June 15, 2023 

Inside the Stephanie Talbot journey back to basketball: Part 3

Talbot returns to running

The first month of the 2023 WNBA season is flying by. Home in Australia, Stephanie Talbot has been keeping an eye on how her friends and former teammates are doing in the league. When we last checked in with Talbot, she was almost two months into her ACL rehab. She was enjoying long walks with her pups and her knee mobility was nearly restored. She had also started to strength train with light weights. The 12-week mark is a big milestone in the recovery as it’s the earliest most surgeons allow running to begin if patients have met certain criteria. The Next got an update from Talbot on her progress as she eclipsed the first-trimester landmark.

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Cardiovascular training

Basketball requires cardiovascular fitness and the ability to move at variable speeds and change directions quickly. A basketball player can run up to several miles during a game. An athlete who typically exercises most days of the week and then suddenly takes a month away from the gym can experience a fast reduction in their fitness. It’s imperative that athletes recovering from an ACL injury preserve their cardiovascular fitness as early into their rehab process as they can.

Talbot was going for long walks to increase her heart rate following surgery, but walking is insufficient to maintain the level of cardiovascular endurance necessary on the basketball court. Soon after surgery, she started using alternative methods to elevate her heart rate. She incorporated swimming, boxing and pilates along with upper body and core training. But even with all those options, she shared that she wasn’t really getting sweaty until they added in the ski ergometer. A ski ergometer is a machine that helps simulate the motion of Nordic skiing. “I like the ski ergometer because you can actually get gassed and sweaty. Like, I feel like it’s an actual workout,” she said.

Why can’t you run earlier? Usually, athletes feel ready to run much sooner than three months after surgery, but several studies have shown that the ACL graft gets weaker after surgery before it gets stronger. The graft needs sufficient time to bind to the bones of the knee, so the delay to initiate running allows for a reduction of quadriceps inhibition and sufficient strengthening of the muscles to protect the weak graft. Athletes can be tested in numerous ways to determine whether they have sufficient strength to protect their new ACL.

Testing

Initiation of running should not be based solely on three months’ time passing since surgery. Strength assessments determine that the athlete’s muscles can help protect the still healing graft. Talbot completed several tests before first trotting across the basketball court and then progressing to running. Her quadriceps strength was deemed sufficient when she could do 20 single-leg squats with good muscle control. She also needed to do 25 calf raises on that leg. Hip strength and balance were also tested and compared to the uninjured leg.

Finally, Talbot also completed a Cybex Test. The Cybex machine measures strength when moving at a specified speed. This is important because in sports, athletes move at different speeds constantly. The machine is set to move slowly, which feels heavy, and measures how much strength the athlete has to move at that speed. This is repeated at a fast speed. Talbot did not have her test results to share but was cleared to begin running, so they must have been satisfactory to her rehab team.

What data might they have collected? The comparison between legs results in a percentage known as the Limb Symmetry Index (LSI). At three months out from surgery, ideally the strength LSI is at least 60% for the quadriceps, hamstrings and glutes. Many surgeons and physical therapists require even higher thresholds to initiate running. Measurements comparing force to the athlete’s body weight are even more valuable than looking at symmetry between legs.

Return to running

The progression back to running shouldn’t be like your childhood game of Red Light, Green Light. Transitioning from a period of no running to suddenly going full speed ahead should include an intentional progression. For Talbot, this started with walking distances and then the addition of focused work on running mechanics. She was stepping over hurdles, working to make sure her heel was striking the floor before the rest of the foot. She is also relearning how to push off using her surgically repaired knee as the back leg, which will later help with sprinting motions. Talbot started mechanics work a few weeks before beginning to trot.

When the testing showed readiness for progression into the running stage, Talbot said, “I semi-forgot how to run. But [the] second time went much better … I’m gliding instead of running.” She trotted the length of a basketball court to start. At the beginning, the runs are very slow speed, short intervals, alternated with walking or sometimes rest. As long as the knee doesn’t swell, the time spent running can increase, and over time, the speed will, too. She’s running almost one kilometer (0.6 miles) without stopping.

Running will be foundational to many other pieces of rehab moving forward. Once she’s able to run for a longer distance, it will help her build cardiovascular endurance more than the other options. Running allows for cardiovascular training, and you can do it while dribbling a basketball. It will also help build up tolerance to landing so that Talbot can eventually progress into jumping and landing, a key skill for someone who averaged 7.4 rebounds per game in the WNBL last season.

Progression of strength training

While running and cardiovascular fitness is imperative, basketball players need to be strong, too. In order to start basketball drills that require a change of direction or cutting, her strength will need to be even higher than the 60% LSI target recommended for running. Talbot’s strength coach has been working on her programming so she can keep getting stronger.

She said, “This week my lifts had lots of fun stuff … front squat for the first time at 42.5 kilos [93 pounds], trap bar deadlifts, reverse sled pulls. And I’ve been doing the worst [thing]: single-leg leg press with the BFR cuffs on. And also leg extensions with the BFR, and holy shit does that burn.”

BFR stands for Blood Flow Restriction training. With this technique, a special tourniquet is placed around the hip to reduce the blood flow to the whole leg while exercising. Since blood flow carries oxygen to muscles and oxygen is needed for energy, the muscles fatigue much faster using BFR. This approach forces the athlete to use more muscle fibers to complete their exercises, which can help build muscle size and strength.


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Talbot was using the BFR to build up her quads. “I’m in BFR mode now,” she said. “BFR mode and quad game mode. Gotta get my quad game back.” Talbot also has started working on hamstring curls, but because she had a hamstring graft for surgery, she initially wasn’t allowed to do them, and then when cleared to start, she wasn’t yet able to. Now she’s starting to be able to move some weight with her hamstrings and the deadlift variations are helping, too.

What’s next?

Talbot’s excited about an upcoming vacation. She’ll be able to continue her rehab solo for a little break away from home while having a change in scenery. Running can really be done anywhere, as can bodyweight strength work. And then it’ll probably be time to pick up a basketball if she wants. We’ll have to wait and see.


Want to learn more about Stephanie Talbot’s return to basketball? Read the next installment of this series, or browse the entire series.

Written by Abby Gordon

Abby Gordon is a Board-Certified Sports Physical Therapist at Seattle Children's Hospital. She was the Team Physical Therapist for the Seattle Storm from 2015 to 2022 and the Travel Coordinator and Equipment Manager for the Connecticut Sun from 2007 to 2010. After four seasons working as a team manager for the UConn Huskies Women's Basketball team, she graduated from the University of Connecticut in 2007 with a Bachelor's in Exercise Science and in 2014 with a Doctorate in Physical Therapy. She writes about WNBA Injuries and Sports Medicine Issues in Women's Basketball for The Next.

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