ACL Prehab – What is it, why is it important, and how can it help you in your post operative journey?
By Jas Whitelaw / B. Physiotherapy (Hons)
So you’ve ruptured your ACL and are awaiting surgery. You’ve been told by your physiotherapist or doctor that in the lead up to surgery you should participate in “prehab” but what does this mean, and what does it involve?
It is a known fact that rupturing the anterior cruciate ligament is a common and often devastating injury. With the incidence of ACL ruptures and consequent reconstructions in Australia the highest in the world, it is vital that both you, and your physiotherapist take the best steps to optimise your post surgical recovery.
Unlike rehabilitation which occurs following an injury or surgery, pre-habilitation is the process of strengthening the structures surrounding a joint prior to surgery to maximise and accelerate a person’s post operative recovery. Furthermore, current best evidence supports that participating in pre-habilitation leads to better postoperative outcomes and overall quality of life for a patient in the long term.
Prehab can be defined as optimising the functional abilities of an individual to readily equip them to withstand the stressors of surgery and the consequential inactivity.
A study published by the American Journal of Sports Medicine found that implementing a 6 week progressive rehabilitation program for athletes awaiting anterior cruciate ligament surgical reconstruction (ACLR) lead to greatly improved and advanced knee function when compared to the control group (no prehab) up to 12 weeks post operation.
Now the question remains; what exercises should be included in ACL prehab and why?
It is largely understood that comprehensive neuromuscular agility training can decrease an athletes risk of ACL rupture, and thus, should be included in their pre and post operative rehab to minimise the incidence of re-rupture.
Neuromuscular training focuses on exercises that excite the nerves and muscles to react and communicate concurrently. These might be in the form of perturbation, balance, stability and proprioceptive exercises.
Additionally, a systematic review published in 2020 found that whilst varying methods of prehab was implemented between 6 separate studies, the content of the protocols was largely similar. This tells us that the current prehab recommendations can be greatly effective in improving postoperative outcomes, and reducing the incidence of re-rupture following return to play.