Top Knee Braces

The anterior cruciate ligament (ACL)
Knee braces are manufactured in a range of styles and sizes.

Knee braces are manufactured in a range of styles and sizes.

The four main types of knee braces are available in a wide range of designs, styles, and prices from several manufacturers. You will need to work with your doctor to be measured properly for a knee brace and to determine the optimal style for your needs.

The most popular brands of knee braces are listed below. DonJoy appears to be the number one choice, and thereafter the ranking is less clear. However, these brands have garnered excellent to very good reports from consumers and are worth investigating. The last entry on the list, Futuro, has products targeted mostly for casual or nonathletes.

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Do Knee Braces Work?

The anterior cruciate ligament (ACL)
Talk to a physician to determine whether you need a knee brace.

Talk to a physician to determine whether you need a knee brace.

The answer to the question, “Do knee braces work?” is yes and no. The first thing you should do is talk to a knowledgeable physician to determine whether you need a brace and if so, the one most suitable for your needs. A knee brace is most likely to be helpful if it is used as part of a rehabilitation program rather than instead of the other components of rehabilitation. That is, a knee brace should not be used as a crutch but as an important tool in your healing process.

Your chances of getting satisfaction from your knee brace are better if you get one that is specially fit for you. A well-fitted knee brace will maximize the benefits you get from your strengthening exercises and other parts of your rehabilitation. Although some knee braces are available off-the-shelf from pharmacies and are less expensive than a custom-made brace, a brace that does not fit properly can cause more harm than good. A knee brace prescribed by a doctor is often covered by health insurance; check with your insurance carrier.

Do I Need A Knee Brace?

The anterior cruciate ligament (ACL)
Research is limited on how effective a knee brace is for preventing knee ligament injuries.

Research is limited on how effective a knee brace is for preventing knee ligament injuries.

Knee braces should be used if they are recommended or prescribed by a physician for anyone who is participating in a rehabilitation program after a knee injury and/or knee surgery. The knee brace should be used along with strength training, flexibility, activity modification, and technique refinement. (Paluska, McKeag) In some cases, a doctor may suggest a knee brace if a patient’s knee is not improving with strengthening and flexibility exercises. However, remember that knee braces are the least important part of preventing knee injuries or recovering from a knee injury or surgery: stretching, strengthening exercises, knee exercises and technique improvement are far more critical.

A recent study published in Sports Medicine reported that while a functional knee brace may offer stability for people who have an ACL injury, research is limited on how useful knee braces are for preventing knee ligament injuries in non-injured athletes. (Rishiraj) In fact, several researchers have suggested that there is no conclusive evidence that wearing a knee brace will reduce the rate or severity of ACL injury during sports. One reason for the lack of research may be that non-injured athletes do not want to wear a knee brace for fear it will hinder their performance. However, many athletes and coaches realize the importance of protecting the knees using a reliable knee brace.

What is a Knee Brace?

The anterior cruciate ligament (ACL)
A knee brace is worn to protect and/or support the knee joint.

A knee brace is worn to protect and/or support the knee joint.

A knee brace is a supportive device worn by athletes as well as nonathletes to protect and/or support the knee joint, either after a MCL, ACL or other knee injury or to prevent one. Knees braces are available either off-the-shelf or can be custom made, and they come in many sizes, designs, and colors. Knee braces are typically made from a combination of metal, plastic, elastic material, and foam and constructed using straps, pads, and hinges.

ACL Program – Advanced Exercises

The anterior cruciate ligament (ACL)

Home Program: please consult your physician before starting any program

Foam Roller

Foam Roller

Foam Roller

  • roll outside of leg
  • find “hot” spot and roll for 20 sec
Modified Squats

Modified Squats

Modified Squats

  • place soccer ball btwn knees
  • sit back and down
  • perform 1/4 squat
Single leg curls or dead lift

Single leg curls or dead lift

Single leg curls or dead lift

  • lie flat on back
  • place heel on ball
  • raise opposite leg
  • raise hips off ground
  • pull ball back towards butt
Lateral Step Ups

Lateral Step Ups

Lateral Step Ups

  • stand on 6″ platform
  • stick your hip back
  • touch heel to floor
Diagonal Shoulder Raise

Diagonal Shoulder Raise

Diagonal Shoulder Raise

  • balance on left leg
  • start with right hand on left hip
  • raise up and outward
Single Leg Squat

Single Leg Squat

Single Leg Squat

  • place bench or chair behind you
  • squat down and try to touch butt to bench
Side Hip Raises

Side Hip Raises

Side Hip Raises

  • place forearm on the bench
  • raise top leg 10x
  • repeat on other side
Posterior Capsule Stretch

Posterior Capsule Stretch

Posterior Capsule Stretch

  • place towel around foot
  • opposite hand on thigh and press down on thigh while pulling heel up
  • hold for 30 sec.
Quad Stretch

Quad Stretch

Quad Stretch

  • lie on side
  • keep knees together
  • pull heel to butt
  • then pull hip back
  • hold for 30 sec

Anatomic Graft Placement in ACL Surgery: Plain Radiographs Are All We Need

The anterior cruciate ligament (ACL)

Intra- and postoperative plain radiographs are a reliable and effective way to assess anatomic ACL graft placement.

The restoration of native anatomy is one of the fundamental principles of orthopedics, pervasive throughout all of the various subspecialties. Surgeons have learned that the restoration of native anatomy is of paramount importance to any reconstructive procedure. One of the most commonly used instruments to assess bony anatomy is the standard radiograph. Traumatologists use radiographs pre-, intra-, and postoperatively to determine and evaluate fracture treatment because the success of a procedure depends on anatomical reduction. The outcome of a fractured acetabulum in a young person is determined by the ability of the surgeon to reproduce native bony anatomy within 2 mm of perfection. Should cruciate ligament surgeons not strive for the same?

Anterior cruciate ligament (ACL) injury and subsequent reconstructive surgery is common in the United States. For this reason, the anatomy, biomechanics, and reconstructive techniques have been, and continue to be, intensely researched and debated topics. Recent investigations have better defined gross, microscopic, and insertion site anatomy, which has improved radiologic and arthroscopic assessment of reconstructive techniques.1-7

It is a generally accepted principle that tunnel position/graft placement is the most critical component to a successful ACL reconstruction. Nonanatomic femoral and/or tibial tunnel placement can lead to poor clinical results.8-10 Pre-, intra-, and postoperative use of radiographic tunnel assessment to help the ACL surgeon reproduce normal anatomy have all been described.6,7,10-12 This article describes simple arthroscopic and radiographic landmarks for anatomic ACL reconstruction.

