The ACL, or anterior cruciate ligament, sits in a vulnerable position inside your knee joint. Sports involving sudden directional changes, such as skiing, tennis, hockey and basketball, leave its athletes susceptible to ACL tears. The decision to have surgery depends on the severity of your injury and your overall activity level. Post-surgery exercises hasten the rehabilitation process.
Rehabilitation Goals
While ACL surgery is an option, it may be the only way to safely return to your sport, says Dr. John E. Gottlieb, founder of Vail-Summit Orthopaedics in Colorado. Your postsurgery workout plan may serve an educational as well as a rehabilitative purpose. Muscle imbalances such as hamstring weakness, for example, may make you susceptible to ACL tears as well as postural and balance issues. Poor proprioception, which is your body's awareness of its position in space, may also contribute to your potential for ACL injury. Targeting these issues in your workout may eventually improve your athletic skills.
Post Op Exercise
Doctors at the Nicholas Institute of Sports Medicine at Lenox Hill Hospital recommend using the continuous passive motion machine, called a CPM, directly after surgery. This device automatically flexes and extends your knee, helping you regain your range of motion and preventing scar tissue development. The doctors recommend using the machine for two sessions of 2 to 3 hours each day, increasing knee flexion by 5 degrees each day. Once you reach 95 degrees, you can call the company and return the machine.
Flexion Exercise
Continuous passive motion machines yield results similar to physical therapist assisted knee flexion, reports lead author R.L. Worland, in a 1998 study published in the "Journal of Arthroplasty," but some doctors do not use them. If yours doesn't, your physical therapist may place you in a prone position and manually flex your knee. A long resistance band attached to your ankle allows you to perform the exercise on your own.
Extension Workouts
Quad sets help you regain extension. Sit upright, with your legs extended. Contract the front of your thigh, and press the back of your knee into the bed. Perform as many repetitions as possible throughout the day. Then roll over on to your stomach with your legs extended. Move to the edge of the bed and allow your legs to hang.The forces of gravity will help your legs extend. A stationary bicycle also assists leg extension. Minimize the tension, and set the seat as high as is comfortable. Peddle the bike, attempting to extend your leg through the full range of motion.
Neuromuscular Education
Neuromuscular education plays a key role in ACL rehabilitation, reports physical therapist May Arna Risberg, in a 2001 study published in the "Journal of Orthopedic and Sports Physical Therapy." Neuromuscular control is defined as the interaction between the musculoskeletal and nervous systems and is directly related to balance and proprioception. Neurological receptors, located in your stabilizing knee ligaments, respond to outside forces and notify the central nervous system, which responds by modifying muscular activity. ACL tears and the consequent surgery often destroys these receptors, thereby impairing proprioception.
Balance Workouts
Begin your neuromuscular education program with simple balance exercises. Stand on one leg, and hold the position for as long as possible. Add challenge by performing the exercise with your eyes closes. As your balance improves, practice the exercise on a balance board. Physical therapist Risberg progresses the program by placing a balance board on top of an aerobic step and having her patients step up to the board. This exercise integrates leg strength and balance training.
Hamstring Weakness Issues
Twisting actions of the knee may cause ACL tears. Your hamstrings, the muscles in the back of your leg, stabilize your knee and prevent knee rotation. Knee hyperextension is another culprit. If you lose your balance during a mogul run on a ski slope, bending your knees will prevent you from falling, but hyperextension may cause an ACL-tearing butt fall. Weak hamstrings and impaired proprioception may confuse your central nervous system, causing you to inappropriately extend your legs when bending would be the protective response.
Hamstring Workouts
The exercise band and stability ball leg curl exercises address hamstring weakness and proprioception problems. Lie prone, with an exercise band around your ankles. Slowly bend your knee, bringing your heel toward your buttocks. Straighten your leg with control, and perform 20 repetitions. For the ball exercise, place a mat and the stability ball on the floor. Lie supine with your legs extended and your feet on top of the ball. Lift each spinal vertebra until you reach a bridge position. Remain in the bridge as you straighten and bend your legs for 15 repetitions. Ask a friend to spot you, to make sure that the ball moves in a straight line without zigzagging.
References
- NISMAT.org: Orthopedic Sports Medicine Corner: Guidelines for the 1st Week after ACL Reconstruction ; November 3, 2007
- "Journal of Arthroplasty" Home Continuous Passive Motion Machine Versus Professional Physical Therapy Following Total Knee Replacement; RL Worland et al; October 13, 1998
- "Journal of Orthopedic and Sports Physical Therapy": Design and Implementation of a Neuromuscular Training Program Following Anterior Cruciate Ligament Reconstruction, May Arna Risberg et al; 2001
- Dr. John E. Gottlieb; Vail-Summit Orthopaedics
