BACKGROUND: The number of ACL injuries has increased sharply over the last 20 years with 250,000-300,000 cases annually. Exercise Science (ES) practitioners often work with clients post ACL injury and surgery, but no studies illuminate the Psychosocial (PS) factors informing critical aspects of client management. The goal of this case report is to describe biological, psychological, and social factors associated with ACL injury through the lens of a 21-year-old female Exercise Science student who experienced 3 ACL reconstructions.METHODS: The history included a PAR-Q, review of systems, health history, Lower Extremity Functional Scale (LEFS), Tampa Scale for Kinesiophobia (TSK) and the SF-36 quality of life assessment. Fitness assessments included posture, gait, range of motion (ROM), strength, balance, coordination, proprioception, and motor control. An ACL MD protocol was followed for ROM, strength, brace wear, proprioception, and patellofemoral mobility. Anticipated return to sport was approximately 9 months. Due to the lack of insurance coverage, management consisted of 0 MD follow-up visits, 4 PT sessions and an independent home program with self-directed management.RESULTS: At 18 weeks post-surgery, assessment indicated a significant delay in recovery. Deficits included: ROM 10% with 6/10 pain, strength 50%, balance 30%, proprioception 10%, motor control 55%, coordination 35%, LEFS score 50%, TSK and SF36 33%. Numerous PS factors played a crucial role delaying recovery and were responsible for 90% of the non-compliant behavior. These factors included fear, lack of time, embarrassment by inability to workout normally, worrying about monopolizing gym space and equipment, lack of external accountability, stress and anger associated with insurance complications, as well as frustration and dejection not meeting the protocol timeline. Effective practitioner PS communication strategies yielded several "breakthroughs", reversed discouraging emotions and lead to hope and internal motivation which resulted in improved compliance and functional performance.CONCLUSION: The aim of this case report was to illustrate the importance of addressing PS factors in ES. This case offers non-exercise interventions that drastically impacted behavior for a client extremely knowledgeable in exercise. To provide best practice, exercise science professionals must be sensitive to PS factors and possess effective behavioral strategies to truly enhance our clients’ quality of life and meet societal needs.

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