Femoral Tunnel

Coronal Placement

Coronal placement of the femoral tunnel is a topic that has come under recent scrutiny. It has been demonstrated that femoral tunnel placement at a more oblique angle vs a more vertical angle provides for greater rotational control (elimination of the pivot-shift).13,14 Furthermore, a more oblique location results in improved clinical outcome.15 The ideal location for the femoral tunnel as viewed on an anteroposterior radiograph is illustrated in Figure 1. Arthroscopically, bony landmarks can be referenced for proper tunnel placement. The tunnel should be drilled inferior to the intercondylar ridge (Figure 2).1,2The bifurcate ridge is another landmark that may be used as a reference point.3 Controversy remains about the specific technique that is best to achieve this tunnel placement (transtibial, medial portal, or 2-incision).

snyder_fig1

snyder_fig1

Figure 1: AP radiograph showing anatomic locations for tunnel placement. Figure 2: Arthroscopic view of femoral tunnel position inferior to the intercondylar ridge (demarcated).

snyder_fig2

snyder_fig2

Sagittal Placement

Sagittal placement of the femoral tunnel is the most important factor affecting postoperative graft isometry.16 Small variations in the anterior to posterior location of the femoral tunnel can result in significant differences in graft kinematics.16 It has also been shown to significantly affect International Knee Documentation Committee score.8 Excessive anterior placement of the tunnel is the most common technical mistake.17 This can commonly occur in the transtibial technique as the tibial bone tunnel may inhibit proper anatomic placement. Figure 3 demonstrates where the tunnel should appear on a lateral radiograph. Since the femoral footprint of the native ACL does not attach to the roof of the intercondylar notch,1-4,7 which is represented by Blumensaat’s line on a lateral radiograph, no part of the tunnel should intersect Blumensaat’s line.

snyder_fig3

snyder_fig3

Figure 3: Lateral radiograph showing anatomic locations for tunnel placement.

Tibial Tunnel

Coronal Placement

Arthroscopic anatomic landmarks including the posterior cruciate ligament (PCL), the anterior horn of the lateral meniscus, the medial tibial eminence, and the ACL stump have all been used to determine intra-articular tunnel location.18,19 The center of the tibial tunnel should be directly medial to the anterior horn of the lateral meniscus. Extra-articularly, the tunnel should originate 1.5 cm medial to the medial margin of the tibial tubercle and 1 cm above the superior margin of the pes anserine.19 Radiographically, the extra-articular starting point, as described, and the intra-articular location, on the anterolateral slope of the medial tibial eminence, can be evaluated (Figure 1).20

Sagittal Placement

The sagittal location of the tibial tunnel is an important factor for successful reconstruction that is often not discussed. Excessive anterior placement of the tibial tunnel can lead to graft impingement and magnetic resonance imaging signal changes within the graft.10 Transtibial techniques frequently place the tunnel too posterior to avoid anterior and vertical femoral tunnel placement. The arthroscopic view of the anatomic location of a tibial tunnel is shown in Figure 4. Of note, the entire tunnel is approximately 1 cm anterior to the traditional nonanatomic placement popularized in the 1990s. The corresponding location on a lateral radiograph is demonstrated in Figure 3. The entire opening of the tibial tunnel at the joint line must be anterior to the medial tibial eminence.

snyder_fig4A

snyder_fig4A

snyder_fig4B

snyder_fig4B

Figure 4: Arthroscopic view of tibial tunnel position with guide wire (A) and reamer (B).

Conclusion

Similar to the way a couple of millimeters in an articular reduction can make a significant difference in patient outcome, improper ACL graft placement may also have detrimental effects on patient outcome and cause recurrent instability. Intra- and postoperative plain radiographs provide a reliable and effective way to assess anatomic graft placement. As we strive to improve outcomes in ACL surgery by doing more precise anatomic reconstruction, similar to fracture surgery, intraoperative fluoroscopy or postoperative radiographs can be used to improve and evaluate their specific techniques for tunnel placement (Figures 5, 6). Whether the transtibial accessory portal or 2-incision outside-in technique for femoral drilling is used, the goal should be the same: restoration of native anatomy. The use of simple arthroscopic and radiologic landmarks can help surgeons be more precise during their personal learning curve.

snyder_fig5

snyder_fig5

snyder_fig6

snyder_fig6

Figure 5: Postoperative AP radiograph after anatomic bone–patellar tendon–bone reconstruction. Figure 6: Postoperative lateral radiograph after anatomic bone–patellar tendon–bone reconstruction.

ACL Pre/Post Surgery Knee Exercises

The anterior cruciate ligament (ACL)

Torn ACLs and knee injuries are surprisingly common, and a prime example of how muscular imbalances create wear on the joints. Proper awareness, balance, and strength training are key to preventing and rehabbing any and all injuries… knees included.

For a knee injury, it is important to build the entire leg: maintain quad strength, build stronger hamstrings, and focus on balanced strength in the hips. Pay attention to proper traction and alignment of the ankle, knee and hip as you exercise – in other words, make sure everything is lining up. You can easily do a movement, but without proper alignment of the joints, muscular imbalances can be created, resulting in continued strain.   The best way to build overall strength and better alignment is to incorporate some form of balance into your exercises. Balancing coerces lesser developed muscles to engage, as well as to kick in a little core support.

Your doctor or PT will probably gave you some similar movements, like squats, leg presses, and lunges, but my recommendation would be to try to incorporate an element of balance with each:

Wall Squats with a balance ball behind the back

Wall Squats with a balance ball behind the back

Wall Squats with a balance ball behind the back – Angle out the legs and work your way to bringing them under your hips. Pay attention that the knee lines up with the center of your foot. Don’t let the knees extend into flexion past the toes, or a 90 degree angle. Hold the squat for 30 seconds.

Single leg wall squats

Single leg wall squats

Single leg wall squats – This is a challenge. Be careful with these.

Standing on one foot Hip hikes

Standing on one foot Hip hikes

Standing on one foot Hip hikes – Using a yoga block, encourage balance work on the standing leg. allow the opposing leg to tap the floor and lift up. Works the hips and standing leg stability.

Balance on one foot

Balance on one foot

Balance on one foot – Balance on an upside down bosu ball, foam roller, or a wobble board at the gym
Practice balance on this for 30 seconds to 2 minutes at a time.

Lunges with bosu ball

Lunges with bosu ball

Lunges with bosu ball – You can flip the bosu either way.  Arm movements are optional.

Swimming over balance ball

Swimming over balance ball

Swimming over balance ball – Lying over the ball. Core is centered. Opposing hand and leg lift, other two remain in contact with the floor. Hold for 5-10 seconds each. Keep both arm and leg completely straight, hold and balance. Switch.

