Chelsey Taggart
Tech and Assessment
Assessment Instrument
April 13, 2015
1. Purpose of this assessment: To measure initial muscular strength and improvement over time in athletes recovering from
ACL surgery.
2. The population that this assessment will target is high school and college athletes, both male and female, who have
experienced an ACL tear and have underwent the reparative surgery. This assessment will not discriminate based on sport but
it is predicted that the most participants will be female athletes who’s activities involve sharp movements as they are most
susceptible to the injury being studied. Ideally the participants will be participating in rehab several times a week so a change
in strength over time can be observed.
3. The general full recovery time for an ACL surgery is 7-9 months (Sports Medicine Institute). This assessment will be
preformed before the start of rehab, at months 3 and 6, and after the athlete is clear to return to their sport. The idea behind
these increments is not only for the tester to observe the improvement over time and the impact that different courses of
rehab may have on different patients but also to provide motivation for the athlete as they are able to have tangible numbers
for their progress. The scale will be graded from 1-10 with 10 being the best possible score. Athletic trainers as well as athletic
training students will administer it as they monitor the patient’s progress.
4./5. Components being measured:
 Pain- the patient will not only experience pain from the injury but also pain from the surgery. Both should
subside but over a significant amount of time. This component will be measured on a scale of 1-10. 1 being the
most pain that they have ever felt and 10 meaning pain free.
 Range of Motion- the normal range of motion for the knee is 0-130 degrees of flexion and 120-0 degrees of
extension. Before surgery the patient will have some but very limited range of motion. Post surgery the patient
will be made immobile with a brace but should be put through range of motion exercises during rehab. In the
pretest the patient will be measured based on their ability. In assessments following surgery the numbers
should be taken from the max number of degrees that the athletic trainer/physical therapist is able to flex the
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knee through both passive and active range of motion. There will be two different boxes for each type. Only knee
flexion will be measured as the patient will be unable to extend the knee because it cannot be fully flexed until
complete recovery. As for all of the components, this will be measured on a scale of 1-10 with the numbers being
outlined below in degrees.
o 1 point- 0-13
o 2 points- 14-26
o 3 points- 27-39
o 4 points- 40-52
o 5 points- 53-65
o 6 points- 66-78
o 7 points – 79-91
o 8 points- 92-104
o 9 points- 105-117
o 10 points- 118-130
Quadricep Strength- during an ACL injury the strength of the surrounding muscles is greatly diminished initially
due to pain and later on in the recovery process inactivity. The goal of the patient during rehab is not only
restoring full range of motion but also to strengthen the muscles of the injured leg in an effort to minimize the
difference in the strength in the patients legs to reduce the risk of further injury (Emory). While both the major
muscle groups in the legs, the quads and the hamstrings, will certainly experience loss of strength and tone the
quads will be the lesser of the two. The physical therapist or the athletic trainer will assess this category.
Strength can be measured on a Biodex machine that can be found in many athletic training settings.
Hamstring Strength- in a healthy individual the hamstrings to quadriceps strength ratio should be 60%-75%. In
an ACL patient this is going to be skewed. The purpose of measuring the strength of these muscles is to insure
that the difference in strength of the injured leg and the healthy leg are not too extreme. Another main focus is to
show improvement over time in an effort to motivate the patient. Grading will be on a 1-10 scale, 1 being no
tension detected (as seen commonly with an extreme injury such as a bicep tendon rupture) and 10 being full
strength.
Attitude- a positive outlook has been scientifically proven to reduce recovery times. Obviously the patient will be
experiencing pain so this scale will vary from case to case but the experimenter is asked to make their best
judgment. The purpose of this component is so that the experimenter can note the impact of attitude on
recovery times with patients that they have had one-on-one contact with. This information could also be used
for future research as this is an interesting area of study. This component will be scaled 1-10, 1 being severely
depressed and needed psychological evaluation and 10 being very upbeat.
6. In order to administer this rating scale the tester must have a background in the health field. This can come in the form of an
HPFM degree, an athletic training certification, or a doctorate in physical therapy. No tests should be preformed by a student
without the supervision of a trained professional to avoid further injury to the patient. The setting in which the scale is
administered can vary but the ideal location is an area in which the tester has access to a goniometer (to accurately measure
knee flexion) as well as a station where quad and hamstring strength can be measured, as mentioned above the best system
for this is a Biodex machine. Testing time may take between 10 to 20 minutes.
7. All recommendations will have to be approved by a doctor before the patient beings any exercise plan but the scale should
be applied as follows.
 When pain and attitude are above a 4 and all other concentrations are above a 3 the patient can begin small sport
specific movements such as walking to the best of their ability or having a catch with a soft ball in an effort to improve
their balance.
 When all components are above a 5 the patients can begin to do larger movements such as walk with a realistic amount
of speed, work with very light weights, and continue with non-contact, low impact sport specific movements.
 When all components are above a 7 the patient can begin to do realistic amounts of time walking on the treadmill
keeping aware of any unusual pain or discomfort. The sport specific training such as having a catch or tapping the
soccer ball around can increase slightly in intensity but continue to be non-contact.
 When all components are above a 9 the patient can begin to incorporate jogging into their daily rehab and increase the
heaviness of the weights that they are working with. The patient may be cleared to participate in practice keeping in
mind that most participation should still be non-contact. When this stage is cleared the patient should consult with
their doctor to determine whether it is possible for them to return to full play.
As stated above it is the final decision of the athlete’s physician whether the patient should engage in any exercise program. It
is key that the administrator is conscious of this in an effort to avoid inflicting any further injury onto the patient.
Patient’s Name:
Injury Date:
Sport:
Tester’s Name:
Pain
Range of Motion
(Flexion Only)
Quadriceps Strength
Hamstring Strength
Attitude
Initial Testing
Date:
Three Months
Date:
Date:
Six Months
Final Assessment
Date:
All grading is on a scale from 1-10, 1 being the least and 10 indicating a fully healthy patient. Both pain and attitude scale will be
subjective and vary from patient to patient. Testing should be done before surgery, three and six months after surgery, and a final
assessment should be preformed when the patient is almost fully functioning. All assessments should be preformed with the supervision
of a doctor or another trained professional and the patient should not engage in any new exercise programs without the consent of their
personal physician. Before beginning the assessment the tester should have access to a goniometer as well as a system for measuring both
hamstring and quad strength.
Works Cited
"ACL Reconstructions." ACL Reconstructions. University of Minnesota, n.d. Web. 13 Apr. 2015.
"Straight Leg Lifts." Emory Healthcare. Emory University, n.d. Web. 13 Apr. 2015.