Now that we are on the other side of a complex client rehab, I figured now would be the perfect time to write about our client Sarah’s journey in hopes it helps others who stumble upon this blog. This veers from our typical scientific/referenced blog post and just simply tells the story of our process behind rehabbing Sarah after her assessment with us in December of 2023. If you’ve struggled with nagging pain from sports and surgeries for years after the fact, you might enjoy hearing that it’s never too late to get help.
The Beginning: Sarah’s Assessment
Some general assessment notes we took at the initial assessment that help paint the picture of what she was going through with her extensive injury history
- Young 34y/o athletic female with a history of playing basketball and volleyball primarily. Now she was into cycling long distances, jogging and hiking, and was planning a big bike trip across a few European countries around 6 months after I assessed her
- First ACL repair was in 2017 on her left knee
- After that, she got a left hip tear that flared up so much that she couldn’t do squats but it was deemed non-surgical in 2018 so she has managed it to the best of her ability
- She had had many ankle sprains in the past, always on the left ankle
- She was very big into activities – and often when skiing, even though she wears her brace, her knee would “slip” a little bit inside her knee brace – and she would feel these little tweaks
- Cycling in 2019 tore her ACL a second time on the left knee
- Opted for surgery 2022 for the left ACL – got a Quad Graft this time PLUS the IT wrap (for additional support in rotation). There were lateral staples put in that she later found out in 2024 needed to be removed and was increasingly in discomfort for that reason
- Running bothers the knees and hip sometimes still
- Her back flares up mostly in ski season
- Left shoulder had been super flared up recently – can’t elevate the arm without pain (forward flexion or abduction – either hurts/pinches)
Assessment Findings
Main concerns from my movement assessment of Sarah were:
1) Overall, her movement tendencies didn’t offer much insight into why she had pain. Not that moving a certain way will lead you to a certain type of injury (it doesn’t). But, her movement assessment looked great and I couldn’t find any sign of compensations, obvious asymmetries, or glaring issues in her movement.
Her running form was both symmetrical and normal, and her squats and single leg squats only showed a slight rotation away from the stance leg on the left compared to the same single leg squat on the right. She showed a more dramatic rotation clockwise (CW) and favoring of the right leg on the jump landings, but we later tested her on the Vald Force Plates and the asymmetries were low and insignificant.
2) The lower body testing we did last in her assessment on the Vald Force Frames revealed some big differences right to left. Of note, hamstring strength was 55% higher on the right than left, right side hip internal rotation was 30% higher on the right, and 10% more hip abduction than the left.
Orange is the right, blue is the left, green indicates increases from our first testing session 3 months prior, and red indicates decreases from our first testing session below:
For us, asymmetries approaching and exceeding 15% for strength testing warrant flagging and addressing.
3) Shoulders didn’t like the empty can test, pronated hand positions on the lat pull down, and had slightly less external rotation (ER) strength on the left shoulder in her strength testing. Overall, the range into shoulder flexion (above the head) was limited, painful only through the mid range, and painful mostly in any internally rotated positions. She had a 45% strength deficit in internal rotation on the left shoulder, notably.
At the end of our assessments, we always say: These are likely all resolvable with the right work and effort and our belief is the same patterns which are more injury-resistant are also the ones which promote better performance over time.
The Process
Whenever we take on these types of complex cases – we are typically summoned in the mid and late return-to-play stages to assist the therapist with ensuring the individual is physically prepared to tolerate the demands of the sport.
This particular case was different because we were years post op… way past the latest of late return-to-play protocols for ACL, and the shoulder had never really been diagnosed or scanned to confirm the issue, we just knew there was pinching and pain in various movements.
As many strength and conditioning coaches will say – we want to reverse engineer the plan with the end goal in mind. When the end goal is no pain, how do we reverse engineer that? The same way we might reverse engineer a return to sport — by identifying the demands, addressing the deficits, and progressively building capacity. We focused on closing the strength gaps in her lower body, restoring pain-free range and strength in her shoulder, and gradually increasing the load and complexity of her training to prepare her for her biking trip.
Achievements and Ongoing Challenges
Sarah was recently completing her goal of biking across Europe and I got this message from her:
“We got home from our bike trip last week! We cycled about 3000km over the 9 weeks through parts of Portugal, Spain, France, Switzerland, Germany, Belgium, Netherlands, Scotland and Ireland! It was a really good trip.
My shoulder has been good! I did some maintenance exercises along the way and it is still pain free! I am hoping to get back into the gym over the next couple weeks while we are home in BC. I will keep you posted when I am coming to Calgary and hopefully can fit in an appointment with you!”
The Role of Comprehensive Rehabilitation
Pinchy or Under-performing Shoulders?
Our Shoulder Foundations program addresses common shortcomings in shoulder rehab, focusing on proper posture and rib cage alignment, helping to progress range of motion, addressing compensations, and emphasizing strength in all directions. Shoulder Foundations is not a replacement for physiotherapy treatments, individualized assessments, or surgical and post-surgical protocols. It is also not intended for those with nerve palsy or spinal nerve involvement, nor is it for early stage frozen shoulder.
Our program IS about countering the potentially detrimental advice to “Keep shoulders down and back” – (see more in our blog about that HERE) – it emphasizes the importance of shoulder blade movement, a stable and moveable ribcage, and builds strength through proper exercise progressions. We’ve already had people see more amazing results from our Shoulder Programming, which you can read about HERE.
If you would like to try it out, use code NOMOREPINCH to get a 20% discount on your first month! Or, if you think your hip strength is a limitation for the end-stages of your knee rehab (or have been told so by your physiotherapist), use code BUTTERYHIPS to get 20% off your first month of Hip Foundations.
Conclusion
Sarah’s story is a powerful reminder that it is never too late to address lingering pain from past injuries and surgeries. Even years after her ACL repairs and with a shoulder issue that had never been formally diagnosed, the right combination of thorough assessment, targeted strength work, and progressive rehabilitation made all the difference. She went from struggling to raise her arm without pain to cycling 3,000 km across Europe — pain free.
If there is one takeaway from this case, it is that your body is more resilient than you might think. With the right guidance, patience, and consistency, meaningful change is absolutely possible — no matter how long ago your injury occurred.
Ready to start your own journey? Book an Initial Training Assessment with us at Vital and let us help you build a plan to move better, feel stronger, and get back to doing the things you love.
More About The Author
Carla Robbins, Co-Founder of Vital Performance Care
Carla’s journey into the world of endurance training, strength and conditioning, and exercise physiology began with her Undergraduate Degree in Exercise Physiology at the University of Calgary and continued into her graduation with a Master’s in Exercise Physiology in 2016. Between working for the Canadian Sports Institute to the creation of her company Vital Strength and Physiology Inc (now Vital Performance Care), Carla is driven by a desire to find better ways to address complex cases in professional and everyday athletes and individuals.
