If you’re a regular reader, you may remember our recent miniseries on Anterior Cruciate Ligament injuries. First, we covered the basics: What is an ACL tear? Then we looked at one of the surgical remedies: What is ACL reconstruction?
As that article pointed out, opting for ACL reconstruction isn’t always simple. It’s a significant operation, one that involves replacing the torn ligament with a graft from your hamstring. Your decision will be determined by things like the severity of the tear, your age and activity levels, and how much the injury is impacting your lifestyle.
But if you do decide to have ACL reconstruction, the next question is: how you can help your knee to thrive on it? How can you speed up that crucial recovery period afterwards?
And that’s where prehabilitation comes in.
What is prehabilitation?
We’re all familiar with the idea of rehabilitation – those treatment and exercise programmes that rebuild strength and movement after an op or injury. Prehabilitation is the same thing, except it’s focused on the period before surgery. It’s all about optimising strength, mobility and blood flow in your injured knee, in order to improve the chances of a strong, long-term recovery afterwards.
Why is that so important for ACLs?
Firstly, because a serious ACL injury will cause you to lose significant strength and range of movement before you even get to the surgery stage. Your knee is likely to swell up. You may be unable to move it properly. You may need to wear a brace – like a cricket pad splint – to keep it straight. All these things cause the joint to stiffen, the muscles to waste, the quadriceps to weaken and so on. That’s not a great background for major surgery, and will prolong your post-op recovery. They also raise the risk of secondary injury, such as chondral damage or a meniscal tear, which complicate things even further.
What does the science say?
Although exercise techniques vary, research has shown that several weeks of prehab can make a major difference. One 2016 study found patients were still seeing benefits two years after surgery. A more recent study extended that to perhaps six years. “The basic components should include improvement in knee ROM [range of movement], quadricep strengthening, and proprioception [the sense of movement and balance],” the researchers wrote. “The duration can be as short as 3 weeks, but the more successful programs last at least 4-6 weeks. In some patients, it may be beneficial to delay surgery to optimize these knee functions.”
So what does prehab look like?
It really starts with the physiotherapist. Once you’re booked in for surgery, we’ll refer you to a physio expert for your pre-op programme. The exercises they give you will be unique to you and your injury but, to give you a rough idea, they could include things like:
Range of movement exercises – such as resting your ankle on a rolled-up towel while lying down, then pushing the knee downwards while the thigh muscles tighten; or lying on your back, then gently lifting your knee and bending it to create flexion
Strengthening exercises – such as lying back and placing a towel under your leg, then gently raising your heel from the ground and holding it there for a few seconds: this helps to strengthen the quadriceps; or standing, with your hands resting on the back of a chair, then slowly lifting your affected leg upwards as you feel the hamstring tighten: this helps to strengthen your hamstrings
Balance exercises – such as standing on your affected leg while you raise the other leg, then closing your eyes and maintaining balance for half a minute or more
As mentioned, you should only take on these types of exercise if they have been specifically recommended for your ACL injury by your physio. Your therapist will be able to show you how to do them safely, set goals for you, and show you how to build up over the following weeks. With time and perseverance, however, the effort should pay dividends – targeted prehab can make a huge difference to your ACL recovery.
Interested in reading more on this topic? Check out these articles:
Mythbuster: 6 big misconceptions about ACL injuries
ACL case study: Robb’s reconstruction journey
ACL Reconstruction – article in our Knee Treatments section