Hamstring curl, pelvic lift series on balance ball or bosu ball

Hamstring curl, pelvic lift series on balance ball or bosu ball

Hamstring curl, pelvic lift series on balance ball or bosu ball – Lying on the floor. Soles of the feet flat on the ball (don’t hang in just heels), curl hips up towards the ceiling and roll back down through the spine. Keep ball stable. Can do with legs together (harder) or shoulder width apart. Curl up and down 10 – 20 times.
1. Next progression: you can keep hips elevated and carefully push the ball out and in. Don’t move hips as you move legs. Be careful with this one.
2. Next progression: you can do single leg pelvis lifts, with opposing leg stretched upward towards the ceiling – again, be careful with this one.

Leg presses on the gym equip

Leg presses on the gym equip

Leg presses on the gym equip. Don’t just power through. Keep body aligned and lengthen spine and low back away from the leg movement.

Foam Roller IT band massage

Foam Roller IT band massage

Foam Roller IT band massage If you have a foam roller at the gym, you might want to roll out the outside of the leg. Actually, investing in a roller for home is a wise purchase. There are a multitude of uses and benefits. Rolling out the IT band can be painful, depending on how tense is. The roller helps release hip and leg tension, while reducing strain on the knee.

ACL Tear (Anterior Cruciate Ligament)

The anterior cruciate ligament (ACL)
The Knee and ACL (rear view)

The Knee and ACL (rear view)

What is an ACL tear?
An ACL tear is a relatively common sporting injury affecting the knee and is characterized by tearing of the Anterior Cruciate Ligament of the knee (ACL).
A ligament is a strong band of connective tissue which attaches bone to bone. The ACL is situated within the knee joint and is responsible for joining the back of the femur (thigh bone) to the front of the tibia (shin bone) (figure 1).
The ACL is one of the most important ligaments of the knee, giving it stability. The ACL achieves this role by preventing excessive twisting, straightening of the knee (hyperextension) and forward movement of the tibia on the femur. When these movements are excessive and beyond what the ACL can withstand, tearing to the ACL occurs. This condition is known as an ACL tear and may range from a small partial tear resulting in minimal pain, to a complete rupture of the ACL resulting in significant pain and disability, and, potentially requiring surgery. An ACL tear can be graded as follows:
Grade 1 tear: a small number of fibres are torn resulting in some pain but allowing full function
Grade 2 tear: a significant number of fibres are torn with moderate loss of function.
Grade 3 tear: all fibres are ruptured resulting in knee instability and major loss of function. Often other structures are also injured such as the menisci or collateral ligaments. Surgery is often required.
Causes of an ACL tear
ACL tears typically occur during activities placing excessive strain on the ACL. This generally occurs suddenly due to a specific incident, however, occasionally may occur due to repetitive strain. There are three main movements that place stress on the ACL, these include:
twisting of the knee
hyperextension of the knee
forward movement of the tibia on the femur
When any of these movements (or combinations of these movements) are excessive and beyond what the ACL can withstand, tearing of the ACL may occur. Of these movements, twisting is the most common cause of an ACL tear.
ACL tears are frequently seen in contact sports or sports requiring rapid changes in direction. These may include: football, netball, basketball and downhill skiing. The usual mechanism of injury for an ACL tear is a twisting movement when weight-bearing (especially when landing from a jump) or due to a collision forcing the knee to bend in the wrong direction (such as another player falling across the outside of the knee). Occasionally an ACL injury may occur during a sudden deceleration when running.
Signs and Symptoms of an ACL tear
Patients with an ACL tear may notice an audible snap or tearing sound at the time of injury. In minor cases of an ACL tear, patients may be able to continue activity only to experience an increase in pain, swelling and stiffness in the knee after activity with rest (particularly first thing in the morning). Often the pain associated with this condition is felt deep within the knee and is poorly localized.
In cases of a complete rupture of the ACL, pain is usually severe at the time of injury, however, may sometimes quickly subside. Patients may also experience a feeling of the knee going out and then going back in as well as a rapid onset of considerable swelling (within the first few hours following injury). Patients with a complete rupture of the ACL generally can not continue activity as the knee may feel unstable, or may collapse during certain movements (particularly twisting). Occasionally, the patient may be unable to weight bear at the time of injury due to pain and may develop bruising and knee stiffness over the coming days (especially an inability to fully straighten the knee). Patients with a complete rupture of the ACL may also experience recurrent episodes of the knee giving way following the injury.
Diagnosis of an ACL tear
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an ACL tear. Investigations such as an X-ray, MRI scan or CT scan may be required to confirm diagnosis and determine the extent of damage or involvement of other structures within the knee.
Treatment for an ACL tear
Most patients with a minor to moderate ACL tear (grades 1 and 2) heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. A vital aspect of treatment is that the patient rests sufficiently from any activity that increases their pain. Activities placing large amounts of stress on the ACL should also be minimized, particularly twisting and hyperextension of the knee. Resting from aggravating activities ensures the body can begin the healing process in the absence of further damage. Once the patient can perform these activities pain free a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with this condition is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence or ACL surgery.
Patients with an ACL tear should follow the R.I.C.E. Regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). The R.I.C.E. regime involves resting from aggravating activities (this may include the use of crutches), regular icing, the use of a compression bandage and keeping the leg elevated. Anti-inflammatory medication may also significantly hasten the healing process in patients with an ACL tear by reducing the pain and swelling associated with inflammation.
Patients with an ACL tear should also perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. One of the key components of ACL rehabilitation is pain-free strengthening of the quadriceps, hamstring and gluteal muscles to improve the control of the knee joint with weight-bearing activities. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.
Surgery for an ACL tear
Surgical reconstruction of the ACL is often required in patients who have a complete rupture of the ACL and are seeking the highest level of function. The procedure is known as an ACL reconstruction and generally comprises of arthroscopic surgery to reconstruct or repair the ACL with other tissue from your body. The hamstring tendon or patella tendon are most frequently used in this process.
Following ACL reconstruction surgery a lengthy period of rehabilitation of 6 – 12 months or longer is required to gain an optimal outcome and return the patient to full activity or sport. Surgery for an ACL tear should be particularly considered in patients who have a complete rupture and:
are < 40 years of age
need a high level of knee function for recreational, work or sporting activity
have associated damage to their menisci or collateral ligaments of the knee
are able to comply and commit to intensive rehabilitation
have ongoing knee pain, swelling or recurrent episodes of the knee giving way despite appropriate rehabilitation
Following a complete ACL tear, patients who choose not to have surgery may suffer from ongoing knee instability and recurrent episodes of the knee collapsing or giving way with certain movements (particularly twisting). Patients with a complete ACL tear may also have an increased likelihood of developing knee osteoarthritis due to excessive movement and subsequent wear and tear of the knee.
In those patients who undergo surgical intervention, rehabilitation should commence from the time of injury, not from the time of surgery. This is essential to minimize swelling, improve range of movement and strength and ensure an optimal outcome following surgery.
Prognosis of an ACL tear
With appropriate management, most patients with a minor to moderate ACL tear (grades 1 and 2) can return to sport or normal activity within 2 – 8 weeks. Patients with a complete rupture of the ACL will frequently require surgical reconstruction followed by a lengthy rehabilitation period of 6 – 12 months or longer to gain optimum function. Patients who also have damage to other structures of the knee such as the meniscus or collateral ligaments are likely to have an extended rehabilitation period.
Physiotherapy for an ACL tear
Physiotherapy for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of future recurrence. Treatment may comprise:
soft tissue massage
joint mobilization
taping
bracing
ice or heat treatment
electrotherapy (e.g. ultrasound)
anti-inflammatory advice
exercises to improve flexibility, strength and balance
hydrotherapy
education
activity modification advice
crutches prescription
biomechanical correction
a gradual return to activity program
Other intervention for an ACL tear
Despite appropriate physiotherapy management, a small percentage of patients with a minor to moderate ACL tear and most patients with a complete ACL tear do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. Surgical reconstruction of the ACL is frequently required in cases of a complete ACL rupture particularly when conservative measures fail.

