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#1 Most Ineffective ACL Rehab Exercise

ACL rehabilitation science is always changing. As clinicians, it is important to stay up to date on current research based literature in order to best serve our clients and patients. ACL rehabilitation is becoming more functional than the former rehabilitation techniques when the surgery first started being performed in the 70s and 80s. Back then, many patients were totally immobilized after surgery in a cast versus the big exciting gear braces we now wear post operative, allowing us to set a specific range of motion to grow into as we progress through rehabilitation. My father had ACL surgery in the 80s and was required to wear a cast for 6 months. His rehabilitation then took him years to get back to being functional because of the cast slowing down all of his progress.  Luckily we are much smarter now, but in some cases there are still many areas of improvement as we continue to gain and learn more about rehabilitation science.

The #1 most ineffective ACL rehab exercise is the straight leg raise. The straight leg raise for many people following ACL surgery is their go to move to strengthen the quads. But there are a few issues with this technique. First and foremost, straight leg raises typically cause pain in most patients because of the force on the knee during the movement. Trying to do this exercise after surgery, while you are dealing with increased swelling and pain is a bad idea.

Secondly, the ACL is most likely injured in a non-contact manor when an athlete plants their foot to kick a ball, plants their foot to change directions or slow down, or lands improperly from a jump. In the approach to the first phase of ACL rehabilitation, from a strengthening standpoint, the most important focus is core strength and core stabilization. In this case, the core becomes the hip. The effectiveness of the hips to stabilize the body when the foot is planted firmly on the ground (either in sport or in rehab) can mean the difference between a stable knee or a knee injury.  The hip strength, particularly in abduction motion, extension, and rotation is very important. I de-emphasize performing straight leg raises as a rehabilitation exercise because they have very little value from a standpoint of therapeutic value based on the evidence of the exercise. The straight leg raise becomes a test for the patient to have leg control, which is fine, but it doesn’t have anything to do with the recovery of the quadriceps muscle or any of the surrounding muscles.  Because your foot has no contact with the ground, and your hips and core have no involvement in the exercise, it is not aiding in your effects to returning to walking, running, or playing sports. It simply has no benefits.

Instead try lateral leg raises and standing leg raises and standing mini squats, the things that create interaction of the hip to the knee through the foot being stabilized is really important. That is why the early use of closed chain exercises is so important.

Stay tuned for my next blog on The 2 Best Post Op ACL Rehab Exercises to learn what exercises are preferred over the straight leg raise.