The rationale for prehab prior to ACL reconstruction is simple: to maximize the function and health of the knee prior to surgery. The stronger your knee going into surgery, the stronger it will be when you come out. The goals of prehab are to:
- Control joint swelling and edema
- Regain normal knee range of motion (ROM)
- Regain a normal gait (walking) pattern
- Improve lower extremity strength and coordination
It has been demonstrated that patients who exhibit full knee extension ROM, absent or minimal swelling, and no knee extension lag during a straight leg raise before surgery have better surgical outcomes. The single most important variable to work on in prehab is SYMMETRICAL knee extension range of motion.
Pre-operative range of motion is indicative of post-op range of motion, so restoring full symmetrical knee extension is vital if you hope to achieve full range of motion after surgery!
To control swelling and pain, elevate the leg and use icepacks around the knee. Try to straighten your leg as much as possible when icing and keep icing sessions no longer than 15 minutes.
It's extremely common to have limited ROM due to swelling and pain following surgery, and regaining full knee ROM (especially extension) can sometimes be extremely difficult. Therefore, regaining as much range of motion as possible prior to surgery is of paramount importance. Some exercises you can do to improve range of motion include:
- Heel slides
- Ankle Pumps
- Bag hangs
- Hamstring stretch
- Calf stretch
- Quad stretch
Preoperative quadriceps strength is a significant predictor of knee function after ACL reconstruction, so it is extremely important to regain as much quadriceps strength as possible prior to surgery. Also, strength and control of the gluteal muscles play a huge role in preventing a future non-contact ACL injury (READ: The Gluteus Maximus and it's Unusual Role in Medial Knee Collapse), so strengthening the hip musculature should be implemented as well. Some exercises you can do include:
- Knee extension full ROM
- Hip abduction
- Hip extension in prone/fire hydrant
- Hamstring curl
- Toe raises
- Side steps
- Box squats
In a recent study by Shaarani et al 2013, they examined the effect of a 6-week prehab protocol that included strengthening exercises (with a focus on the quadriceps) to a group that did nothing before surgery. The prehab group reported improved knee function subjectively, as well as scoring better on the single leg hop tests at 12 weeks post-op. Putting in a little bit of time and energy into prehab has the potential to drastically improve your rehabilitation outcome in those ever so important first couple months of intensive rehabilitation.