Many people ascribe to the notion that the best way to address an injury is to rest.

1. HOW TO PREPARE FOR ACL SURGERY W/ PREHAB
DID YOU KN OW PRE-ACL RECON S TRU CTION REH AB LEADS TO BETTER
OU TCOMES ?
Prepare for ACL Reconstruction with
Prehab Physical Therapy-
Many people ascribe to the notion that
the best way to address an injury is to
rest. While this is true in certain cases,
like when healing a bone fracture, in
many other cases complete rest can lead
to muscle atrophy and delay return to full
function.
A torn ACL is an injury that defies this
notion as well and though activities will
most definitely need to be modified due
to the pain, swelling, and instability that
arise from an acutely torn ACL, a
carefully prescribed rehabilitation
program prior to ACL reconstruction
surgery may lead to better long term outcomes (Melick et al., 2016).
In this article we will talk about what components may be included in an ACL
reconstruction preoperative program.
WH AT PREOPERATIVE FACTORS S H OU LD I TARGET?
Much research has been done to try and determine what preoperative factors are
associated with better long-term outcomes for those undergoing ACL reconstruction.
Some factors like age and sex cannot be modified with a preoperative rehab program.
Other factors, however, such as knee range of motion, quadriceps strength, and level
of activity prior to surgery (measured by the Tegner Activity Scale) are associated with
positive indicators at one to two years post-surgery and beyond.
Decrease swelling and restore range of motion: The primary goal of early preoperative
management for ACL injury is decreasing swelling (joint effusion) and restoring full
passive and active knee range of motion. Regaining knee extension and flexion range
of motion is an important goal before ACL reconstruction surgery. Trouble regaining full
knee range of motion is one of the more common complications of ACL reconstruction
surgery and failing to achieve full range of motion in the preoperative phase is a risk
factor for this complication (Quelard et al., 2010).
Since swelling in and around the joint capsule impairs range of motion and can inhibit
muscle activation, reducing swelling should be one of the first goals of an ACL surgery
prep program. Here are a few methods for managing swelling:
• Apply ice to the area for 15 minutes, 3-4 times a day
• Elevate the leg above the level of the heart throughout the day
• Apply compression with a bandage or compression sleeve
• Modify weight bearing as needed to limit an inflammatory response
NOVEMBER 3, 2022
HOW TO PREPARE FOR ACL SURGERY WITH
PREHAB PHYSICAL THERAPY
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Start a progressive exercise program: Goals in this second phase of early post-injury
rehab for an ACL tear include maximizing muscle strength, specifically quadriceps
muscle strength, and neuromuscular control. Having at least 90% return of quadriceps
strength compared to the opposite side is important leading into ACL reconstruction
but undergoing additional therapy to address impairments in neuromuscular control of
the knee and all the joints of the leg can improve functional outcomes two years after
surgery (Failla et al., 2016). Once you’ve attained a “quiet knee” without joint effusion,
with full range of motion, and the ability to hop on one leg, progressing toward heavy
resistance training and even plyometric exercises has been found to be safe with a low
incidence of adverse events and can have benefits that extend years beyond ACL
reconstruction (Filbay, S. and Grindem, H., 2019).
It is important to consult with a physical therapist who can prescribe and progress a
program that is specific to you. Trying to do this on your own may lead to failure to
achieve and sustain a “quiet knee” but also may lead to underdosing of beneficial
exercises. Let's take a look at examples of exercises that might be included in a 5-6
week preoperative protocol. Please note that these exercises are not necessarily
ordered as a progression.
Quad sets: performed in sitting with the injured leg extended in front of you, try and lift
your heel as you press the back of your knee into a towel. When possible, try to sustain
a contraction of the quadriceps muscle for six seconds. This exercise is great to
establish motor control and volitional contraction of the quadriceps muscle.
Straight leg raise: lying on your back, with the injured knee straight, raise the leg up off
the table without letting the knee bend then slowly lower it back to the table.
Squats: Starting with body weight, use a mirror as feedback to maintain equal weight
through both legs. Progressions of this exercise include adding weight and performing
as a single leg squat or single leg sit to stand.
Knee extension: Initially you may perform this exercise seated in a chair and extending
the injured knee to raise the lower leg against gravity. As you gain strength you may
progress to adding ankle weights or using a resistance machine.
Single leg balance: Stand on one leg while trying to maintain a level pelvis. Aim to
increase the time you can hold this position and vary the surface to a softer or more
compliant surface for added challenge.
Perturbation training: these dynamic exercises help to improve the stability of the knee.
Most likely starting as a double leg activity and progressing to a single leg activity,
perturbation training involves withstanding challenges to balance and postural control in
multiple planes of movement. They may be performed on a variety of unstable
surfaces.
While an ACL injury can feel overwhelming and the recovery may seem daunting, a
good preoperative rehabilitation program can set you up for better success. Let
physical therapy guide you through this process and create an individualized ACL
reconstruction preparation program just for you so that you can go into surgery with the
comfort of knowing you have done everything you can to have the best surgical
outcome possible. The physical therapists at Evolve are ready to help even day one
after an injury because the road to recovery from an ACL tear begins right away.
Don’t Wait Until After ACL Reconstruction to Begin Your Rehab! Click here to find out
more information about ACL physical therapy and our specialized prehab physical
therapy programs.
About EvolveNY-
Brooklyn's Premier Holistic Physical
Therapy Clinics- There’s physical therapy,
there’s training, and then there’s
EVOLVE. We use the science of
biomechanics merged with fitness to
help our patients get better and stay
better!
First we evaluate, then we heal, then we
strengthen our clients so they can reach their goals, feel better, and live happier lives.
We do so by utilizing a range of core techniques and specialized treatments to reduce
pain, improve mobility, enhance physical strength and deal with the underlying issues,
not just the pain itself.
Multiple Brooklyn Physical Therapy Clinic Locations!
1-718-395-6551
https://EvolveNY.com
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