Exercises for an ACL tear
The following exercises are commonly prescribed to patients with an ACL tear. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Knee Bend to Straighten
Begin this exercise by lying on your back as demonstrated (figure 2). Bend and straighten your knee as far as possible without increasing your pain. Repeat 20 times.

Knee Bend to Straighten (right leg)

Knee Bend to Straighten (right leg)

Static Quadriceps Contraction

Begin this exercise in the position demonstrated (figure 3). Tighten the muscle at the front of your thigh (quadriceps) by pushing your knee down into a towel. Put your fingers on your inner quadriceps to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times as hard as possible without increasing your symptoms.

Static Quadriceps Contraction (left leg)

Static Quadriceps Contraction (left leg)

Static Hamstring Contraction

Begin this exercise in sitting with your knee bent to about 45 degrees. Press your heel into the floor tightening the back of your thigh (hamstrings). Hold for 5 seconds and repeat 10 times as hard as possible pain free.

Static Hamstring Contraction (right leg)

Static Hamstring Contraction (right leg)

Physiotherapy products for an ACL tear
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with an ACL tear include:
Knee Braces
Crutches
Ice packs or hot packs
Protective Tape
Foam Rollers for self massage
Spikey Massage Balls for self massage
Wobble Boards
Skins Compression Garments

Warming up prevents injuries

The anterior cruciate ligament (ACL)
Warming up prevents injuries

Warming up prevents injuries

GOING through a set of warm-up exercises before practices and games cuts the rate of knee and ankle injuries in teenage girls playing soccer and basketball, a U.S. study said.

Training coaches in these exercises prevents non-contact injuries such as anterior cruciate ligament (ACL) sprains that may turn girls off physical activity and require expensive surgery, according to findings published in the Archives of Paediatrics & Adolescent Medicine.

Exercise in teenage girls has been linked to better marks , less obesity and lower pregnancy rates.

“Girls who are active in sports are less likely to get involved in other high-risk behaviours, so keeping them active and injury-free is important,” said Cynthia LaBella at the Northwestern University Feinberg School of Medicine, who worked on the study.

“Warm-ups are worth the time and the money invested for the long-term health of the girls.”

During puberty, both girls and boys shoot up in height, but girls’ muscles don’t develop as much as boys’ do, said Tim Hewett, head of sports medicine research at the Ohio State University and Cincinnati Children’s Hospital.

Because of that imbalance, studies have shown girls get between two and 10 times more injuries such as ACL sprains than boys do.

The study focused on about 1 500 girls, mostly low-income girls playing on high school soccer and basketball teams in Chicago public schools. Half were on teams that did the warm-up programme and half were not.

Ninety coaches were randomly assigned to lead a 20-minute warm-up programme that involved strengthening, balance and agility exercises before every game and practice, or to stick with their usual warm-up routine. The warm-up included exercises focusing on jumping and landing safely.

Over the 2006 to 2007 season, the group that did the warm-up programme had 50 injuries involving a leg, ankle or foot. The group that did not do the programme had 96 injuries.

Specifically, there was a 35% reduction in leg overuse injuries with the warm-up programme, and a 44% lower rate of acute non-contact injuries.

LaBella noted that some coaches might not want to use the warm-up programme because it took time out of already limited practices, but Hewett said the exercises, when done correctly, can also improve jumping height and power.

“You can make a huge difference in the athleticism of these girls. There are many ways we can show these kids that they’re faster, quicker, more balanced athletes,” he added. — Reuters.

Top 10 ACL Rehab Exercises To Get Back On Track

The anterior cruciate ligament (ACL)
ACL Rehab Exercises

ACL Rehab Exercises

1. Range of Motion Exercises – Range of motion exercises may help torn ACL symptoms to get your knee back in good condition. These exercises will increase the ability of your knee to move without any pain or difficulty.

2. Hamstring Stretches – Hamstring stretches are one of the important ACL rehab exercises. You can modify this exercises according to your ability and comfort level, so it is a great one to start with.

3. Straight Leg Raises – Straight leg raises can help minimize or eliminate knee ligament pain, by stretching and strengthening your tissues and preventing future problems from occurring.

4. Heel Slides – One of the ACL rehab exercises that is simple and easy to do at any level is heel slides. Sit with your legs outstretched and then bend your injured knee while you slide your heel towards you.

5. Quadriceps Isometric Contractions – After patella surgery, quadriceps isometric contractions can be a very helpful exercise for rehabilitation. These contractions help strengthen your supporting tissues.

6. Calf Raises – ACL rehab exercises are used to strengthen and increase your muscles and ligaments, and calf raises can play an important role in this. This exercise is a great and non impact way to improve your movement and abilities.

7. Half Squats – Half squats are often used as ACL rehab exercises, for a number of reasons. These exercises stretch, strengthen, and build all at the same time.

8. Partial Lunges – Partial lunges can be an important exercise after knee manipulation or surgery. Stand with your feet a shoulder width apart, while holding onto an edge or stable surface. Step forward half a step, and then slowly bend your knees while lowering some. After holding this position for ten seconds slowly rise back up.

9. Heel Raises – Heel raises not only strengthen your knee muscles and ligaments but can also help with all your leg and calf tissues as well. Slowly rise onto your toes while holding an object for support. After holding for ten seconds slowly lower yourself back down.

10. Swimming – Swimming is one of the best ACL rehab exercises you can do. Swimming has no impact and does not force your recovering knee to bear weight during the exercise, yet will still stretch and strengthen your knee area.

Knee Range of Motion Exercises

The anterior cruciate ligament (ACL)
Knee Range of Motion Exercises

Knee Range of Motion Exercises

Knee Range of Motion Exercises has the top 5 knee range of motion exercises to do after knee surgery. 2 weeks after my ACl surgery my range of motion has greatly increased in week 2, it has gone from 4 degrees and 100 degrees week 1 to 0 and 130 degrees. I think it was in large part due to the 5 exercises. Heel prop, heel slides, quad sets, Prone knee extension and bicycle pendulum.

