Physio Network

[Case Studies] ACL rehab in a professional basketballer with Laura Opstedal

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In this episode with Laura Opstedal, we explore an interesting case study on a real patient of hers - the rehabilitation of a basketball player who sustained an ACL injury and underwent ACL reconstruction using patella tendon graft. We cover:

  • How the injury occurred & this player's previous ACL injury history
  • The rehabilitation process - including use of KPI’s and force capacity testing
  • Working through “mishaps” in rehabilitation
  • Deceleration vs acceleration exposure in ACL rehabilitation

This episode is closely tied to Laura’s case study she did with us. With case studies, you can see how top clinicians manage real-world cases and apply their strategies to get better results with your patients.

👉🏻 Watch Laura’s case study here with our 7-day free trial:
https://physio.network/casestudies-opstedal

Laura Opstedal, PT, DPT, began her physical therapy career in 2001 after graduating from the University of Puget Sound in Tacoma, Washington. She is dual board certified in Orthopaedics and Sports, a USA Weightlifting Level 2 coach, and founded Build Physio & Performance in 2019 and Build Gym in 2024 in Bozeman, Montana. Her expertise spans ACL rehabilitation, bone stress injuries, complex knee issues, injury management in high-performance athletes, and the use of advanced testing technologies. 

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Our host is @NoahMandelPhysio from Physio Network

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SPEAKER_01:

On today's episode with Laura Obstadel, we discuss a case of an NCAA basketball player who tore her ACL and received surgery. Laura helped guide this athlete through every stage of her rehab and explains how she did it in this episode. Laura began her physical therapy career in 2001. She is dual board certified in orthopedics and sports and has a level 2 coaching certification from USA Weightlifting. Laura opened Build Physio and Performance in 2019 and Build Gym in 2024 in Bozeman, Montana. Laura is a recurrent invited speaker at national conferences and authored her own continuing education course, ACL Rehab in a Weekend, for physical therapists and athletic trainers. Laura has helped the spectrum of athlete, from novice to professional, spanning across many different sports. Laura has done a case study with Physio Network on this exact case where you could dive a lot deeper into this case than we were able to do in today's episode. You can click the link in the show notes to watch Laura's case study with a seven-day free trial. You are really going to enjoy this episode as Laura explains what it takes to get high-level athletes back to sport after suffering an ACL injury. I'm Noah Mandel, and this is Case Studies. All right, I am here with Laura Obstad. Oh, Laura, thank you for coming on the podcast.

SPEAKER_02:

Thank you so much for having me.

SPEAKER_01:

It's our pleasure. So the reason that we're having you on is because you recently created a case study for Physio Network on an NCAA basketball player who tore her ACL and you helped her with her recovery. So can you give us just a brief overview of that case?

SPEAKER_02:

So this was an NCAA women's basketball player who tore her ACL and she tore it fairly early in the season. One season, this was a secondary ACL. So she had torn her ACL for the first time about six or seven years prior while she was in high school, had a hamstring graft. And then this time she did a patellar tendon graft. And so uh I do I don't work for the university. I'm a private clinic, but I do tend to work with the team quite a bit. So she was referred to me for her rehab. And it was kind of a weird mechanism. They were playing in a non-conference game out of the country in a very humid environment, and her foot got stuck, and it actually ended up being a contact injury. She was a post-player. Felt the pop in her knee, a very familiar feeling to her as she has done it before and removed from play and so on and so forth.

SPEAKER_01:

When you started off that case, you early on in the actual case study itself, you introduced the KPIs, the key performance indicators. And I like that you did that very early on in the case because it kind of sets it sets the stage for the rehab process. Can you walk us through how you determine what KPIs to use and perhaps specifically what KPIs you decided to use for this basketball player?

SPEAKER_02:

So our KPIs that we use or I use in my clinic are pretty standard for most athletes. It's not specific to a basketball player because we're looking at recovery of muscle function, and that would be some kind of capacity test. So our isometric and isokinetic testing on the isokinetic machine would be kind of our force capacity test that we use throughout the rehab. And then we start integrating force plates once we start jumping and looking at counter movement jumps and single leg counter movement jumps and single leg drop jump verticals. And then we might add something more specific to basketball. In this case, she's working with the staff at the university too. So we were looking at reconditioning and her tolerance to those total loads that are occurring. When we put together our KPIs, the athletes know really early on this is what we're going to use for decision making. And also it's our feedback to make sure the athlete's improving month to month. So removes a lot of anxiety and takes the guesswork out for us. And then it's a way for me to communicate progress to her training staff.

SPEAKER_01:

Would those KPIs be different for an athlete compared to someone who just wanted to get back to regular ADLs, just activities of daily living?

SPEAKER_02:

We would use some kind of force capacity test for everyone. And then the jumping might be specific to an athlete. It may or may not be like if somebody doesn't need to jump for a day-to-day thing or they do a sport like cycling or something that we didn't feel it was necessary, we might not do some force plate testing. But for the most part, with our active population and Bozeman, we'll do a combination of the two. And I like to think of the jumping more as how someone expresses their force. So we've got force capacity and then we've got force expression. So we're kind of covering our bases on return of muscle function.

