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Thomas A. Holmes 07-07-2009 07:50 PM

Pre/Post-Surgery Strengthening
A friend of mine has just torn her ACL completely. I know there are a million ACL posts in here and I've read some of them. But I'm sort of zero-ing in on something specific.

She's going to have surgery soon and will have an ACL replacement. Her Doctor has instructed her to do some pre-surgery training to strengthen the muscles around the knee. She can walk and do maybe a third of or half of a squat without pain. She might even be able to do full squats without pain. But obviously, there can be no lateral or pivoting movement. The Doctor has recommended swimming and light cycling because they are easy on the knee. He also mentioned that squatting would be good.

I wanted to test his recommendation against you guys in here on the message board. She's asked me to help her with her strengthening because she knows I'm a level 1 trainer. But I know little about rehab or prep work for an ACL replacement. What do you guys think of what he's saying?

Also wanted to throw a few questions out there about strengthening and rehab.

Should she be squatting to some degree pre-surgery?

Is lunging a good way to help build strength pre or post surgery, or is that a dangerous movement for her at this time?

Since running is out, would getting on the rower and going easy on it be a good alternative to running since there's no impact? Should she be doing any of this pre-surgery? And how should her strength training for those surrounding muscles look different post surgery?

I appreciate any input you guys might have on this. I'm sorry I didn't get it all from the search bar. Was hoping there'd be some people who enjoy answering these questions.

Steven Low 07-08-2009 02:18 AM

Re: Pre/Post-Surgery Strengthening
Ask your local physical therapist.

Pre- Squatting/step ups/etc. all can definitely be done, but it depends on the person if they can handle it and such.

Post- generally therapists will stick with "proven" protocol and they'll progress you fairly slowly because they don't want to risk reinjury

YOu definitely want ot be doing activity to prevent atrophy and such, but no one here is going to give any recommendations because it's case by case.

Everett Steinbarger 07-08-2009 02:24 AM

Re: Pre/Post-Surgery Strengthening
Most pre-surgical strengthening for someone about to have an ACL reconstruction is usually targeted at quadsets and hamstring sets.

Traditionally I've had patients focus on straight leg raises and terminal extension. (Terminal extension is the last 30 degrees of extension.) Hamstrings can be strengthened for these patients by going back to the old gym equipment and using the hamstring curl. We do this because for many ACL Recon patients, straightening the knee after surgery takes a lot of work. The hamstrings, if properly strengthened, may make up for a blown ACL if they can be strengthened to the point that they inhibit forward tibial translation. After surgery, nice strong hams will take up the slack in the knee while the graft,(new ACL), is healing.

Patients who have just ruptured the ACL will, as your friend does, have difficulty with most squatting and lunging. Their body has not adjusted to the lack of ligamentous tension in the knee, and the knee is full of blood from the injury. Both of these problems throw off your bodies proprioception, (sense of position).

Has she thought of seeing a Physical Therapist?

Thomas A. Holmes 07-08-2009 09:02 PM

Re: Pre/Post-Surgery Strengthening
Thanks both of you. Preciate the input. She has thought of seeing a physical therapist. One of our friends is actually a PT, but we wanted to get input from a bunch of different sources and I know when it comes to rehab, crossfit is often at odds with a lot of doctors who will tell their patients not to squat because they've heard bad things about the squat from patients who hurt themselves doing it wrong.

So basically, pre - surgery, she needs to be doing some squatting, step ups and some good hamstring strengthening.

Post Surgery is going to be all physical therapy. Sound about right? Thanks guys.

Everett Steinbarger 07-09-2009 02:09 AM

Re: Pre/Post-Surgery Strengthening
Pre-Surgery I would avoid the squats until she has control and a good range of motion.

Post-Surgery should definitely be the venue of the PT.

Just my 2 cents.

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