Sports Rehab Write-Up: QB Daniel Jones, Phase I

Oof! Not another ACL!

They had high hopes headed into this season, but things just keep getting worse for the New York Giants!

Their season’s all but over after their Week 9 loss to the Las Vegas Raiders, and it’s not just because of their record…

Daniel Jones, the team’s starting QB & 2019 1st round draft-pick, went down with a season-ending ACL injury! Ouch!

Jones was overheard on the sideline telling teammates, “It just buckled,” speaking to the sudden onset instability that we’d expect to accompany a torn ACL.

Couple that with the footage we’ve got, it’s a pretty open & shut case! As we know, the vast majority of ACL injuries are non-contact! We spoke at length about the nature of ACL injuries with Trevon Diggs, a couple of weeks ago – check it out!

Since we’ve already got a little background on ACLs, let’s take this as an opportunity to dive further into the latest evidence-based rehab recommendations for some perspective on what Jones has to look forward to!

Filbay & Grindem put together a review in 2019 & recommended five distinct phases of ACL rehab:

1. the Preoperative phase,
2. the Acute phase,
3. the Intermediate phase,
4. the Late phase
5. the Continued Injury Prevention phase.

This week we’ll focus in on the Preoperative or Prehab phase, where Jones finds himself currently!

The process is to let the swelling go down and get the range of motion back and go from there... I’ll have surgery sometime in the next couple of weeks. --Daniel Jones

That’s pretty spot on!

The focus of the Preoperative phase is to minimize swelling in the affected knee, as well as to maximize the available strength, stability, & range-of-motion.

Back in 2015, Grindem et. al completed a study that compared pre- & post-op outcomes between patients that underwent a prehab phase & those that did not! Those patients that did undergo a successful pre-op ACL rehab, that effectively maximized their strength, ROM, and functional stability, were shown to have beneficial pain, symptom, and sports outcomes that extended to at least two years after surgery!

So it looks like Daniel’s on the right path so far!

Grindem’s team recommended getting the ACL-injured knee to 90% quad & hamstring strength, as well as hopping ability, relative to the unaffected knee!

It's unclear when exactly Jones will be going in for his reconstruction, but Cunha & Solomon have recommended 4 to 6 weeks of prehab in their 2022 article! The researchers also go on to fully outline the ideal 6-week prehab program with recommendations for appropriate exercises, activities, & modalities! Check it out down below!

Some studies highlight the time from injury to surgery being as long as 15-months with no negative outcomes -- recommending delaying surgery for at least 3-months!

But, of course we’ve got to consider that the Giants are hoping to see Danny Dimes back on the field for the start of next season!

I think I’m focused on what I’m doing right now and trying to get my knee ready for the surgery and ready for the process to come back stronger... So, in terms of my future, and what I’m thinking about it, it’s to attack this process and come back stronger, and a better football player in the future.

Looks like the Giants QB is all in on the prehab process!

When we consider the 4 to 6 week prehab recommendation, along with the 9-month post-op return recommendation for preventing reinjury, Jones is in a position to make his return right before the 2024 regular season begins!

Good news for all the Giants fans out there! No luck this season, but maybe 2024 is y’all’s year!

Works Cited & Further Reading

Filbay, S. R., & Grindem, H. (2019). Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best practice & research. Clinical rheumatology, 33(1), 33–47. https://doi.org/10.1016/j.berh.2019.01.018

Grindem, H., Granan, L. P., Risberg, M. A., Engebretsen, L., Snyder-Mackler, L., & Eitzen, I. (2015). How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. British journal of sports medicine, 49(6), 385–389. https://doi.org/10.1136/bjsports-2014-093891

Cunha, J., & Solomon, D. J. (2022). ACL Prehabilitation Improves Postoperative Strength and Motion and Return to Sport in Athletes. Arthroscopy, sports medicine, and rehabilitation, 4(1), e65–e69. https://doi.org/10.1016/j.asmr.2021.11.001

Giesche, F., Niederer, D., Banzer, W., & Vogt, L. (2020). Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review. PloS one, 15(10), e0240192. https://doi.org/10.1371/journal.pone.0240192