Anterior Cruciate Ligament (ACL) injuries are a common yet challenging issue, especially for athletes and active individuals. When surgery becomes necessary, proper preparation can significantly impact recovery outcomes. This preparation phase, known as prehabilitation or “prehab,” is a critical step that sets the stage for successful surgery and rehabilitation.
What is Prehab?
Prehab refers to a 6-8 weeks structured period of physiotherapy and exercise rehab prior to ACL reconstruction (ACLR) surgery. The objectives of the prehab period are to settle initial inflammation and swelling, restore range of motion and proprioception, and build specific and functional muscle strength. Think of it as laying a solid foundation for a house—the stronger and more stable the foundation, the better the structure built on top.
In the case of an ACL injury, prehab aims to optimize the knee’s function before surgery. This proactive approach not only helps prepare the body for the surgical procedure but also facilitates a smoother and more efficient recovery.
What Does Prehab Involve?
Prehab can be divided into two primary stages: the initial stage and the secondary stage. Each stage has specific goals and strategies to ensure the knee is in the best possible condition before surgery.
Initial Stage
The initial stage of prehab focuses on:
- Reducing Swelling and Inflammation:
- Techniques like icing, elevation, and compression are essential to manage swelling. Reducing inflammation helps restore mobility and prevents further damage.
- Restoring Range of Motion:
- Regaining full knee extension and as much flexion as possible is critical. A stiff knee before surgery can lead to complications, including joint stiffness post-surgery.
- Restoring Normal Day-to-Day Function:
- Activities like walking, climbing stairs, and performing sit-to-stand movements should be as close to normal as possible. Achieving a proper walking gait without limping is particularly important for minimizing compensatory movement patterns.
Secondary Stage
Once the knee is stable and swelling is under control, the focus shifts to:
- Improving Muscle Strength:
- Specific exercises target key muscle groups like the quadriceps, hamstrings, and glutes. Strong muscles help stabilize the knee and reduce the risk of further injury.
- Restoring Functional Strength and Capacity:
- Functional exercises mimic real-life movements and sports-specific actions. Examples include step-ups, squats, and lunges, which prepare the knee for dynamic activities.
- Enhancing Proprioception:
- Proprioception refers to the body’s ability to sense movement and position. Balance exercises and controlled weight-shifting movements help retrain the body to react appropriately, reducing the risk of re-injury.
Why is Prehab Important?
Prehab is more than just preparation—it’s an investment in your recovery and long-term knee health. Here’s why it’s so crucial:
1. Easier Post-Surgical Rehab
Prehabilitation (“prehab”) is likely to lead to an easier and faster post-surgical recovery. By improving strength, range of motion, and overall function before surgery, patients are more likely to experience:
- Reduced post-operative pain: A stronger body is better equipped to handle the stress of surgery.
- Faster progress: Improved knee function pre-surgery translates to quicker gains in mobility and strength afterwards.
- More efficient recovery: Prehab can streamline the rehabilitation process, leading to a faster return to normal activities.
In essence, prehab increases the likelihood of a smoother and more successful surgical outcome.
2. Increased Likelihood of Returning to Pre-Injury Levels of Sport
Prehab is crucial for athletes aiming to return to their pre-injury level of sport. It helps preserve muscle strength and range of motion, leading to better outcomes and a quicker return to the field or court.
Research supports this, showing that patients who undergo an 8-week prehab program are more likely to:
- Successfully return to their pre-injury level of sport: By building a stronger, more functional knee before surgery, athletes are better equipped for the demands of their sport.
- Experience a smoother recovery: Maintaining strength and flexibility minimizes post-operative setbacks and facilitates a faster return to training.
Essentially, prehab increases the likelihood of a successful comeback for athletes.
3. Opportunity for Non-Operative Management
Prehab provides a chance to assess whether surgery is truly necessary. In some cases, individuals with ACL injuries may respond so well to prehab that they can manage their condition non-operatively. This is particularly true for those with partial tears or less physically demanding lifestyles.
4. Reduced Risk of Post-Surgical Complications
Limited range of motion before surgery significantly increases the risk of prolonged stiffness and complications afterwards. This is why prehab is so important.
By restoring full extension and maximizing flexion before surgery, patients are less likely to experience:
- Joint stiffness: Prehab helps maintain flexibility, making it easier to regain full range of motion after surgery.
- Post-operative complications: Increased flexibility reduces the risk of developing complications like knee stiffness or contractures.
Essentially, prehab helps ensure a smoother recovery with less stiffness and fewer complications.
5. Minimized Muscle Wastage and Inhibition
Muscle inhibition—when the brain reduces the activation of muscles due to pain or swelling—can lead to significant muscle wastage. Prehab strengthens the muscles around the knee, helping to counteract this process and reducing the degree of atrophy that occurs after surgery.
The Bigger Picture: Benefits Beyond Surgery
Prehab isn’t just about preparing the knee—it’s about preparing the whole person. From building physical resilience to fostering a positive mindset, the benefits of prehab extend far beyond the operating room. Patients often report feeling more confident, informed, and motivated heading into surgery, which can significantly impact recovery outcomes.
Additionally, prehab is an opportunity to establish a strong rapport with your physiotherapist. This relationship will be invaluable as you transition from prehab to post-operative rehabilitation and eventually return to your daily activities or sport.
If you or someone you know is facing ACL surgery, consider prehab as the first step in your recovery journey. At Adaptive Physiotherapy, our team of skilled physiotherapists is here to guide you through every stage of the process, ensuring you’re equipped to achieve your best possible outcome.