Cruiate Ligament and Physios advice

Conditioned

I've recently being speaking to a lad that had a cruciate repair operation last October. He had started to do weights I think the end of January after receiving the go ahead from the physio.

He started off with not even the bar in the squat and has built up to 70kg x 5. He's also done the deadlift for 92.5kg x 5. the only other lower body exercise he has been doing is GHR. Which he found quite easy. He weights around 75kg and has never lifted weights before this.

His physio tells him that he should be doing single leg curls and extensions as one leg is way bigger than the other. I would have thought one leg would be slightly bigger anyway for a few months? Are the physios recommendations good for rehab or are there better alternatives?

amazingemmet

leg extensions and ligament damage in the knee is a huge no no and is out dated by years in rehab circles.

Personally If I was the lad I'd focus on single leg exercises, lunges, walking lunges bulgarians etc for a while. For two reasons one to help get him used to activating the other leg muscles and balancing out the load and two to help regain stability in the knee region and to aid tracking.

fcleere

now there is a coincidence,i had an ACL reconstruction back in october too! i have a physio programme and it includes leg extensions and curls
, aswel as squats nd dips.
i had my first strength test with the specialists physio in kk two weeks ago and my quads are down 35% in terms of power!
is it true bout the leg extensions?thats basically what the strength test was nd the physio assured me i couldnt hurt the graft while doin it.
he also said i should be back doin a runnin programme but my regular physio said not yet.

Conditioned

Thanks Emmet. I was thinking along them lines myself but wasn't sure.

Have you got any links to studies to back that up?

Roper

Below is my amateur view The other guy went to college I just reads books I do.

As Emmet has said it seem like out of date rehab. The sort of machine rehab stuff he was prescribed is purely muscular/structural rehab (and bad stuctural rehab imo) with little or no neural component whereas I think the current thinking is to start with the neural element asap ie. along with the structural work. So you see guys using light bands tied to table legs instead of curl machines, progressing to heavier bands and then followed by single leg bodyweight exercises like lunges etc. My mate was basically told that all of his exercises would have surface contact. That initially his uninjured leg would be grounded and as rehab prgressed the injured leg would be grounded.

All that comes with the proviso that I've never rehabed a knee. Mind you a lot of physios have never rehabed a knee either, at least not one that hasn't reoffended. Rather than giving him advice though I would recommend he goes and finds a really good physio who knows his stuff.

fcleere

well said roper. from experience, i started off with leg raises and progressed up through bands nd lunges to weights. i am in wexford and go to a very good physio, they dont go for these accelerated recovery programmes like some places.
they have a fairly good track record with rehabin knees too. i think there is currently 4 people with ACL reconstructs attending there now.
apparently they're like buses!!

Conditioned

The physio would be highly rated, the physio is actually an inter county physio with about ten years experience at of inter county football as well as other sports. That doesn't necessarily make the physio a good physio but I'm just given some background. The physio would have worked with other people who had the same injury and made a sucessful come back.

Another piece of advice given was that he should either just work the weak leg or work the good leg and work the operated leg twice as much. It doesn't seem right to be. My unqualified advice would be to work the weak leg first and then the strong leg with the same weights and reps. I'd imagine it would have minimal effect on the good leg but it would give you a good indicator how how the strength in the bad leg was progressing.

Roper

Well if he has a good track record then I'd do what he says. Physios don't write strength programmes though, they just tell you when you're okay to go and do strength again. So if the physio says the rehab is over, then you can do what you want anyway.

Conditioned

Track record is mixed like you said most physios will get you the the stage where you can do some strength work but after that I feel their advice is not much better than any of us other plebs.


I fell like most other things the best the best people to talk to are people that have made a sucessful recovery but I'd expect in some case a lot of people wouldn't really know what had worked best for them.

Roper

My mate had a successful ACL reconstruction with the Beacon Clinic and he said that his rehab actually scared him it was that hard and painful. But 2 years on he's playing again and he's had no trouble. His first op was 7 years ago and the rehab was very light and he had continuing knee problems until the second tear. I think in thses cases you have to trust the pro whose hands you're in unfortunately.

amazingemmet

Conditioned wrote: »

Thanks Emmet. I was thinking along them lines myself but wasn't sure.

Have you got any links to studies to back that up?

I haven't got them on my home computer but if you pm your e-mail I can send you some pdf's of studies during the week.

The reasoning behind not using leg extension machine is that it places a shear force on the knee joint and the most likely cause of a acl injury is a shear force so you are basically replicating the injury. Also as roper said there's more of a neural focus when starting rehab now a days.