Are There Speed Limits in Rehabilitation?

Kevin E. Wilk

DOI: 10.2519/jospt.2005.0102

During the course of rehabilitation of a patient, I often wonder if there are speed limits to our rehabilitation program. This dilemma usually occurs when a patient is recovering exceedingly fast, making me wonder if we are progressing too quickly and violating the soft tissue healing constraints. In the specific case of patients who have undergone ACL reconstruction, the primary healing constraints we should be concerned about are revascularization of the graft, graft remodeling, graft incorporation, and regeneration of graft strength. With these patients, I'm mainly concerned about the consequences of a fast or accelerated rehabilitation process. Does the accelerated rehabilitation program lead to increased laxity, a higher rate of graft failure, articular cartilage damage, or early degenerative changes of the joint? By returning someone back to sports quickly, are we placing the patient at risk for other problems now or years later? Is our ultimate goal of rehabilitation to return someone to sports as quickly as possible or to return them when it's safe for them? The case report by Roi et al, along with the invited commentaries by Drs Fithian and Shelbourne, published in this month's Journal raise many issues we must all ponder when considering the speed of the rehabilitation process.

J Orthop Sports Phys Ther. 2005; 35(2):50-51. doi:10.2519/jospt.2005.0102

Key Words: rehabilitaion; soft tissue healing constraints

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