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Build Physio & Performance

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Bozeman, MT
Build Physio & Performance

Sports physical therapy clinic in Bozeman, MT. Experts in ACL rehabilitation & sports injuries, isokinetic strength testing and sports performance.

04/17/2026

Post op Achilles rehab is relatively straight forward in the early phase, like George Kittle says “You either do standing calf raises or seated calf raises until you can run and walk and stuff”

The question then becomes, how many different versions of standing/seated calf raises can we do?

Dependent on equipment and restrictions, these are some great options for early stage:

Seated Isometrics w/Tindeq
Seated Heel Raises
Voltra Plantarflexion
End Range Plantarflexion Holds
DL-SL Eccentrics
SL Heel Raises

Take note of the BFR present in all of these 👀👀👀

04/06/2026

With longer term restrictions of non weightbearing, it can be difficult to maintain calf size/strength for ankle injuries. Bands aren’t enough resistance for calves and it can be difficult to have a secure/comfortable enough setup to make isometrics high enough intensity.

This is our current iteration for NWBing plantarflexion isometrics, we find the wood block much more comfortable for the foot to press into compared to an ankle cuff.

The Tindeq provides the feedback to patient to track progress each session and ensure high enough intensity. Amount of DF is adjustable via blue strap and the patients own body provides the anchor/resistance.

We will probably cycle through multiple more iterations before landing on a final version.

03/25/2026

As we have been testing quad Rate of Torque Development over the past ~2 years with our ACL patients we have begun to notice this trend develop.

No matter how far out from surgery the testing begins, symmetry for isometric RTD 0-200ms is ~10% lower than isometric peak torque symmetry.

While not perfect data as we often stop testing peak torque when symmetric and good TTBW, this is still 131 time points of same day RTD & peak testing with this trend holding up.

May be a useful heuristic if you are unable to conduct a valid RTD test.

01/22/2026

A drop jump test is intended to measure an athlete’s reactive strength - the ability to utilize a fast stretch-shortening cycle (SSC). In other words, it measures the ability to effectively transition from eccentric to concentric contractions with minimal loss of energy in the amortization phase (ground contact). In order to do this test properly, the athlete should be achieving the same jump height from their standard countermovement jump (CMJ), while completing the test with a ground contact time (GCT) of 250ms or less. If the athlete is unable to achieve both of those metrics, it is likely the drop jump box height is too high for the athlete’s current abilities. Once the ground contact time exceeds 250 ms, it is no longer considered a fast SSC.

The first video is gathering jump height from a max CMJ test.

Then we performed a drop jump from 8” box height where the athlete is able to maintain his jump height while also having a GCT of 240ms which is faster than the goal of 250ms.

The final video is trialing a 12” box height, but he was unable to maintain either his jump height or a GCT of sub 250ms. This would indicate that this box height is too high for the athlete to still utilize a short duration SSC.

The popularized default box height for a drop jump test is 12” (31cm), however this is often unrealistic for many patients to maintain both jump height and

01/20/2026

came back from break and threw up some huge numbers!

5 months post quad tendon ACL
⚡️80% quad symmetry and well over 3 Nm/kg so I moved the goal post to 4.5 Nm/kg
⚡️78% quad rate of torque development symmetry measured @ 200ms
⚡️Isokinetic quad 65% and ham 88%
⚡️CMJ symmetry in propulsive and braking phases

Noa followed the program and stayed accountable at the gym while away for a month.

01/12/2026

Torque Unsteadiness ⚡️

When performing an MVIC isometric quad contraction (first video), occasionally we note difficulties in maintaining steady torque production. In some cases this can be exceedingly shaky which is illustrated in the force time curve (2nd pic).

We can quantify unsteadiness using TorqLab (thetorqlab.com) by using raw data from our Humac (3rd pic). The great folks at Dave Sherman’s lab at Northeastern are fighting a good fight and we appreciated the time Dave took to clarify the metrics used.

Two metrics might be useful:
CoV- the magnitude of force fluctuation (low numbers are better)
Yank- max yank will tell us the instantaneous rate of toque (think of the steepest point of the jagged lines versus a smooth line).

It doesn’t make sense to compare the two limbs when each is producing a different amount of torque, so we rectified this by repeating the test so that each side produced the same amount of torque. We chose 50% MVIC on the affected side and repeated the test for both sides using that target which was 75 ftlbs (4th pic). There is still a large difference between sides partially with max yank.

