How to Prepare for ACL Surgery with Prehab Physical Therapy
How to Prepare for ACL Surgery w/ Prehab
Did You Know Pre-ACL Reconstruction Rehab Leads to Better Outcomes?
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.
WHAT PREOPERATIVE FACTORS SHOULD 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 ACL 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
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-
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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.
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