ACL: Quad Strength is KING
If you have no idea what to do for your ACL rehab a really easy place to start is getting the quads freaky strong. We have A LOT of literature to support that quad strength is the most significant predictor of successful rehab and return to function.
Sure I think other things matter like the hop test, single leg depth jumps, range of motion, etc, but based off the research none of that matters AS MUCH as quad strength.
So how do we do it?
Initially, we will experience a huge decrease in quad strength and size. This is crucial to get back as many experience deficits even long term. Re-establishing the neural connection between the brain and the quad is crucial. I always recommend being able to achieve a voluntary quad contraction first BEFORE adding electrical stimulation. So I would want to see a good quad contraction as shown below then I would add electrical stimulation to enhance the contraction.
Early on frequency is your best friend. I advocate for daily mobility sessions multiple times per day as well as quad sets throughout the day. The goal should be to get 500-1000 reps in per day.
How about later stages?
Quad sets and straight leg raises may be good for the first week or two, but we should progress pretty quickly to harder exercises. My next step is to progress patients into a wall sit and isometric lunge. These two pillars will be in their program for the duration of therapy.
The goal should be to work up to 2-5 minutes on each of these positions.
At the 4-6 week mark I start introducing open chain quad exercises like single leg leg extensions. And before you say it, THEY ARE SAFE!
The idea that SL leg extensions "increase the laxity of the ACL" or "increase shear forces" is false. Research has shown that walking and squatting induces more shear forces on the ACL than leg extensions. So should we stop walking and sitting on the toilet?
It also brings up the point, is shear bad? Too much shear causes bones to break, muscles to tear, and ligaments to tear. But the right amount of shear causes all of those to get stronger, its called going to the gym. So we need to expose the ACL to shear forces if we expect to get back to things like running and cutting.
All of that said, SL leg extensions are one of the best exercises you can do for the quads because they do not allow you to cheat. I love squats and split squats and i think you should do them, BUT it is much easier to compensate and not actually load the quad during those exercises. The leg extension leaves you no choice and exposes your weaknesses.
That is how I normally progress some one with their quad strength. Obviously we will also be doing lots of squats, split squats, and there variations.
Hope this helps! See you next time!
BIG CAT OUT🦁