting my knee flexion (bending) to 90 degrees.
This was essential to allow for optimal posterior horn medial meniscus healing. During this time I started
strengthening my Vastus Medialis Oblique (VMO is essential for full knee extension and knee stability),
glute medius (important for hip stability), glute maximus (needed for hip extension when you are
walking and seeing as I wasn’t, I needed to maintain the strength I had), calf muscles, hamstrings and
abdominals. The E-Stims machine (Compex) came in very handy when trying to strengthen muscles
without weight bearing. I would highly recommend it as the improvements are immense.

I spent hours on Range Of Motion (ROM) and decreasing swelling through Rest Ice Compress Elevate
(good ol’ RICE). When it came time to start weight bearing, the research directed me towards my first
goal. Before you consider conservative you first need to be identified as a COPER. Seeing as my initial
focus was on my meniscus it was time for me to ramp it up.

According to the research “Rehabilitation candidates are those patients who meet all 4 criteria:
(1) Timed hop test score of 80% or more of the uninjured limb
(2) Activities of Daily Living (ADL) score of 80% or more
(3) Global rating of 60% or more, and
(4) No more than 1 episode of giving way since the incident injury to the time of screening
Patients who fail to meet any of these criteria are classified as noncandidates.” I’ll discuss the following
tests in detail in my next blog. Steps 2-4 were easily passed, but the timed hop test required many hours
in the gym to feel comfortable to perform several tests hopping on one leg. I managed to complete
these tests successfully 3 months after the initial injury. This boosted my confidence and allowed me to
continue with the ACL protocol I had put in place.

 

The result

Unfortunately there is no conservative ACL protocol, so I constructed my rehab by following an ACL

reconstruction protocol (which is readily available and doesn’t differ considerably between orthopedic
doctors) and I added in extra strength work for my hamstrings and calf muscles because I needed to

improve my tibial translation. Tibial translation is when the tibia (bone of the lower leg) moves
anteriorly in comparison to the femur (bone in your thigh) due to the deficiency of my ACL. Now you can
imagine that would cause long term problem if the alignment of the knee was disrupted. I will also
discuss the operative rehab process in a separate blog.

Stay tuned.

Dereck Fu

Physiotherapist

 

Dereck completed his physiotherapy training at the Hong Kong Polytechnic University. After graduation, he started practicing in a public hospital where he had extensive experience in treating different musculoskeletal, orthopedics, and sports conditions. He recognizes the complex contribution to pain and musculoskeletal injuries and is keen on using a wide range of skill sets such as exercise therapy, manual therapy, and acupuncture tailored to individual conditions.

Before joining HKSC, Dereck completed his Master of Clinical Physiotherapy (Musculoskeletal Physiotherapy) and accreditation in Level 1 strength and conditioning coach under the Australian Strength and Conditioning Association (ASCA). These exposures enriched his practice, considering the psychosocial, biomechanical, and training load aspect of the clients’ story.

He has a particular interest in treating sports-related injuries and desk job conditions, assisting clients on their way back to function, and prevent recurring injuries.

Dereck has been a sports enthusiast since his teenage years. He is a keen football (soccer) and badminton player who treasures the enjoyment and satisfaction brought by both team and individual sports.

Icy Bo Lin

Head of Mobility

Icy has spent thousands of hours studying yoga, stretching and mobility through a broad range of in-depth courses. She has more than 7 years of experience teaching group and 1-on-1 classes to people ranging from athletes, pregnant ladies and new mums, children and especially the average Joe’s.

Icy is passionate about helping people move better, recover well and get pain free.

She believes it takes a combination of tools to help build a healthy body and has therefore spent substantial time practising strengthening and conditioning as well

Her passion for her craft is demonstrated through a focus and attention to detail with her clients.

Icy is a mother, experienced former banker and we are proud to have such an accomplished person on our team.