ACL Test

The anterior cruciate ligament (ACL)

This ACL Surgery question comes from Jonathan. He was wondering if there is an ACL test he can do himself. I completely understand the motivation to try and determine yourself if there has been any damage to the knee by doing the test yourself.
Testing yourself to determine if there has been an increased laxness is really difficult! I dont believe I can do it.
However after I re-tore my ACL I was able to do a ACL test on myself and was confident it was re-torn.

ACL Test
This test describes how to test your right knee, you should test both knees to determine if you can tell a difference. If you are doing an ACL test on your left knee simply reveres the left/rights below.
1.Sit in a chair with your legs at 90 degrees
2.Place your left hand on top of your knee cap and hold your knee and femur in place
3.Place your right hand on the upper outside of your right calf
4.Relax your leg as best as possible
5.Start gradually and push your right hand into your calf pushing your shin forward
6.Increase the speed and force at which you push, what you are feeling for is a “hard stop”. If you can push a short distance and feel a hard stop than you have likely not torn you knee. If you push your shin forward and notice on your leg in question its not a firm stop and your shin can travel a greater distance than there is a chance you have torn your ACL and should go see a doctor.

How to Do a Proper ACL Test

How to Do a Proper ACL Test

ACL Test CAUTION!
This is not even close to reliable and has the potential to cause further injury. Even a doctor doing a proper test like in the video below, can get your diagnosis wrong. I recommend you get an MRI is you are unsure as to whether you have a torn ACL

ACL Test Reliability
A sports medicine doctor saw me after I first tore my ACL and mis-diagnosed it doing the Lachman test as in the video above. It is worth getting a second opinion and best of all getting an MRI.

5 Intrinsic factors that Lead to ACL Injuries in Females

The anterior cruciate ligament (ACL)
Female Pelvis Wider

Female Pelvis Wider

#1 – The Pelvis – The female pelvis is wider than the male pelvis. A wider pelvis causes a more forward tilted femur near the hips as the shin bone is angled toward the knee, resulting in knock-knees, which in turn, place a great amount of stress on the ACL.

#2 – Narrow Notch – Females have narrower intercondylar notch, through which the ACL passes through. It has been suggested that cutting and jumping movements with narrow femoral notches may weaken the ACL.

#3 – Smaller ACL – Women have smaller anterior cruciate ligament size, making it more vulnerable to fraying.

#4 – Hormones – Generally, women have greater knee laxity, which may be influenced by the hormones secreted in large amounts by the females. Receptors for estrogen and progesterone have been identified on the ACL; thus, hormonal fluctuations occurring during the menstrual cycle may influence the structure of the ACL. It was found that women are more susceptible to ACL tears during the ovulatory phase (days 5 through 12 of the menstrual cycle), when the estrogen and progesterone levels are high, increasing the laxity and susceptibility of the ligament to overstretching.

#5 Weaker Leg Strength – Women have lesser muscle strength and slower muscle reaction times when compared to men. A strong and fast-reacting hamstrings is vital to keep the ACL intact during abrupt changes of direction. In addition, women also tend to recruit or use their front thigh musles or quadriceps, increasing the risk of AC L injuries. The hamstrings protect the ACL by decreasing the stress applied on the knee as the lower leg moves forward. The quadriceps pulls the shin bone forward, consequently placing additional stress on the ACL.

ACL Injuries in Female Athletes

The anterior cruciate ligament (ACL)
ACL Injuries in Female Athletes

ACL Injuries in Female Athletes

Over the last decade, torn and ruptured anterior cruciate ligament (ACL) in female athletes have increased at an alarming rate.

Consistently, it has been found that a higher prevalence of ACL injuries occurs in female athletes over their male counterparts. Women are 2.4 to 9.7 times more likely to suffer from ACL injury when compared to men of similar competition and training levels.

Females involved in sports involving landing from a jump, abrupt changing of directions and cutting, such as basketball, soccer, gymnastics, skiing and gymnastics are especially at risk. Reports state that women basketball players are 5 to 7 times more likely to have an ACL injuries than men and that female soccer players are injured more than twice as often as men (American Council on Exercise, 2009). On average, women rupture their ACL ligaments 5 years earlier than men do. In addition, majority of females with torn ACLs are between the ages of 15 and 25.

Although the exact cause is still unclear, and the possibility of a complex interplay between different factors is likely, possible explanations of the gender difference in the rate of ACL injuries have been suggest and reviewed. The suggested reasons are anatomic differences, joint laxity, range of motion, hormonal secretion and training techniques are suggested factors that predispose women to ACL injuries.

There are two different factors that can influence an injury. The first is intrinsic factors. Intrinsic factors are internal factors with the body that can increase the risk of injury.

Anterior Cruciate Ligament (ACL) Injury Rehabilitation Exercises

The anterior cruciate ligament (ACL)
Anterior Cruciate Ligament (ACL) Injury Rehabilitation Exercises

Anterior Cruciate Ligament (ACL) Injury Rehabilitation Exercises

You may begin with the first 3 exercises right away. When swelling in your knee has gone down and you are able to stand with equal weight on both legs, you may do the remaining exercises.

Heel slide: Sit on a firm surface with your legs straight in front of you. Slowly slide the heel of your injured leg leg toward your buttock by pulling your knee to your chest as you slide. Return to the starting position. Do 3 sets of 10.
Quad sets: Sitting on the floor with your injured leg straight and your other leg bent, press the back of the knee of your injured leg against the floor by tightening the muscles on the top of your thigh. Hold this position 10 seconds. Relax. Do 3 sets of 10.
Passive knee extension: Do this exercise if you are unable to fully extend your knee. While lying on your back, place a rolled-up towel underneath the heel of your injured leg so the heel is about 6 inches off the ground. Relax your leg muscles and let gravity slowly straighten your knee. You may feel some discomfort while doing this exercise. Try to hold this position for 2 minutes. Repeat 3 times. Do this exercise several times per day. This exercise can also be done while sitting in a chair with your heel on another chair or stool.
Wall squat with a ball: Stand with your back, shoulders, and head against a wall and look straight ahead. Keep your shoulders relaxed and your feet 2 feet away from the wall and a shoulder’s width apart. Place a soccer or basketball-sized ball behind your back. Keeping your back upright, slowly squat down to a 45-degree angle. Your thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the wall. Repeat 10 times. Build up to 3 sets of 10.

Anterior Cruciate Ligament (ACL) Injury Rehabilitation Exercises

Anterior Cruciate Ligament (ACL) Injury Rehabilitation Exercises

Balance and reach exercises
Stand upright next to a chair with your injured leg farthest from the chair. This will provide you with support if you need it. Stand just on the foot of your injured leg. Try to raise the arch of this foot while keeping your toes on the floor.

