New Program Announcement with Scott Prunier, CSCS, TPI of Top Fitness and Brandt Capone, PT, CSCS of Apple Therapy

Apple Therapy Manchester (downtown), in partnership with Top Fitness in Nashua and New Hampshire Orthopedic Center (NHOC), is now offering a post-Physical Therapy Strength and Conditioning program for athletes in the late stages of rehabilitation following ACL reconstruction.

How do we know when it’s safe to return to sport following ACL reconstruction?

Our new strength and conditioning program will help answer that question.  A return to sport following ACL reconstruction is often one of the most difficult decisions a clinician can make when working with athletes.  The current standard of practice is anywhere from 9-12 months postoperatively.   Our program aims to eliminate a “time” based decision and incorporate a clinical, “criterion” based decision.  We will use objective, functional data obtained in program training and testing that can be used collaboratively with the attending MD and sports medicine team when deciding on a safe return to sport.

Are you strong enough, agile enough, have enough motor control and coordination to return to play?  Luckily, quality research is beginning to illuminate the answers to some of these questions and helping define what athletes should demonstrate to safely return to their sport.

The Data

Only 13.9% of athletes met criteria to return to sport.  Eighty percent of athletes did not meet strength criteria and 50% met hop test criteria.  Overall, only 66.1% of athletes returned to or exceeded their prior sports activity level after ALCR at 1 year and after return to play clearance.  However, if athletes met and passed both strength and hop test criteria, 81.3% were able to maintain their prior level of sport participation at 1 year after being cleared to play”.  Joe Nance, PT, MPT, OCS, COMT, FAAOMPT, ATC

According to the Delaware-Oslo cohort study, simple decision rules made in the rehabilitation process can reduce reinjury by 84% after ACL reconstruction.  These authors suggest delaying a return to sport until 9 months post ACL reconstruction, giving the athlete more time to meet strength and quadriceps growth criteria.  They found that for every month that return to sport was delayed, until 9 months after ACL reconstruction, the rate of reinjury was reduced by 51%.  Additionally, they found that more symmetrical quadriceps girth and strength prior to return to sport significantly reduced knee reinjury rate.  (1)

Our Program

Using a team-based approach of Orthopedic MDs, Physical Therapists, Athletic Trainers, and Strength and Conditioning Specialists we will help the athlete safely get back to the activities and sports they enjoy.  Our “bridge” program after Physical therapy falls under our P.R.O.S name (post-rehabilitation orthopedic services) and will be custom-tailored to meet specific return to sport requirements and address any limitations identified in the testing and strengthening process.  Communication is key, each team member has their own area of expertise and we work together to give the best rehabilitation experience possible.   Our programs will incorporate the latest, evidence-based strength and conditioning, as well as, return to sport testing.   This program can start about 5-6 months post ACL reconstruction.

Why return to sport testing?

To identify limitations/risk factors so the program can be individually tailored

Non-Negotiable Clinical Criteria:   We will be preparing our athletes to pass these and additional tests.

  • Hop test (Fowler Kennedy Functional Testing Evaluation)/Vail sports Test
  • Quad strength and Symmetry
  • Demonstrate Mental Reediness and Confidence
  • Field Test (T-Test, 5-0-5)
  • Isokinetic Quads and Hamstrings <10%

We will work hard to safely prepare the athlete for return to sport.  We will be looking for the surgically repaired leg muscle strength to be within <10% of the non-surgical leg and for the athlete to demonstrate quality movement, agility, and mechanics before a return to play.  The general goal will be to safely return an athlete to the sport by 12 months post ACL reconstruction.

For more information on our P.R.O.S Post ACL Reconstruction Strength and Conditioning program please email:

Brandt Capone, PT, CSCS

Scott Prunier, CSCS, TPI

Dan Bouvier, MD

Apple Therapy
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New Hampshire Othopaedic Center
ACL reconstruction post surgery therapy