How to PreHab Before ACL Surgery

Prehabilitation ("prehab") before ACL surgery is a critical step in optimizing outcomes. It helps reduce swelling, restore range of motion, strengthen surrounding muscles, and mentally prepare for recovery. Here's a detailed guide tailored for athletes:

Goals of ACL Prehabilitation

1. Reduce Swelling and Inflammation
   • Decrease joint stiffness and pain.
2. Restore Range of Motion (ROM)
   • Achieve full extension and as much flexion as possible.
3. Strengthen Key Muscles
   • Build strength in the quadriceps, hamstrings, glutes, and core to support the knee.
4. Enhance Balance and Proprioception
   • Prepare your body for post-surgery rehabilitation.
5. Mental Preparation
   • Boost resilience and confidence for recovery.

1. Manage Swelling and Inflammation

• Rest and Ice
  • Elevate the leg and apply ice packs (20 minutes on, 20 minutes off).
• Compression
  • Use an elastic bandage or compression sleeve to control swelling.
• Anti-Inflammatory Measures
  • Follow your physician’s advice for medications like NSAIDs.

2. Restore Range of Motion (ROM)

• Heel Slides
  • Lie on your back. Slide your heel toward your buttocks, bending the knee as far as possible without pain. Slowly return to the starting position.
• Passive Knee Extensions
  • Sit on a chair or table with your heel supported and allow the knee to straighten fully. Use a small weight for gentle overpressure if needed.
• Calf Stretch
  • Stretch the calf muscles to promote knee extension.

3. Strengthen Key Muscles

Quadriceps

• Straight Leg Raises
  • Tighten your quad with the knee straight. Lift your leg a few inches, hold, and lower slowly.
• Quad Sets
  • Sit or lie with your leg extended. Tighten the quad to push the knee toward the ground. Hold for 5 seconds.

Hamstrings

• Hamstring Curls
  • Lie on your stomach and bring your heel toward your buttocks, keeping the movement slow and controlled.

Glutes

• Bridges
  • Lie on your back with knees bent. Lift your hips, squeezing the glutes at the top, and lower slowly.

Core

• Planks
  • Hold a plank position, focusing on a tight core and straight body alignment.

4. Improve Balance and Proprioception

• Single-Leg Stands
  • Stand on your injured leg, using support if needed. Progress by removing support or closing your eyes.
• Balance Board Work
  • Use a balance board to challenge stability.

5. Maintain Cardiovascular Fitness

• Low-Impact Activities
  • Swimming or upper-body-focused cardio (e.g., rowing machine or stationary bike without resistance) can keep you fit without stressing the knee.

6. Prepare Mentally

• Set Goals
  • Break recovery into manageable stages, such as regaining motion, walking, and eventually returning to sport.
• Mindfulness Practices
  • Use visualization techniques to picture successful recovery and performance.
• Educate Yourself
  • Learn about the surgical process and post-op rehab to reduce anxiety.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.