Prehab: Physical Therapy prior to ACL Reconstruction can improve outcomes after surgery.
Of all joints of the human body, the knee joint is the leading cause of sports-related surgeries. Of these knee surgeries, repairs of the anterior cruciate ligament (ACL) are common amongst athletic populations, whether that be professional and collegiate athletes, weekend warriors, or tactical athletes. Those who sustain ACL tears are likely to undergo surgical reconstruction depending on the severity of the tear and their activity levels.
A concept that is gaining popularity with knee surgeons and rehabilitation professionals is “prehab”, or a structured course of physical therapy before having surgery. The goal of prehab is simple: maximize function. After sustaining an ACL tear, a person is likely to experience swelling, loss of range of motion, and pain. Prehab prior to surgery can help address these deficits and prepare your body for surgery. Often, the state of the knee prior to surgery is indicative of post-operative success, so restoring full knee range of motion, reducing pain and swelling, normalizing gait (walking pattern), and maximizing strength are vital to improving surgical outcomes after ACL reconstruction.
What can a patient expect from prehab? After an evaluation from a physical therapist, the patient will undergo a program 2-3 times per week aimed at addressing their most pressing deficits. The therapist may perform manual therapy to address swelling, muscular restrictions, and pain reduction. Additionally, one of the most important variables to address is regaining the ability to fully straighten the knee. Activating the quadriceps muscle, along with stretching of the calf and hamstring muscles, can help improve your ability to straighten your knee. Aside from the ability to flex and extend your knee, strength of the quadriceps and gluteal muscles are a significant predictor of knee function after ACL reconstruction as well as prevention of future injury. Your physical therapist may give you exercises such as bridges, straight leg raises, knee bends, squats, lunges, side steps, and hip raises to address strength issues.
Prehab physical therapy is strongly advocated by rehab professionals, sports medicine doctors, and sports surgeons. Putting in the extra effort towards rehabilitation before surgery can drastically improve rehabilitation after surgery and give patients the confidence they need before having their knee repaired. If you or someone you know has sustained an ACL injury with plans for surgical reconstruction, make sure that prehab is part of the recovery process.
About the author
By Danielle Morency, PT, DPT, CSCS
Physical Therapist, Certified Strength and Conditioning Specialist
Midwest Orthopaedics at Rush