One of the interventions utilized to improve torque steadiness is NMES. We had to of course test that out too (2nd video). Did it work? You bet (last pic).

If you want to read more- Dan Cobian, PT, DPT, PhD. U Wisconsin
has a great post from his study looking at force unsteadiness. Force unsteadiness can persist throughout rehab and is a prerequisite to restoring quad strength symmetry post ACL.

Thank you to Dave Sherman, PT, DPT, ATC, PhD for taking our call. And thank you to our athlete for being a good sport!

01/08/2026

Recent PT graduate .johnson just returned to Manhattan Christian women’s basketball team after having successful MPFL + TTO surgery 7 mo ago. Markelle crushed all parts of rehab some of which included:

- Countermovement jump
- Single leg CMJ
- RTD isometric quad (norm 13+)
- R: 15.2 Nm/Kg/s
- L: 14.75 Nm/Kg/s
- Isometric strength
- Quad LSI 96%, 143%BW R, 148%BW L
Isokinetic strength
- Quad LSI 93%, 93%BW R, 99%BW L
- Hamstring LSI 94%, 67%BW R, 63%BW L

12/11/2025

looking fire 4 months post ACL with quad tendon autograft hitting big quad numbers very close to 100% torque to body weight with isometric testing on his surgery side and 133% on non surgical side. Isokinetic testing equally impressive. He gets a break from us as he heads home for Christmas but we’ll be ready to ramp up when he gets back! No doubt he will be spending lots of time in the gym 🦵🏉

11/26/2025

Big thank you to .44 for the infograms as part of his senior project! We can’t wait for Matthew to join our profession some day 💙💙💙

11/17/2025

We discussed lingering concentric phase impulse asymmetry in the double limb countermovement jump in our previous post. What about single leg countermovement jumps? What metrics do we find useful?

We plotted typical output metrics, jump height and mRSI against 2 metrics that we like from the braking (eccentric deceleration) phase. Remember from our last post, that braking is the “downward” phase of a jump.

A strategy, typical in an ACL reconstructed patient, is to reduce both the distance downward (countermovement depth) and speed (peak eccentric velocity) likely because the person has inadequate braking impulse needed to stop their momentum at the bottom of a squat at a depth similar to their non affected side. This is noted as the “stiff knee” strategy.

We can see that over time, the affected limb counter movement depth and eccentric peak velocity improves to values similar to the non affected side. Jump height and mRSI (more on mRSI later) as “outputs” are relatively similar, but achieved by different strategies and remain consistent deficits throughout all of rehab.

11/13/2025

We aren’t the only ones to note that concentric impulse phase asymmetry during a countermovement jump persists well after athletes complete their ACL rehabilitation and return to sport.

For those less familiar, concentric is the “push off” phase of a jump, and impulse is the product of force and time.
Rehab focus tends to focus heavily on the physical components of deceleration because the majority of ACL injuries occur while someone decelerates.

The “downward movement” or braking phase of a countermovement jump is how we may track progress in someone’s braking capabilities over time by looking at net braking impulse and asymmetry. We’ve compared both braking (eccentric deceleration) impulse and concentric impulse asymmetry over time in ~45 patients each month.

Even with very good rehab, athletes often feel persistent performance deficits in their ability to produce high concentric forces rapidly, such as during high speed sprinting, often named “flat tire effect”, even after being cleared back to sport. These patient experiences correspond to the concentric impulse asymmetry we see in serial countermovement testing.

How much of a performance deficit would you allow in your return to sport decision making? Are we doing enough?

11/11/2025

We recently were updating our clinic’s ACL testing data and decided to sort by graft type and pulled 6 month testing data as that is a commonly reported time point in research.

This clinical data backs up a commonly reported issue for PTs when rehabbing quad tendon grafts where it is much more challenging to regain quad strength compared to other graft types. While they ultimately catch up, and many can do well early on, it is often a slower progression early on in rehab.

May be an important talking point when considering graft type choice with patients pre operatively, especially when working under a tight timeframe for return to sport or limited time to dedicate to rehab.

Address

609 Pronghorn Trl
Bozeman, MT
59718

Opening Hours

Monday	7am - 6pm
Tuesday	7am - 6pm
Wednesday	7am - 6pm
Thursday	7am - 6pm
Friday	7am - 6pm

Telephone

+14065800803

Website

http://buildphysio.com/

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