Keep your foot in this position and reach forward in front of you with the hand farthest away from the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets.
Stand in the same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 10.
Knee stabilization: Wrap a piece of elastic tubing around the ankle of the uninjured leg. Tie a knot in the other end of the tubing and close it in a door.
Stand facing the door on the leg without tubing and bend your knee slightly, keeping your thigh muscles tight. While maintaining this position, move the leg with the tubing straight back behind you. Do 3 sets of 10.
Turn 90 degrees so the leg without tubing is closest to the door. Move the leg with tubing away from your body. Do 3 sets of 10.
Turn 90 degrees again so your back is to the door. Move the leg with tubing straight out in front of you. Do 3 sets of 10.
Turn your body 90 degrees again so the leg with tubing is closest to the door. Move the leg with tubing across your body. Do 3 sets of 10.
Hold onto a chair if you need help balancing. This exercise can be made even more challenging by standing on a pillow while you move the leg with tubing.

Resisted terminal knee extension: Make a loop from a piece of elastic tubing by tying a knot in both ends. Close both knots in a door. Step into the loop so the tubing is around the back of your injured leg. Lift the other foot off the ground. Hold onto a chair for balance, if needed. Bend the knee on the leg with tubing about 45 degrees. Slowly straighten your leg, keeping your thigh muscle tight as you do this. Do this 10 times. Do 3 sets. An easier way to do this is to stand on both legs for better support while you do the exercise.
Wobble board exercises:
Stand on a wobble board with your feet shoulder width apart. Rock the board forwards and backwards 30 times, then side to side 30 times. Hold on to a chair if you need support.
Rotate the wobble board around so that the edge of the board is in contact with the floor at all times. Do this 30 times in a clockwise and then a counterclockwise direction.
Balance on the wobble board for as long as you can without letting the edges touch the floor. Try to do this for 2 minutes without touching the floor.
Rotate the wobble board in clockwise and counterclockwise circles, but do not allow the edge of the board to touch the floor.
When you have mastered exercises A through D, try repeating them while standing on only one leg (your injured leg).
Once you can do these exercises on one leg, try to do them with your eyes closed. Make sure you have something nearby to support you in case you lose your balance.

Rehabbing Running Injuries With Pilates

The anterior cruciate ligament (ACL)
Pilates

Pilates

When Joseph Pilates developed his exercise method in the early 20th century, it is unlikely that he imagined how popular it would become. As a child, he suffered from illnesses including asthma, rickets and rheumatic fever. Dedicated to improving his physical fitness, Pilates believed that postural dysfunction and inefficient breathing techniques contributed to poor health.

He refined his method, originally called Contrology, while interned in a camp with other German nationalists in England during World War I. While there, Pilates worked with injured and ill detainees, using hospital bedsprings to provide assistance and resistance for rehabilitation from illness and injury.

Although he was trained as a boxer and gymnast, and enjoyed skiing and diving, when Pilates immigrated to NYC in the 1920s, he developed a following in the dance community.

His method was soon adopted as an integral part of training and rehabilitation for dancers and, as it has evolved, is now commonly found in fitness centers and physical therapy clinics.

With a focus on developing dynamic core stability, Pilates is an effective exercise modality for runners. Research shows that an exercise program focusing on the hip, pelvis and trunk musculature can be useful in the treatment and prevention of common running injuries.1

Pilates helps physical therapists identify faulty movement patterns, correct form, and use equipment to regress or progress an activity. Pilates allows the specific demands of running to be replicated for use during injury rehabilitation, or as part of a runner’s program for strengthening and stabilization to prevent injury.

Two Fitness Trends

Just as Pilates emerged as a popular exercise method, the past decade has also witnessed a tremendous surge in the participation in recreational running. Since 2000 the number of half-marathon finishers has tripled, growing 24 percent from 2009 to 2010, and has become the fastest growing road race distance in the United States.2

Due to the rise in popularity of running, recent trends in minimalist footwear, and programs promoting specific training philosophies, the number of running-related continuing education courses for physical therapists has also significantly increased.

As more individuals integrate running into their fitness routines, physical therapists will be an essential part of the rehabilitation and prevention of running-related injuries. Runners often develop muscular imbalances and faulty movement patterns, or have poor training strategies predisposing them to injury.

Physical therapists must be able to evaluate dysfunction and the mechanics that contribute to injury.

Dr. Stuart McGill, a researcher of spine biomechanics, proposes that progression of a stability program should include identification and correction of faulty movement patterns, with emphasis on teaching hip motion separate from lumbar motion; development of spine stability followed by whole body stability through exercises specific to a patient’s functional tasks; and development of endurance.3

Pilates can be used as a tool for assessing and retraining movement patterns, and to improve strength and stability to meet the demands of running.

The Single Leg Squat

A thorough evaluation of the injured runner must include observation of movements specific to running. The Single Leg Squat is a coordinated, multi-joint movement that requires integration of the entire body for correct performance.

Though challenging, The Single Leg Squat is a foundational movement of running and an excellent predictor of run mechanics. Clinically, The Single Leg Squat Test is used to identify faulty movement patterns including pelvic drop, femoral adduction or internal rotation and excessive pronation.

The Single Leg Squat Test may be replicated on the Reformer to make the movement less challenging, while still providing an opportunity to assess alignment and retrain faulty movement patterns.

For the Single Leg Press, the runner lies supine on the Reformer with one foot on the footbar and the other held in a tabletop position.

Pushing against the footbar, the leg extends against resistance. Although the Reformer provides trunk support, a runner with weak gluteals may still demonstrate femoral adduction during the movement.

Pelvic position should be evaluated for pelvic tilt and lower abdominal recruitment. Foot placement will provide additional information about a runner’s mechanics.

Once positional faults are identified, the therapist can teach the runner correct alignment using verbal or tactile cuing. After the correct movement is learned, the Single Leg Press can be progressed by adding springs while requiring the runner to maintain correct alignment.

The Step Up on the Chair, a progression from the Reformer, provides valuable information about a runner’s ability to integrate trunk stability with lower extremity movement in the absence of trunk support. Standing facing the Chair, with one foot on top and the other on the pedal, the runner steps onto the chair, using springs to assist the movement.

During the exercise, positional faults at the lumbar spine, pelvis, continuing down the kinetic chain may be seen. The number of springs used depends on the amount of assistance required and should be documented as an objective measure of progress, with fewer springs used as the runner gains strength and stability.

The Jumpboard is an accessory attached to the Reformer used to introduce absorption to a runner following injury, or for the development of power to enhance run performance. Once a runner is able to demonstrate correct lower extremity alignment during the Single Leg Press, absorption activities may be added.

The Stable Trunk

The ability to move the legs reciprocally while maintaining a stable trunk is an essential component of running. However, excessive pelvic motion is often observed and can be a contributing factor to many common running injuries. Matwork reveals a runner’s ability to integrate trunk stability with lower-extremity movement.

