Pilates for Wakeboarding
Returning to Wakeboarding after ACL reconstruction using the Physio-Pilates Method
A 30 year old female was referred to Focus Pilates after an ACL reconstruction, her goal was to get full range of movement back in her knee and be strong enough to return to wake boarding.
By week 12, using Physio-Pilates the patient was able to regain full range of motion, her muscle power increased back to normal standards, she was running 20-30 minutes and she was able to hop and jump on her affected leg.
The following case study shows her progress through a three-month rehabilitation program.
What is wake boarding?
Wake boarding is popular water sport that includes using wake board (similar to snow board) to ride over the surface of water.
This sport requires very strong core muscles at first, with extreme strength of upper and especially lower limbs.
Beside strength this sport requires proper flexibility, balance and proprioception to provide efficient movement and stability.
What is an ACL tear?
An ACL (anterior cruciate ligament) is a crossed ligament inside knee-joint, between thighbone and shinbone, which keeps knee from shifting backwards.
ACL injuries usually occur from twisting of the knee and sudden deceleration. ACL injuries usually happen in conjunction with tears in other ligaments of the knee so they are very painful and time-consuming to rehabilitate, with 90% of the cases requiring surgery.
The following shows how treatment progressed over a 12 week period using the Physio-Pilates method for rehabilitation.
First week
The patient was walking with assistance using crouches and a knee brace. Her knee was painful and swollen after the operation, with limited range of motion and muscle strength was extremely low for both quadriceps and hamstrings (less than 2 out of 5). Treatment at this time included physiotherapy such as ultrasound, soft tissue massage and encouraging gentle range of motion to reduce pain, swelling and facilitate muscle contractions.
Week 2
Pain and swelling had decreased allowing treatment to concentrate on more range of movement and strengthening exercises using the reformer (Pilates machine). The reformer allows patients to exercise lying down to eliminate gravity and provide a controlled environment for weight-bearing. These exercises also helped the client to engage her core muscles which are particularly important for wake boarding. Exercises at this stage were closed chain conducted on Pilates equipment, which means the leg was always supported against a surface when performing an exercises to protect the new ACL graft.
See the following video for an example of a closed chain exercise using Pilates equipment.
Week 2-6
Pilates exercises progressed to include more resistance moving from lying down to seated and standing exercises using a variety of specialised Pilates equipment.
At this stage Pilates machines were used to challenge the client by giving her exercises against gravity and moving into more functional movements.
Exercises at this stage focused on whole-body movements to encourage many muscles to gain strength with the goal that the client wanted to get back to her sport as soon as possible.
Week 6
By the end of week six the patient had regained two-thirds of her range of motion in her knee, muscle power in her leg had increased to 4 out of 5, walking was normal with no aid and she was able to climb stairs and cycle at the gym for 20-30 minutes without pain. The following video shows exercises given at this stage.
Week 7 – 8
Further challenge was provided by incorporating more Pilates exercises to increase/decrease resistance, narrow the base of support, allow client to rely more on her balance and drawing her attention to proprioception (awareness of her limbs in space).
To encourage the client to work on sport specific movement strategies and whole-body muscle strength exercises were given which required whole body movement integration.
Week 9-11
Exercises progressed to include open-chain exercises (e.g. straightening and extending leg against resistance). This is challenging because the person has to control movement in space without the support of a surface, this requires stronger muscles, flexibility and motor control.
Week 12
By the end of week 12 the patient had full range of motion in her knee and was able to do a full squat, muscle power had increased to +4/5. She was now able to run with inclination and was able to hop and jump on her injured knee.
Functional exercises that require movement and coordination from all parts of the body were given so that the patient could better prepare her body to return to wake boarding.
The following video shows an example of a functional exercise for wake boarding.
During her physiotherapy treatment the patient committed to coming twice per week and completed a home exercise program three times per week in order to help with her recovery.
Week 13 +
The patient was discharged from physiotherapy after three months however she was encouraged to do two Pilates and two gym sessions per week to continue to build strength.
She returned to wake boarding nine months after her surgery.
She continues to attend Pilates group classes in order to ensure her core stays strong and her muscles are conditioned to prevent further injuries.
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