SPEAKER_01:

Okay, makes sense. Now, rehab doesn't always go perfectly to plan. And there was a little mishap that happened in this case. Can you walk us through the injury that occurred and how maybe common that type of injury is and how you navigated it?

SPEAKER_02:

Yeah, this was an unfortunate situation. And also the reason why I picked this case study because it wasn't straightforward. I feel like, you know, the really straightforward ones that go great, you know, you don't learn you don't learn a whole lot from those. But this case, really early on, I think she was maybe four weeks in, three to five weeks in somewhere in there. She was doing an isometric contraction on our isokinetic machine. So just pushing in. She's very competitive and pushed very hard and fast and felt a pop at her patellar tendon with the distal pull of the patella. And I was not in the office that day. That was with a colleague, but he removed her from the machine and checked it out. And we ultimately decided to send her for imaging just to make sure that we did not fracture her patella. That can occur very rarely, like maybe less than 2% of the time in the literature with the patellar tendon graphs, simply because they take part of the bone from the patella. So you get a light little microfracture in the patella, and then a contract quad contraction might expose that fracture. But at any rate, it was negative, thank God. But it continued to cause problems throughout most of the rehab. So kind of went away, got things under control. And then as time went on, as we started doing more court work, it started to get really flared up. And so we had to make some decisions regarding if we're gonna proceed with PRP or if we are gonna just shut her down for a while. A lot of big decisions needed to be made because we were running out of time. We were planning on returning to play at the year mark, which was like very generous in sport, just with the way the timing worked out. But we were looking at that time frame being expired in three months. So we had to proceed with PRP and then um make some changes in both our KPIs and our rehab.

SPEAKER_00:

Ever wished you could see how experts treat real patients of theirs with case studies by Physio Network, you can. Watch presentations where top clinicians break down real-life patient cases step by step, showing how they assess and treat even the trickiest of conditions. It's the best way to improve your clinical reasoning and build confidence in the clinic. Click the link in the show notes to start your free trial today.

SPEAKER_01:

And you dive into that into a little more detail in the case, and I think you came up with some very creative solutions. But I do want to talk about the on court work that you mentioned. Something that you highlighted in the case was that in ACL rehab, accelerating can actually be a little bit easier than decelerating sometimes. Can you walk us through why decelerating may be more of a potential challenge for someone who's going through ACL rehab?

SPEAKER_02:

Yeah. So in decelerations, there's just higher loading rates and peak forces than acceleration. And so if somebody has the inability to tolerate these forces, they're going to have poor breaking. We know that poor breaking strategies can result in a recurrence of injury or re-injury compared to accelerations. You don't typically see many people injured during an acceleration, if you think about it that way. I think deficits and acceleration would be more problematic from a performance lens, not necessarily re-injury. So we work on both, obviously, but I would say a greater emphasis on the decelerations.

SPEAKER_01:

It's very interesting because some people may make the mistake of thinking decelerating would be easier because, oh, we're just slowing down. We already got out of the hard part, which was building up to a top speed. But in order to slow down from a top speed, especially if you're doing it quickly, there's a lot of force involved in that. Does that load the front of the knee preferentially?

SPEAKER_02:

Yeah, with the decelerations for sure. There's more demand on the quads.

SPEAKER_01:

Do you think that is what caused those flare-ups when the athlete began the on court work?

SPEAKER_02:

Most likely, I like to say that my decision making was sound and I was doing all the things, the force testing and making sure she could tolerate those loads. What I think happened, and if I went back and did this over again, I would look at volume because they might not be sore over a couple of sessions on the court or whatnot. It seems to be more of a chronic workload issue where maybe we just ramped up too high over the course of three or four weeks and flared her up. And by that point, it's shoot, we need to make some real changes. But this has been going on for a while. And me being on the private sector, not really on the court watching what's going on. I think I could have been better at monitoring that load somehow with staff. And I think they did a great job too. I think maybe it was the perfect scenario and everything went perfect and this just happened anyway. But if I went back in time, I think I could have been better at managing overall workload in that short period of time. That's being like pretty self-critical.

SPEAKER_01:

Yeah. At the end of the day, the case went well.

SPEAKER_02:

Yeah. I mean, we we had multiple conversations, athletic trainer and I, on okay, what are we going to allow this week? And we were really mindful of reps and things like that. And it still happened. And there's responsibility with athletes too. Like, is it feeling good? Is it feeling bad? Everybody's super excited to get to that point and work into live play. But I think the ramp up was probably higher than it should have been.

SPEAKER_01:

Well, I think this case study is such an excellent example of not just how you deal with adversity in ACL rehab, as we've just discussed, but also just in general how we should structure ACL rehab and what sort of things we measure and how we progress exercises. I think in just an hour, you made something that was really, really comprehensive. And of course, in this podcast, we're just scraping the surface of it and we were not able to get into all of the details, which is why we have a seven day free trial that you can use to watch Laura's case study. And that link is just in the show notes below. Laura, thank you so much for joining us. We really appreciate it.

SPEAKER_02:

Thank you so much for having me.