The Side Kick Series is a group of exercises focusing on hip strengthening and trunk stabilization. While propped on elbow in sidelying, the runner lifts the top leg to hip height and completes forward and back swings, lifts and circles while attempting to stabilize the trunk.

Single Leg Circles are practiced in supine with the working leg held straight in the air. The runner stabilizes the pelvis while circumducting the leg. Depending on the stability of the runner, the exercise may be regressed.

Runners with short hamstrings or hip flexors may be unable to assume the traditional position of hip extension for the resting leg and should start in a hooklying position. A resistance band placed over the foot of the working leg and held in the opposite hand may be incorporated to provide kinesthetic feedback, leading to a more controlled movement.

During each exercise the therapist should look for pelvic instability. Once the runner is able to stabilize the pelvis during matwork, the exercises can be progressed to standing.
The main focus of the exercises chosen is on the development of lower-body strength and mobility with trunk stability; however, running is a full-body sport and a thorough program must include trunk mobility and upper-extremity strengthening exercises.

While no specific routine is appropriate for everyone, the following exercises have components that are beneficial to most runners.

The Single Leg Stretch improves breath control, increases core stability and develops endurance during reciprocal lower-extremity movement. The runner lies supine in a partial curl position with one leg extended at a 45-degree angle.

The other hip is flexed to a 90-degree angle with the hands positioned on either side of the knee to encourage correct alignment in the frontal plane. The runner switches legs, coordinating the movement with his breathing, while maintaining a stable trunk.

Standing Hip Abduction on the Reformer has been shown to decrease knee pain, increase strength and improve alignment during a step-down, a biomechanically similar maneuver during initial contact to mid-stance in running.1 While standing with one foot on the carriage of the Reformer, the runner performs bilateral hip abduction while maintaining neutral lower-extremity alignment.

Bridge with Extension is used to develop eccentric hamstring strength, essential during running to slow the swing leg in preparation for footstrike. Lying supine on the Reformer with feet on the footbar, the runner performs a bridge against light resistance while preventing carriage movement.

Once in the bridge position, the hips and knees extend to move the carriage back, then flex to pull the carriage in to the bumper.

By understanding the mechanics of running and identifying movement faults that place a runner at risk of injury, the trained therapist can develop an exercise program using matwork or Pilates apparatus to help runners of all levels hit their stride.

THERAPEUTIC EXERCISE FOR ACL INJURIES

The anterior cruciate ligament (ACL)
THERAPEUTIC EXERCISE FOR ACL INJURIES

THERAPEUTIC EXERCISE FOR ACL INJURIES

Your anterior cruciate ligament helps to support and stabilize your knee joint. ACL injuries range from mild strains to tears that require arthroscopic surgery. Therapeutic exercise for ACL injuries concentrates on rehabilitating your knee’s supporting muscles to return you to as fully functional a lifestyle as possible. Check with your doctor before undertaking any exercises for ACL injuries, since not all exercises may be appropriate for your condition.

Strengthen Hamstrings

Therapeutic exercise for ACL injuries should strengthen your hamstrings and quadriceps to provide a natural shock-absorption mechanism that reduces knee-joint stress and strain, lowers pain levels and protects against further injury, according to the American Academy of Orthopaedic Surgeons. Work on strengthening your hamstrings by doing standing curls. Stand facing the back of a firm chair, feet shoulder-width apart. Slowly lift your injured leg and bend your knee so your heel goes toward your butt, the HEP2go website instructs. Bend your knee as far as possible. Do not move your back. Hold this position 10 seconds. Slowly return to the original position. Relax for 10 seconds. Repeat this exercise 10 times.

Stretch Hamstrings

Therapeutic exercise for ACL injuries needs to work on restoring flexibility to your hamstrings, the muscles along the back side of your knee. Stretching out your hamstrings plays a role in straightening your leg, reducing knee stiffness and reducing pain levels. Start by using the wall as an exercise tool while doing a wall stretch maneuver, the Nicholas Institute of Sports Medicine and Athletic Trauma instructs. Either lie on the floor or an exercise table for this exercise. Lie on your back and move your body close enough to a wall so you can lift your injured-side leg and place the back of it on the wall. Keep your injured knee as straight as possible. Hold the stretch for 30 seconds. Slowly scoot back and return to your original position. Relax 10 seconds. Repeat the exercise five times. The closer you position your body to the wall, the more intense the stretch.

Strengthen Quads

The quadriceps run along the front of your thigh and are your knee’s largest supporting muscles. Exercises that concentrate on restoring strength to these muscles play an essential role in properly rehabilitating your knee after an ACL injury. Start doing some wall squats, the American Academy of Orthopaedic Surgeons suggests. Stand with your back, hips and shoulders against the wall, feet shoulder-width apart. Gently position your feet to allow a 2-foot space between your heel and the wall. Keep your arms at your sides and slowly lower your body toward the floor while bending your knees. Bend your knees to a 90-degree angle. Hold this position for 15 seconds. Slowly return to the original position. Relax 10 seconds. Repeat this exercise five times.

Flex Quads

Stretching your quadriceps after doing strengthening exercises helps prevent muscle stiffness, soreness and lowers risks of further injury. Therapeutic exercise for ACL injuries should increase quadriceps flexibility through a standing quad stretch maneuver. Stand upright facing the back of a chair, feet shoulder-width apart. Lift your injured foot and grab ahold of the ankle with your same-side hand. Gently pull your ankle to increase your knee bend, feeling the stretch along the front part of your thigh and knee. Bring your heel to your butt, or as far as possible without causing undue pain. Hold the stretch for 20 seconds. Slowly return to the original position. Relax 10 seconds. Repeat the exercise 10 times.

REHAB EXERCISES FOR AN ACL TEAR PRE-SURGERY

The anterior cruciate ligament (ACL)
ACL TEAR PRE-SURGERY

ACL TEAR PRE-SURGERY

Your ACL, anterior cruciate ligament, is the ligament that lies in the middle of the knee joint on the front portion. This ligament connects your thigh and lower leg bones together along with the other ligaments in your knee that each help keep the knee joint stable. Injury to your ACL is unfortunately common in athletes, especially in sports requiring significant amounts of running or contact. Many surgeons recommend waiting to perform surgery until after swelling and range of motion have returned to the knee. This phase is often called pre-habilitation, which involves physical therapy to prepare for surgery.

Cardiovascular Exercise

If only the ACL is injured, stability in the knee will be affected but you can still perform cardiovascular exercises. This will improve circulation to the knee and improve range of motion prior to surgery. Recommended exercises include walking, riding a stationary bicycle and swimming, although you may wish to avoid the breaststroke, which can be too hard on your knee. Avoid contact sports and running.

