ACL and knee ligament injuries part 2. What do you want ? a good knee or a great knee ?

Time to have a look at what's needed in your first phase of your gym based ACL rehab journey.


  • Completion of an intensive 5-6 week exercise program can help determine whether you need surgery or not.

  • This program done preoperatively has shown to improve outcomes at 2 and 5 years after surgery.

  • The most important aspect in successful ACL / Lower limb rehab is a consistent approach to a comprehensive program that is designed towards your needs and goals.

  • You can get back to sport but this will take upto 9-12 months to ensure long term success.

  • If you look after your knee it will look after you.

  • This article applies to most rehab of orthopedic lower limb injuries, including hip knee and ankle sporting injuries.


Following on from our first look at ACL injuries we now want to look for the best outcomes for the ACL reconstructed knee or ACL deficIent knee. We often see people chasing a silver bullet approach to get them back to full fitness as soon as possible, which may involve newer types of grafts or surgical procedures or the latest fad in exercise.

However the secret for clinicians and patients is not in chasing the next sexy surgical trend but in ensuring completion of an outstanding comprehensive rehabilitation programme geared towards their goals.


There is mounting evidence that Individuals who undergo a progressive preoperative and postoperative rehabilitation have superior outcomes both pre-operatively and 2 years postoperatively compared to patients who undertake a standard rehab path.



I've just ruptured my ACL and had it assessed, what should i do next ?


Looking at the current literature and research the first-line treatment for people following ACL injury should be a comprehensive exercise rehabilitation involving addressing the following areas;


  • Range of movement deficits.

  • Lower-limb strength (with a focus on quadriceps).

  • Neuromuscular control, retraining jumping and landing techniques.

  • Kinetic chain i.e integrating the core, hip, knee and foot function.

  • Progressive return to pain-free function and sport.


There is a good body of evidence that now suggest that a minimum of TWO rehab sessions per week over period of at least FIVE WEEKS makes an BIG difference in;


  • post operative outcomes for ACL reconstruction at 2 and 5 years after the surgery.

  • Success in this program may also may indicate if you may actually cope without requiring an ACL repair.


The exercise programs in these pieces of research involved a progressive gym based rehabilitation protocol looking at;


  • Strengthening the muscles around the hip and knee.

  • Neuromuscular control at the hip knee and ankle.

  • Training jumping and landing strategies.


One area that we add to this at Arana Hills Physiotherapy is our emphasis on lateral core and hip stability in the program. A very important component in injury reduction.


We also recommend at least 6-8 weeks on the initial gym based rehab phase to ensure good progression and set you up for success in the first phase of testing.

This gym based phase also runs concurrently with a HOME BASED program done 1-2 times per week.


Here is video giving you a taste of the type of exercises included in the 5 week programs that showed the outstanding results, even before surgery is even contemplated.


(We've also added some of our extra flavours to improve it further.)




What do you do next after this 5- 6 week ACL rehab program ?


After 6 to 8 weeks of your gym based rehab journey we need to see how it is progressing regarding strength, power and dynamic control.


These are great tests to determine what should be focused on next in your rehab to optimize outcome and determine if you are ready to progress to the next step of activity milestones.


Tests we use at the clinic are:



  • Split squat for strength.

  • Single leg squat for strength endurance.

  • single leg hop.

  • triple hop.

  • tuck jump.

  • 40 cm Lateral hops for time.







Here is a look at some of these tests important in ACL rehabilitation.


How long will ACL rehab take then and when can i expect to return to sport or exercise ?


As a ballpark figure we look at contact or collision based sports , to return around the 12 month mark as long as physical milestones and competencies have been achieved. These will vary depending on the requirements of the sport.

These types of sport include:


  • Football codes

  • Basketball

  • Netball

  • Hockey


For non -contact/ collision based sports it depends again on physical competencies that are required .


These skills and specific qualities are addressed in the more late stage rehab and return to sport phases, read more about this phase here.


If you want the best result from your knee and are hoping to get back to your previous sport then this is the best possible way to get you there.

In our next instalment we will look at advanced end stage rehabilitation and what is required to return to play.


If you need help getting prepared for ACL surgery or are needing comprehensive knee rehab to get you back to your best book in here to see one of the team.


Cheers

Dave.



Failla MJ, Logerstedt DS, Grindem H, et al. Does extended pre-operative rehabilitation influence outcomes 2 years after ACL reconstruction? A comparative effectiveness study between MOON and Delaware-Oslo ACL cohorts. Am J Sports Med. 2016;44(10):2608-2614.


H Grindem1, L P Granan2,3,4, M A Risberg1,5, L Engebretsen3,6, L Snyder-Mackler7, I Eitzen5 How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry

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