Below is a list of her completed training:

Leslie T. Evangelista

Head of Strength and Conditioning

Leslie’s athletic achievements speak for themselves. She is a true world class power lifter and continues to compete at the highest level. She has reached the pinnacle of her sport, medalling in a number of international powerlifting federation events. She has been Asia’s best lifter and holds a number of national records.

As impressive as it is, Leslie’s athletic resume pales in comparison to her passion, knowledge and dedication to the science of physical human performance. She is a student and expert of strength and conditioning, working in the industry as a coach and consultant for 10 years. We are very glad to have her on our team as her technical knowledge of compound movements and training methodology helps us bridge the gap between injury and a better you.

Leslie takes most pleasure in teaching the average person. Leslie’s deep knowledge and experience means she can build you from the bottom up or take you to a level beyond your expectations. Whether you are a mother or a mother to be, an office worker wanting to learn how to keep strong, or a youth wanting to learn the essentials of training, she is the expert for you.

Leslie is available as a consultant for long or short-term basis if you are serious about improving your health. She is an invaluable asset to have on anyone’s team.

Hideo “Harry” Loasby

Head Running Coach, Founder of BuffCo

Harry discovered running at 16, and quickly rose through the ranks in Hong Kong and became a national champion over 1500m when he was 17. He represented Hong Kong at the Asian Schools Championships and won several gold medals in cross country and track. Harry’s performances earned him a place on the Loyola Marymount University cross country and track team.

Towards the end of his university career, Harry became increasingly interested in studying various training methods and running philosophies. After moving back home, and knowing first hand the gap in grass roots development in Hong Kong, he set up Buffalo Running Company (BuffCo) in the hopes of changing that for the better. While coaching full time, Harry has remained competitive in the local scene, winning the 2020 China Coast Marathon by over 8 minutes. During the absence of races, he coached himself to personal bests in solo road time trials in the 10k and half marathon, running 31:38 and 70:30 respectively.

After running and now coaching in Hong Kong for the majority of his running career, Harry builds his coaching and training philosophy around the context of the city and what it means to be a runner here. He enjoys hunting for excellence in every level of runner, because he knows what Hong Kong’s running scene has to offer despite the tough conditions. From complete beginner to aspiring college athlete, on any surface over any distance, Harry is keen to help you with your running journey.

Harry is available as a consultant for any race you have on the calendar, but he is particularly passionate in developing runners over several years and building a sustainable relationship with all aspects of the sport, so that you can enjoy a lifetime of healthy, happy running.

May Lee
Sports Massage Therapist and Sports Scientist

May is an Internationally experienced Sports Massage Therapist, she focuses on deep tissue massaging to aid recovery, optimise performance but also general health and well-being. Throughout her years of training and watching others train, May has found that many people neglect the recovery process. The recovery process is fundamental for muscles to grow and develop and more importantly to reduce injury in the long term. Deep tissue massage helps to smooth out those little aches and pains you experience in normal day to day activities.

May has studied Sports Science at degree level and has completed her Level 4 Diploma in Sports Massage Therapy in the UK as well as being qualified in Dry Needling, Myofascial Release, Trigger point therapy and Pre-Hospital immediate care in sport.

She has previously worked a ski season in Niseko followed by working in clinical practice in Tokyo before deciding to move to Hong Kong to pursue her career further.

May has always had a keen interest in sports, training and exercise which has allowed her to pursue a successful career within sports and exercise rehabilitation.

Lizemari Marais
Physiotherapist and Pilates Instructor

Liz is a Physiotherapist and Pilates Instructor from South Africa. Her greatest passion is health education and empowerment, which is why she flourishes in the corporate wellness setting. She’s good at analysing corporate settings to determine risk factors to individual health as well as employee productivity. She will not just remind your employees to sit up straight – she will walk a path with your company to encourage healthy lifestyles and happy employees.

Liz’s approach to rehabilitation is grounded in the balance between mobility and foundation strength. She explores this in her calisthenics, yoga and pilates. She believes that with the right foundation and training, the human body can do anything.

Liz values independence and wishes to equip her patients with everything they would need to maximise their body’s potential, allowing them to pursue independent lives.

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