Prehab For ACL Reconstruction

What Is the ACL?

If you are an athlete or have been around sports chances are you have heard of Anterior Cruciate Ligament tears or ACL tears. 

Often thought of as the “boogeyman” of sports injuries the ACL is one of the four main ligaments that stabilize the knee joint, its role is to prevent any forward motion of the shin bone in relation to the thigh bone. 

The ACL tear is often a season ending injury that is unfortunately very common. If surgery is indicated it is critical that a proper pre rehabilitation (occurring before) and rehabilitation (occurring after) is completed to give the athlete the highest odds of returning back to sport. 

Who Is At Risk?

ACL tears typically happen in sports that require quick, sudden movements such as basketball, soccer, volleyball and football. The ACL is unique in that it is predominantly an injury that is not a result of contact, some reports are as high as 75% of ACL ruptures are non contact injuries meaning the athlete did not come into contact with another athlete. 

Women are also at an elevated risk of an ACL tear, the exact mechanism as to why are still largely out for debate, however, neuromuscular control and anatomical structures are thought to play a role. 

The Surgery

ACL reconstruction is one of the most daunting surgeries you can recover from as an athlete, it is a long and gruelling rehab process that typically requires 9-12 months of rehab before an athlete is given the green light for return to play. Post operative rehab protocols have been thoroughly researched and physiotherapy plays a vital role in re establishing function and returning back to sport. However, the role of Physiotherapy prior to surgery has often been under utilized in regards to optimizing function and strength post surgery. 

What is The goal prior to surgery?

Post operatively quad strength and general neuromuscular control is severely decreased and this is often one of the main focal points in post op therapy. Therefore, it is thought that in order to improve postoperative outcomes one can increase strength and neuromuscular control preoperatively in an attempt to diminish the impacts of surgery. 

Components of Prehab:

The research support components such as lower limb strength training in both open and closed chain positions, neuromuscular exercises (perturbations, balance, stability and proprioceptive exercises), range of motion exercises of the lower limb and specific isolated strength work to the quadriceps muscle. 

Duration Of prehab:

It is reported that the length of the prehab period should be between 4-6 weeks and have a consistent increase in level of intensity as the athlete progresses through the stages. 

Goals of prehab: 

  1. Restore knee range of motion 
  2. Restore lower extremity strength 
  3. Restore knee stability 
  4. Restore balance/proprioception

Does prehab work?

Exercise therapy has been shown to have a positive impact on functional performance both pre operatively and post operatively. In combination with a postoperative rehab plan prehab has the potential to elevate outcomes and help facilitate a safe return to sport. 

Have you recently torn your ACL and are waiting for surgery? Speak with a physiotherapist who has experience with ACL prehap and set yourself up for long term success. 

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