Sports Rehab Write-Up: QB Daniel Jones, Return to Sport
And, last but certainly not least in our ACL series…
New York Giants QB Daniel Jones is facing the most high-stakes season of his NFL career -- returning from an ACL injury, with some analysts speculating that he may currently be the worst starting QB in the entire league!
With the Giants retooling their offensive line & drafting a blue-chip receiver for Jones to throw to, the pressure is officially on!
Rehabbing a major injury is stressful enough without being on the hot seat! How do we think Jones is managing?
We previously spoke about the prehab & early phases of rehab with Jones, highlighting the focus on minimizing pain and safely normalizing strength & range of motion. Unfortunately, at the highest level, everyone’s strong & mobile! We’re now into the stages that truly makes a difference, where the focus is on cutting, power, and sport-specific movements!
With that being said, let’s break things down & talk about what Jones – and Giants fans – have to look forward to this Preseason!
Just like last time, we’re highlighting the 2019 review by Filbay & Grindem in which they outlined 5 distinct rehab phases [1]:
the Preoperative phase,
the Acute phase,
the Intermediate phase,
the Late phase,
the Continued Injury Prevention phase.
Jones successfully underwent an ACL repair surgery just 2 weeks after his injury during the Giants’ Week 9 match-up against the Las Vegas Raiders – we’re pulling up on 6 months post-op!
At 6 months, I’d be discharging the average patient from my caseload!
This late in the game, the expectation is that Jones would be pain-free with full range of motion, and displaying quadriceps strength that’s nearing pre-rupture levels!
Jones should be at the point where he’s on a controlled practice field jumping, jogging, accelerating, and decelerating!
We’re very firmly in Filbay & Grindem’s Late Phase!
The two researcher’s specify that late phase rehab should be patient-specific, with a constant focus on reproducing the demands of the athlete’s sport.
When it comes to determining readiness for competition, the recommendation is that clinicians utilize criterion-based return to sport protocols, with emphasis on progressing limb symmetry in strength, hopping, agility, and coordination tests.
Just as important as progressing strength & mobility at this stage is rebuilding confidence, and criterion-based progressions in intensity are hugely beneficial in that regard. It’s extremely valuable for an athlete to be able to quantify their gains, visualize their progressions, and to understand the significance of the various criterion-based milestones that they are reaching!
While Jones is no-doubt starting to feel increasingly “normal” at this point in his rehab, the currently literature would strongly suggest that he’s not quite there yet!
Plenty of athletes are able to return to sport at pre-injury levels 6 months out [2], but that does come with a few risks!
At 6 months, we know that the knee cartilage in post-op ACL patients is still of a significantly more fragile, lesser quality state [3], potentially predisposing our athletes to future injuries, even in the opposing limb!
We also know that the generally agreed upon “conservative” return to sport timeline would be 9-months or later, because, as we’ve seen, athletes that return earlier generally have an increased risk of re-injury in that affected knee [4]!
The more time for focused, progressive rehabilitation, the better!
The work isn’t over once the 2024 season starts up; Jones should be continuing an injury prevention program with an emphasis on maintaining expert levels of proprioceptive ability, as well as quadriceps & hamstring strength!
Stability during dynamic tasks is of the upmost importance for an NFL athlete and can be trained significantly to help Jones avoid the damage caused by those awkward twisting & shifting forces his knee might experience out on the field!
With the 2024 NFL season right around the corner & his career potentially in the balance, firmly & strategically adhering to a continued injury prevention program is vital!
Barring any major setbacks, Daniel Jones will be ready to roll Week 1! He probably even feels ready to roll right now! But, it’s crucial for Jones & the Giants training staff to continue to maximize his recovery & thus, his longevity!
Works Cited & Further Reading
Filbay, S. R., & Grindem, H. (2019). Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best practice & research. Clinical rheumatology, 33(1), 33–47. https://doi.org/10.1016/j.berh.2019.01.018
Lai, C. C. H., Ardern, C. L., Feller, J. A., & Webster, K. E. (2018). Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. British journal of sports medicine, 52(2), 128–138. https://doi.org/10.1136/bjsports-2016-096836
Van Ginckel, A., Verdonk, P., Victor, J., & Witvrouw, E. (2013). Cartilage Status in Relation to Return to Sports After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine, 41(3), 550–559. doi:10.1177/0363546512473568
Brinlee AW, Dickenson SB, Hunter-Giordano A, Snyder-Mackler L. ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports Health. 2022;14(5):770-779. doi:10.1177/19417381211056873