Strengthening Exercises

Strengthening exercises for the knee do not have to involve a wide range of motion. Until your range of motion returns following ACL injury, you may perform isometric exercises. One example is lying on your back and placing a rolled-up towel underneath your feet. Keep your legs straight, as you press the knee toward the floor, tensing your quadriceps muscles in the front of the thighs. Another strengthening exercise involves lying on a table on your stomach, with your lower legs hanging off the table. Keep your legs straight as you lift them up — first straight, then bending your legs toward your buttocks.

Range of Motion Exercises

Prior to surgery, your physical therapist will likely set a goal for you to fully extend your leg. To accomplish this, you will use exercises like towel extensions, where you wrap a towel around the foot of the affected leg, holding an end in each hand. Pulling the towel toward you can help stretch the knee. Another exercise known as wall slides involves lying on your back and placing your feet flat on a wall, walking one foot and then the other up the wall.

Benefits

Rehabilitation exercises prior to ACL tear repair surgery help prevent the development of scar tissue following surgery. Because the muscles and tendons have more time to heal during the pre-rehabilitation period, you are less likely to experience scarring that affects your range of motion. Increasing strength also enhances stability after surgery, speeding your recovery period.

ACL REHAB PROGRAMS

The anterior cruciate ligament (ACL)
ACL REHAB PROGRAMS

ACL REHAB PROGRAMS

There are four major ligaments in the human knee, including the anterior cruciate ligament, commonly referred to as the ACL. Injuries to the ACL are extremely common in athletes. Small ACL injuries such as strains may be able to healed with physical therapy, whereas ACL tears almost always require surgical repair. Post-surgery rehabilitation is necessary with all ACL reconstructions. Although everyone progresses at a different rate, the same general progression is usually followed during rehabilitation.

Preoperative

There is often a period of lag time between ACL injury and the actual repair of the ligament. Although some strength will be lost with surgery and rehabilitation, the goal of the preoperative period is to maintain as much quadricep strength as possible. The stronger the muscles are at the time of surgery, the faster rehabilitation will be postoperatively. Quad sets are an easy way to strengthen the muscles without placing additional pressure on the knee. To perform a quad set, the leg should be extended and relaxed. The quadricep muscle should be contracted as hard as possible and held for ten seconds without lifting the foot. The exercise should be repeated several times with 10 second rest periods between each set.

The First Two Weeks

There are two major goals for the first two weeks after ACL repair: Minimization of swelling and regaining range of motion. Ice and elevation are key components of the treatment regimen to help minimize inflammation. You will be referred to a physical therapist after surgery to help develop and progress your rehabilitation as needed. . Common exercises performed during this period may include knee extensions, quad sets, straight leg raises and heel slides. These exercises should challenge you but not cause significant amounts of pain. Special consideration should be given to performing the exercises gently and gradually to help avoid reinjury. Patients are generally prescribed crutches during this period to avoid placing pressure on the leg while walking.

Three to Five Weeks

At this point, you should be able to ambulate without the assistance of crutches under the guidance of your doctor or physical therapist. The goal of this period is to increase flexion of the knee and regain normal and full range of motion. The same exercises used in previous weeks to increase quadriceps strength are generally continued. Low impact activities that challenge the flexion of the knee may be added if you can participate without causing significant pain and discomfort. Swelling should still be monitored closely, and any exercise that results in dramatic swelling after performance should be lessened or discontinued until it can be well tolerated.

Six Weeks and Beyond

This period of rehabilitation focuses on building strength while allowing the ligament to continue to heal. Many physical therapists employ closed-chain kinetic exercises which do not allow movement of the foot during performance during this time. Weight machines such as the leg press and knee extension/flexion machine may be included in a workout program at this point. Weight should be added conservatively and gradually. Returning to competitive and recreational sports is generally not advised until after three months post-op.

ACL REHAB EXERCISE

The anterior cruciate ligament (ACL)
ACL REHAB EXERCISE

ACL REHAB EXERCISE

ACL injuries–particularly in sports–are an all too-common occurrence. As a matter of fact, ACL researcher, Timothy Hewett estimates that between 75,000 and 250,000 of these types of injuries occur each year the United States. Within these numbers, female athletes suffer a disproportionately higher incidence of ACL injuries–as much as six to eight times higher than their male counterparts.

Function

The ACL, or anterior cruciate ligament, is one of the primary ligaments that keeps your knee joint intact–it aids in the knee’s mobility and stability. Damage your ACL and you’ll more than likely not only experience knee pain, but also instability in the joint.

Open Versus Closed Chain Exercises

Knee joint and ACL rehabilitation exercises fall into one of two categories; open-chain and closed-chain. Open-chain leg exercises can be described as those where the foot on the exercising leg does not remain in contact with the ground or other stationary object throughout the exercise. An example of this type of exercise is the leg extension. Closed-chain exercises, on the other hand, are ones in which the foot on the exercising leg remains in contact with a stationary object, such as the ground, throughout the exercise. Examples of this type of exercise would be a squat or leg press. Generally speaking, closed-chain exercises are thought to be, by many experts in the field, safer for the knee and ACL because they cause less stress on those structures.
While much research has been developed on which of these types of exercises is best for ACL rehabilitation, there appears to be no clear-cut answer. However, one thing that many of the researchers do agree on is that no matter which type of exercise is used for ACL rehabilitation, an important key is to perform the exercise in a way that does not put undue stress on the ACL. Although open-chain exercises have been cited as putting tremendous stress on the knee and ACL, according to researcher G. Kelley Fitzgerald, both types of exercise can be used in ways that do not put undue stress on the ACL. For example, with open-chained exercises, such as the leg extension, Fitzgerald suggests that by limiting the range of motion for that exercise from the normal 90 degrees to approximately 45 degrees, less stress may be placed on the knee joint.

Closed Chain Exercises

Assuming you have been cleared by your physician to exercise after either a surgical or therapeutic intervention, squats are a good overall lower body strength exercise. Performing squats with your body weight or with added external weight such as dumbbells will help you improve your quad and hamstring strength. This exercise can be performed in a variety of ways, depending on your needs. For example, half or “mini” squats where you do not bend your knees to a full 90 degrees, wall squats or slides where you perform the squat with your back against the wall, and single-leg squats are all versions of this exercise.

Open-Chain Exercises

Quadriceps or “quad” muscle weakness is a major concern following an ACL injury, according to Fitzgerald. Isometric leg lifts are a good way to improve the strength in your quads while not creating the stresses on your knee and ACL typically associated with open-chain exercises. Leg extensions with a limited range of motion are another good quadriceps developer for your legs.

Considerations

With any rehab work there is no one-size-fits-all exercise program. What’s important is that you listen to your physician, listen to your body, and take your time. The goal should be not only to recover from your ACL injury, but to strengthen your body so as to help avoid future injury.