Safe Workouts After ACL Tear

Safe Workouts After ACL Tear

Safe Workouts After ACL Tear It is important to do prehab or pre surgery rehabilitation so you can set yourself up for a successful surgery. The problem is many insurance companies do not cover enough visits to allow patients to see a physical therapist before and after surgery, and honestly they usually don’t provide enough visits for a full return to sport after ACL surgery either. Before doing any type of workouts make sure you speak with your surgeon and/or physical therapist regarding your specific limitations as every injury is different and every person’s strength levels are different. These are merely recommendations of safe exercises to work on while having a nonfunctional ACL but they are not a medical prescription. If you have any pain, do not perform these exercises and consult your doctor. If you have further ligament damage than just ACL, it might be best not attempt exercising and focus on your swelling and pain management. Heading into ACL surgery it is important to keep your swelling down. Surgeons cannot operate on a swollen knee so make sure you give yourself the rest and recovery needed. Swelling will contribute to loss of range of motion and it is not a good idea to operate on a knee that doesn’t have full range of motion. If you are in a lot of pain or have continued swelling then it would be a good idea to reference the exercises listed in my blog on The 2 Best Post Op ACL Exercises, as they can help you before surgery too. It would be good to practice these because they will...
The 2 Best Post Op ACL Rehab Exercises

The 2 Best Post Op ACL Rehab Exercises

The 2 Best Post Op ACL Rehab Exercises After ACL surgery you might think that you will be laying around recovering, which is partially true. Fresh out of surgery, your increased swelling is going to cause weakness and atrophy at your muscles, especially in the quads and hamstrings. The problem is the longer you wait to begin strengthening those muscles, the harder it is going to be to activate them again.  As long as the exercises don’t cause you any extra pain, it is important to contract and fire the hamstrings and the quads in order to rewire your brain to those muscles and responses. As mentioned in my post #1 Most Ineffective ACL Rehab Exercise, the straight leg raise is usually a go to exercise for many patients in order to strengthen their quads after ACL surgery but it has no therapeutic value and can be painful.  Instead, the 2 Best Post Op ACL Rehab Exercises are hamstring co-contractions, and quad set pluses. It is much safer, less painful, and more beneficial to begin working the hamstrings BEFORE the quads immediately following ACL surgery. Isometric hamstring activations decompress the knee and can help with pain relief. The hamstrings capability of firing quicker and faster is essential for athletes, especially female athletes who are quad dominant meaning the quads fire before the hamstrings causing an increased risk of ACL tear. Try the Hamstring Co-Contractions below as soon as you feel comfortable after your procedure. Start with a few reps and as you gain strength and stamina increase the amount you do per day. Do not do these if you...
#1 Most Ineffective ACL Rehab Exercise

#1 Most Ineffective ACL Rehab Exercise

#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...
RNT – Reactive Neuromuscular Training

RNT – Reactive Neuromuscular Training

ACL Rehabilitation has many intricacies and deviations from patient to patient. Some patients have a harder time reactivating certain muscles or muscle groups after injury or surgery.  This is a little more typical in female athletes and any patient with ongoing chronic trauma and instability at the knee joint whether due to having multiple surgeries or just from having inadequate biomechanics for so long. The body will purposely recruit other muscles to help with joint stability if the stabilizer muscles aren’t strong enough or firing properly. Overtime it will rewire it’s mechanics to compensate for this inefficiency in order to continue to create effective movements.  With patients or athletes who fall into this category simple strength training mechanisms alone might not be enough to alter the recruitment patterns and change the neuromuscular efficiency. This is where RNT can be extremely effective. Reactive Neuromuscular Training or RNT uses outside resistance to neurologically turn on an automatic response. It teaches the muscles and the brain to resist and react to the applied force on the band allowing the body to recruit muscles that have weakened and become inefficient over time. RNT helps to increase neuromuscular coordination and improve joint stability which are both two common issues regarding ACL rehabilitation. The example in the picture is my client Kim. She has had 4 knee surgeries on her right knee and suffers from chronic instability and knee valgus due to weakness and chronic VMO issues resulting from her surgeries.  By using the resistance band in the direction of her compensation problem at the VMO muscle (located on the lower quad on the inside),...
The ACL and Quad Dominance

The ACL and Quad Dominance

Most females are quad dominant meaning they heavily utilize the quadriceps muscles during actions that require quads, hamstrings, and glutes.  This is important to note because if the muscles are not firing in the proper sequencing there could be a delay in the firing sequence causing the athlete to be more prone to injury.  The different biomechanics of most female athletes causes a different activation pattern at heel strike which makes the quads contract first causing a sling shot effect on the ACL. In most men the hamstrings fire more efficiently eliminating this issue. For example, the hamstrings control eccentric forces (or lengthening of the muscle) and help an athlete to safely slow down after accelerating.  If there is a delay in the firing of the hamstring complex  (where the quads fire first) then that muscle group is not able to fire quickly enough to help the athlete safely decelerate causing the ACL to take over and ultimately sprain or tear.  It is ideal is for the hamstring complex to be at least 60% of quadriceps strength. In addition to messing up the proper firing sequencing, quad dominance also creates increased wear on the knee joint over time particularly at the Patella (knee cap) because it is attached to the quadriceps complex via the quadriceps tendon.  If the athlete has strong hamstrings and glutes those muscles will work together to load the forces of the movements of the body more to the posterior chain or muscles on the back side of the body.  This is important because it takes pressure off the knees and the lower back. By strengthening...