ACL Pre-hab and ACL Rehab
ACL Pre-hab Stretches and Rehab Exercises
The anterior cruciate ligament, or ACL, is one of the four main ligaments connecting the femur to the tibia (thigh bone to the main shin bone). The ACL provides stability as we move our knees through flexion and extension, and as we stand and bear weight through our legs. A torn ACL may occur if the knee rotates too far or from a direct hit to the front of the knee. There are more than 250,000 athletes diagnosed with ACL injuries each year, females being 2-8 more times likely to sustain one. If the ACL experiences a full tear, your orthopedic doctor may recommend surgery to repair it.
An ACL repair surgery is considered to be pretty invasive. Read on for a brief overview of what will happen during this procedure.
Think of a procedure like this as a controlled trauma. You will receive anesthesia as prescribed by the anesthesiologist on call and surgeons will make multiple incisions around the knee in order to insert surgical instruments into the area. The surgeon will start by removing the remaining pieces of your ACL from around your knee. They will then obtain a graft to replace the ACL with. They can either use a piece of your patellar tendon, a hamstring tendon, or obtain a donor tendon. Each of these options have their pros and cons which we will discuss below as they affect the rehabilitation process. The surgeon will create an attachment point for the graft by drilling small holes, or tunnels, into your tibia and femur. They will then place one end of the graft in each tunnel to create a new ACL tendon. Finally, the surgeon will place screws into each of the tunnels to hold your new ligament in place. New bone growth will fill the tunnels over the next 6-8 weeks to further stabilize the graft.
If you have torn your ACL and want to continue playing cutting sports such as tennis, football, basketball, or soccer, your doctor may recommend an ACL prehab therapy and ACL reconstruction as described above. If you have not yet met with your surgeon to discuss your plan, it is still very important to address the swelling immediately, regain quad strength, as well as range of motion.
ACL Prehab Exercises:
Hamstring Stretch: Lie on your back with your injured leg raised up toward the ceiling. Wrap your hands around the back of your thigh while you slowly flex and extend your knee. Go through this motion, repeating it 10-20 times.
Hamstring Curl: Begin face down on your stomach. Bend your injured knee so that your foot is facing the ceiling. Slowly lower your foot back down to straighten it (eccentric) and then bend it back up to the starting position (concentric). Do 3 sets of 10 repetitions. As you progress, you may add resistance by placing your non-injured foot behind the heel of the injured one, and slightly press down.
Leg Extension: Sit up at the end of a chair with your knees bent to 90 degrees. Straighten the injured leg while engaging your quad. Do 3 sets of 10 repetitions. As you progress you may add a theraband around your ankle and anchor it to the bottom of the chair.
Assisted Quad Stretch: Lie face down on your stomach. Bend your injured knee as far as you can, bringing your foot close to your lower back. Use a towel or a yoga strap to pull your foot even deeper into the stretch.
Glute Bridge: Lie flat on your back with your hands, palms down, extended next to your sides, your knees bent, and your feet flat on the ground near your glutes. Using your core, bring your hips up off the ground into a bridge position. Squeeze your glutes together at the top. Do 3 sets of 10 repetitions.
ACL Rehab Therapy
Once you have had your surgery, physical therapy should begin after 2-3 days. Your physical therapist will ask you what type of graft you received. Younger patients who are involved in playing high velocity sports usually get a graft from their hamstring or patella. Some advantages to this option are that the body will not reject the graft, as it is from your own anatomy. However, there will be a recovery period for the area that it was taken from. Older patients who are not as active often receive a graft from a donor. There will be no recovery from a graft site with this option. However, there is a small risk of the body rejecting the tendon.
Patellar tendon grafts are great because they closely resemble the tendon being reconstructed. A disadvantage is a risk of a patellar fracture following the surgery. If you had a patellar tendon graft, your therapist will make sure to rehabilitate that site as well to reduce the risk of this happening. When a hamstring tendon is taken the incision is smaller. This tendon is longer, allowing for a thicker graft. However, this will take longer to heal and will need to be protected for a longer period of time. It is important that your physical therapist is aware of these details so that they can carry out your treatment plan appropriately.
The recovery after an ACL reconstruction can last anywhere from 9-12 months. Your therapist will break down your recovery plan into phases by gradually increasing your strength and range of motion in a safe progression. They will also ensure that you get back to your functional tasks such as walking without crutches or a brace, normal ambulation, and ascending and descending stairs. During later stages of rehab, your therapist will help you get back to specialty activities such as running, sprinting and other sport specific drills. It is crucial that you listen to your surgeon and physical therapist in regards to returning to your sport.
Having an ACL reconstruction surgery? Call us to prepare you!
after surgery and continue for 6-10 weeks. This takes about 9 months to fully heal. Avoid contact sports, racquet sports, and other sports requiring rapid direction changes, or cutting. Click here to find out more information about ACL Pre-hab or ACL rehab
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