Global Perspectives on ACL Rehabilitation: Insights from Aspetar to Lilydale
What does it take to provide the "World's Best Physiotherapy"? In this installment of our global search, Sam Souk sits down with Andreas Bjerregaard, a Danish physiotherapist with 15 years of experience, including nearly seven years at Aspetar in Qatar—one of the world's most prestigious orthopedic and sports medicine hospitals.
Through his international lens, Andreas explores the commonalities in global physiotherapy, the pitfalls of clinical interpretation, and the emerging role of technology in patient care.
1. The Aspetar Experience: A Melting Pot of Clinical Excellence
Aspetar is a unique ecosystem where approximately 300 physiotherapists from 30 different countries collaborate. Andreas observed that while clinicians worldwide use identical tools—such as the Lachman’s Test for ACL stability or Red Flag screening for back pain—their interpretation of those results varies wildly.
The Key Lesson:
Clinical skill isn't just about performing a test; it's about the decision-making that follows. A "negative" test result in one country might lead to a different rehabilitation path than in another, highlighting the importance of standardized, evidence-based frameworks like the ones we implement at Exercise Thought.
2. Measuring Success: Moving Beyond "Did They Call Me Back?"
A common pitfall in private practice is assuming a patient is healed simply because they stopped booking appointments. Andreas challenges this "no news is good news" philosophy.
The Data Gap in Outcomes:
Recall Bias: A study at Aspetar showed that patients often report "feeling better" even when their objective pain scores remain high. This is because their goals shift from "walking without pain" to "running a marathon."
Global Rate of Change: At Exercise Thought, we use a 0-100 scale to track progress toward a patient’s specific life goals. As Andreas notes, cultural adaptation is vital; "feeling full" or "feeling pain" means different things in Denmark, Qatar, and Australia.
Limb Symmetry Index (LSI): While LSI is the gold standard (comparing the strength of the injured leg to the healthy one), Andreas warns it can be misleading. If the "healthy" leg has also weakened during the recovery period, a 100% symmetry score could actually represent two weak legs.
3. The Biopsychosocial Model: Treating the Person, Not the Scan
A recurring theme in high-level physiotherapy is the "Scan Trap." Andreas recounts instances of surgeons looking only at a Biodex strength report or an MRI without ever looking at the patient.
The Exercise Thought Mantra: Treat the person, not the picture. Treat the symptoms, not the scan. A "terrible" scan of a lumbar spine does not equal a terrible life. Effective rehabilitation must address:
Biological: Muscle strength and ligament integrity.
Psychological: Self-efficacy and the confidence to return to sport.
Social: The human need for connection, especially evident during the COVID-19 lockdowns in Melbourne.
4. The Digital Frontier: AI and Telehealth
Andreas and Sam discuss the "Man behind the steering wheel" theory of AI.
Accessibility: With 85% of the world connected to the internet, AI tools can offer diagnostic flowcharts and risk assessments (like the 85th percentile for knee extension strength) to those who cannot afford traditional care.
Denmark’s Digital Goal: Denmark has a national goal that 30% of all consultations should be online by 2028.
The Hybrid Future: While AI can track a squat via a smartphone camera, it cannot replace the "warmth" of human contact. The future of physiotherapy in Lilydale and the Dandenong Ranges is a hybrid of objective digital data and compassionate human touch.
5. Clinical Reasoning: The "World's Best Student"
When asked if he is the world's best physio, Andreas responds with humility: "I am the world's best student." This mindset is essential for any clinician. The moment a practitioner stops being "hungry to learn," they become a "guru" stuck in dogmatic thinking.
For graduate physiotherapists, the lesson is clear: Stay open-minded, stand on the shoulders of giants, and always ask, "Prove me wrong."
FAQ: People Also Ask
1. What is Aspetar and why is it famous in physiotherapy? Aspetar is a world-renowned sports medicine hospital in Qatar. It is famous for its high concentration of international experts and its leading research into ACL rehabilitation and sports injuries.
2. Why is Limb Symmetry Index (LSI) sometimes inaccurate for ACL recovery? LSI compares your injured leg to your non-injured leg. However, if you have been inactive, your "healthy" leg may have lost strength. This can make your injured leg look "recovered" (100% symmetry) even though it is still too weak for high-impact sports.
3. When should I get an MRI for back pain? Current clinical guidelines suggest that unless "red flags" are present (such as loss of bowel/bladder control or severe neurological deficit), an MRI is often unnecessary in the first three months of treatment, as many findings on scans are normal signs of aging.
4. Can physiotherapy be done effectively online? Yes. For many conditions, including ACL rehab and chronic back pain, telehealth allows for consistent monitoring, exercise correction via camera, and education. It also removes the barrier of travel time for busy patients.
5. How does Exercise Thought measure my progress? We use a combination of objective strength testing and subjective goal tracking (0-100 scale). We focus on whether you are returning to the activities you love, not just whether a specific test score has improved.
Take the Next Step in Your Recovery
At Exercise Thought, we bring the global standards of Aspetar to the local community of the Lilydale.
For Patients: Experience a data-driven, person-centered approach to healing. Book Now.
For Students: Learn the frameworks used by the world's leading clinics. Explore our Education Resources at ExerciseThought.com/students