If you're feeling your way through the ACL prehab process, you may have heard a few ACL prehab goals to strive for before heading into surgery from your doctor. These goals often include targets like:
- Normal gait
- Knee extension range of motion = 0
- Knee flexion range of motion at least 120 degrees
- Perform 20 straight leg raises with no lag
- Minimal effusion/swelling
Hitting these goals WILL put you in a much better position than if you were to avoid prehab altogether. However, much more can be achieved during the prehab phase. The overarching goal we recommend is to get yourself as close to 100% as possible before surgery (hitting the targets listed above are definitely not indications of being 100%). Doing so will increase your chances of an optimal recovery on the back end, increase confidence heading into surgery (which also plays a role in recovery), and potentially set you up to have a conversation with your doctor about whether or not you even NEED surgery (this article dives into that).
What Would Heading Into Surgery Close To 100% Really Look Like?
If we're truly beginning the prehab process with the end goal in mind, here are a few targets we would strive to hit. Again, some of what you can and cannot do may be dictated by your doctor or physical therapist. Always stay within their recommendations. Additionally, you may not hit all of these ACL prehab goals before surgery, and that's ok. But as they say… if you shoot for the moon and miss, you'll land among the stars. If we begin the process with these goals in mind, we can set ourselves up for that much more success on the back end of surgery.
The Basics
- Full Range Of Motion
- No Swelling
- No Pain
- Ability To Activate The Quad
These are very similar to the ACL prehab goals listed at the top of the article, and they still need to be achieved. The only difference here is that being at 100% means not only getting to 120 degrees of flexion and 0 degrees extension, but FULL flexion. Ideally, you can bend and straighten the injured knee as far as the non-injured knee.
5. Strength
Your injured quadricep and hamstring should be at least 90% as strong as the opposite leg. This can be measured using a Biodex or dynamometer, hopefully at your PT clinic. If you haven't chosen a PT yet, you may want to search around for a clinic that has a Biodex isokinetic testing system. This can help you to determine where your leg strength is throughout the recovery process.
6. Hop Tests
A series of hop tests can be used to assess how confident your body is in using the injured leg in dynamic, explosive movements, as well as to test landing form and balance. Again, you'll be targeting at least 90% symmetry from side to side with these tests. Fowler Kennedy put together a nice guide here that describes various tests in detail and provides a scoring system.
7. Lack Of Compensation
After an ACL injury, the body finds all different kinds of ways to compensate to try to reduce stress on the affected knee. When you are at or close to 100%, those compensations will no longer be present. A trained eye and a few simple exercises can help to determine if your body is still compensating for the injury.
8. Full Confidence
If you've hit each of the four goals above, it's likely that you're feeling pretty confident again on the injured knee. Believe it or not, your attitude heading into surgery can be a predictor of how successful you'll be with recovery AFTER surgery. Additionally, your confidence upon return to sport can be a predictor of future injury. Other than going off of "feel," your confidence for return to sport can be measured using the questionnaire found here on the Ortho Tool Kit website. Generally, a score of 80-90% on this test is considered to be consistent with an athlete who does not have a knee condition, so this would be the target.
If You're Still Short Of These Goals
If surgery is a few weeks away and you're still short of these targets, the nervous system may need a stronger signal than exercise alone can give it. We use direct current e-stim while you move to get the quad working again and the knee moving through its full range, all within your surgeon's guidelines. You can try it in a free 2-day trial with the button below.
