Cross Transfer and Bad Physical Therapy

Jun 22, 2022

“Common sense is not very common”
I got the question below, and another just like it, over the last few days.
“Mike, have you ever worked with a PT who restricted or eliminated lower body work on the non-involved leg after an ACL injury/surgery?  They are attempting to reach an 80% ratio injured to non-injured before allowing athletes to perform any lower extremity work”.
THIS IS STUPID. If, as Forrest Gump said “stupid is as stupid does”, this PT in question is just plain stupid, ( and uniformed to boot).
Think about this? Would you encourage atrophy in a perfectly healthy limb to serve statistics? Would you encourage weakness to justify statistics? STUPID.
Cross transfer is real and, we have know about it for 30 years. Want to get someone back from any injury really quick? Use the nervous system to your benefit and work the uninvolved side.
In The Contralateral Approach to Exercise Rehab chiropractor Kim Christiansen describes cross transfer as
One way to provide the stimulus of early exercising to an injured area, while avoiding excessive irritation, is by using contralateral exercise. This neurological phenomenon (also called "cross education" or "cross transfer") has been identified for many years, yet rarely is used by clinicians treating acute injuries. While this procedure is particularly helpful in the treatment of shoulder and ankle injuries, it can be used successfully for many areas of the body.
The amazing thing to me is that cross transfer is not a new phenomenon or a recent discovery. As a strength and conditioning coach I always felt it was our way to assist in the rehab process. I tell our athletes that have injured a knee or a shoulder that they are 75% healthy. An athlete with a shoulder injury has one good arm and two good legs. Why not continue to exercise? We put tremendous effort into finding ways to do as many exercises as possible to work around an injury and to speed recovery.  We also want as little strength loss as possible in the remaining 75% of the body so that the return to play portion of the rehab proceeds as quickly as possible. We begin to work the uninjured side as soon as the athlete is safely capable. We have gone as far as using single Olympic lifts in the later stages of our ACL rehabs to keep our athletes both powerful and engaged. It is standard operating procedure for any athlete, with any injury to continue to train the rest of the body while rehabbing.
Bottom line, cross transfer is real and it works. If you are a PT who discourages exercising the non-injured body part, please stop. It defies both science and, common sense. If you are a trainer or a strength and conditioning coach contemplating doing some cross transfer work think about two rules.
Rule 1- Do No Harm
Rule 2- Be as Aggressive As Possible Without Breaking Rule #1
The Contralateral Approach to Exercise Rehab, Kim Christensen, DC, DACRB, CCSP, CSCS,