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Torn ACL? Now What?

by Katie Weisenberger, DPT, CSCS

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Anterior Cruciate Ligament, or ACL, injuries are one of the most common knee injuries that can affect athletes of all ages, sports and genders. Although these injuries can sometimes be managed without surgery, the best treatment most often is surgical reconstruction of the ligament. The good news is that there are steps you can take before you even have surgery to help improve your outcome afterwards. The goals of rehab before surgery, or “prehab,” include reducing swelling, regaining full range of motion, and strengthening the quadriceps muscle. Use the following interventions to address these goals and set yourself up for more successful rehabilitation after surgery!

1. Swelling: Your goal is to eliminate as much swelling as possible from your knee. You can follow the RICE (Rest, Ice, Elevation, Compression) principle to do this. Use a bag of ice on your knee for 20 minutes at a time, 2-3 times per day. Elevate your leg when icing and wrap it with an Ace Wrap if you have one.

2. Range of Motion: The following 3 exercises can be used to improve your knee’s ability to bend and straighten. Perform these exercises throughout the day as often as you can. Your goal is to make the range of motion in your injured knee equal to that of the uninjured knee.

Prone Knee Hang

This is used to improve your ability to straighten your knee. To perform, lay on your stomach on a bed/couch with your knee and lower leg hanging off the edge. Allow gravity to apply pressure to your leg to force it to hang straight. If you feel comfortable, you can add an ankle weight to increase the force. See how long you can hold this position!

Seated Heel Prop

This position is also used to improve your ability to straighten your knee. To perform, sit in a chair and prop your heel up on another chair/coffee table. Make sure the back of your knee is not supported so that gravity can work to push your knee straight. If you feel comfortable, you can apply pressure to the top of your knee with your hands to increase the force. See how long you can sit in this position!

Heel Slides (3-5 sec holds x 15-20 reps)

These are used to improve your ability to bend your knee. Use a strap (or towel) around your heel, then pull the strap to slide your heel close to your hips. Pull back as far as you can, then hold for 3-5 seconds. Allow the heel to slide back out.

3. Quadriceps Strength: The quadriceps (the muscle on top of your thigh) is one of the most important muscles to strengthen when you are recovering from an ACL injury. The strength of the quadriceps muscle is also a common indicator of readiness to return to sport, so performing the following 2 exercises before surgery will help give you a head start!

Quad Sets (3-5 sec holds x as many reps as possible)

To perform, sit with your legs extended straight in front of you. Squeeze your quad muscle (the front of your thigh) as hard as you can and hold for 3-5 seconds. You should feel the back of your knee push down into the ground and your heel pop off the ground. You should also be able to see your kneecap move up towards your hip. If you're having trouble, try performing on your uninjured leg to see what it should feel like. This exercise should be completed as often as possible, up to 300 times per day!

Straight Leg Raise (3 sets x 10 reps)

To perform, start with a quad set (see above). Maintain this strong quad contraction as you lift your leg up in the air to ~45 degrees. Try to perform 10 reps without letting your knee bend at all. If you notice that your knee is bending, stop and reactivate your quad with a quad set, then continue.

For more guidance on prehab and rehab for ACL injury, feel free to reach out to a physical therapist!

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