I spun the wheel of Journal Club topics and it landed back in the orthopedic/sport rehab world.  Today, we will be dealing with the infamous ACL reconstruction!  Now, if you have been in the orthopedic/sport rehab field for any duration of time, you will recognize that this is a common surgical procedure and you have most likely treated several patients who have had ACL reconstructions.
  
There are so many types and ways to repair the ACL from using hamstring grafts to patella tendon grafts to even cadaver grafts.  Each surgeon you work with will have his or her “go to” surgical technique and rehab protocol to guide the recovery process.  Generally, though it’s a rather lengthy process with certain milestones across the months ultimately ending with a functional return to sport test.

I’m sure you administer functional return to sport testing when the time comes just as I do.  We want to make certain that our patients are strong, stable, and ready to return to their respective activity objectively.  But what about mentally?  What about psychologically?  Are we assessing the psychological readiness of the patient to return to sport alongside the objective data?

We don’t want to miss this aspect of recovery and this was the discussion of our recent journal club meeting.  We discussed a psychological tool to administer to our patients who are recovering from ACL reconstruction.  That tool is the ACL Return to Sport after Injury Scale (ACL-RSI).  Below you will find the actual questionnaire along with 2 articles that provide more information about the tool and factors affecting psychological readiness.

ACL-RSI Tool         Factors Associated with Psychological Readiness        Progression of Psychological ACL-RSI Score
      
I think the main takeaway from these articles is being able to identify overconfidence or under-confidence in a patient. That will enable us, as the clinicians, to spend time educating the patient appropriately.  If a patient tests really well objectively but displays anxiety or timidity with full return to sport or activity, we can talk to the patient and coach them to see they are, indeed, ready.  Likewise, if a patient tests poorly during the objective measures but has a really high confidence index and thinks they can do more than what their knee can actually handle, we can educate on the importance of continued strengthening and activity caution.

I hope you begin to utilize ACL-RSI in your practice.  I think it will only improve your outcomes as you consider both the objective and subjective aspects of ACL reconstruction rehabilitation. Let’s go change the rehab world! 

​Jason

Excited to have a guest contribution from Caleb Mellinger today!  He is discussing the temptation to compartmentalize our work and church life.  I think you will enjoy it!

"There are many temptations we deal with in life. It could be a temptation to cheat on a diet. Or a temptation to hide the truth. Another big temptation we all face is maintaining consistency in our character.  It can be so easy to act or speak a certain way in one context and then be totally different in another context. The same is true when it comes to our faith and our work. There is a strong temptation to separate those two spheres of life. But today I want to encourage you to guard against that temptation and be consistent in character whether at church or work.

One of my favorite verses is 1 Corinthians 15:58. Paul says, “Therefore, my beloved brothers, be steadfast, immovable, always abounding in the work of the Lord, knowing that in the Lord your labor is not in vain.” When I meditate on this passage I have to ask myself a few questions: How am I being steadfast? What does it mean to be immovable? Am I always abounding in the work of the Lord? These are good questions to ask yourself as you  pursue holiness.  But I want to focus on the last question this passage illuminates. Do I view my work, in the modern day sense, as a way to labor for God? I always find it helpful to look at the life of Jesus and find how he had success and then apply what I learn into my own life.  After all, John 3:30 tells us “He must increase, I must decrease.”
 
Jesus was and is the best embodiment of living out consistency in character in his labors because of His unchanging character. Hebrews 13:8 says “Jesus Christ is the same yesterday and today and forever.” His ability to always be obedient to the Father’s heart and will in every setting of life yielded fruit in all of his endeavors for the Father. Let’s look at some examples.
 
Jesus as a Teacher.  Jesus says in Matthew 5:16, “In the same way, let your light shine before others, so that they may see your good works and give glory to your Father in heaven.” Here we see in a formal setting that Jesus taught and modeled that no matter what we do, we should labor for God and live for his glory.
 
Jesus as a Friend.  During the Last Supper with his closest companions on probably the most stressful night of his life, Jesus says in John 15:8 “My Father is glorified by this: that you produce much fruit and prove to be my disciples.” Again, Jesus is telling his disciples and us to live for the glory of God but this was in a much less formal setting.  Do you display the same character with your friends compared to your character at work, church, or other activities?
 
Jesus Alone by Himself.  Jesus, alone in the garden the night before He was crucified, prays in Matthew 26:39 “My Father, if it is possible, let this cup pass from me. Yet not as I will, but as your will.”
 
I think you are seeing the pattern here.  In each of these scenarios, Jesus is living for the glory of the Father, the kingdom of Heaven, and the responsibility as a child of God to bear fruit in all arenas of life.  The context changes but his message does not.  The setting changes but the character does not. So to be like Jesus means to labor for being the same at church, at work, with friends, or alone with my thoughts. How can we do that everyday? Let me offer a few suggestions:

• Be the same person in every setting (work, church, with friends, or alone) by looking to Jesus for unchanging character. Ask questions at work like would I speak this way at church? In front of my family? Am I loving others like Jesus loves me?
• Bear fruit at work by living, speaking, and praying the gospel. Ask questions like have I shared the gospel today? Have I prayed for or with a patient today? How am I bearing fruit for God today? Are my words building up or tearing down? How am I showing the gospel without my words?
• Spend time alone with Jesus at home and at work to be better prepared to take the cup He has for you. Self examine your time and assess do I spend time with the One who labors perfectly? Am I running to Jesus? How am I feeding the Spirit which leads to life (Gal 5)? How am I starving the flesh to avoid producing death (Gal 5)?

 
I pray that you find this encouraging and helpful to avoid the temptation to separate your faith life and work life. Jesus didn’t do that so we shouldn’t either.  Let’s be of the same character no matter in which context we may find ourselves.  And let’s live for the glory of God by fixing our eyes on Jesus!"

Caleb