Ask Dr. Skendzel: Can pre-surgical therapy improve my ACL surgical outcome?

We know that physical therapy after joint surgery is a critical part of the recovery process, but can therapy before surgery also improve our recovery?

ACL Therapy

When a knee injury requires surgery, every patient wants the best outcome possible. Accurate injury diagnosis, surgical skill, and post-surgical therapy are critical to regaining knee function after an ACL reconstruction; but what about pre-surgical ACL therapy? Are there steps patients can take in advance of their surgery to improve their outcome?

“The number one complication after an ACL reconstruction is a stiff knee,” explains Dr. Skendzel. “We know that having good motion before the ACL is repaired and reconstructed predicts post-operative motion. If a patient goes into surgery with impaired motion, there’s a higher chance that they’ll have poor motion after surgery.”

Benefit of ACL therapy before surgery

“An ACL injury inflames the knee,” he continues. “Within a day of the injury, the knee gets stiff and patients may have a difficult time fully bend or straighten the leg. This is why we’ll often work with a therapist to improve the knee’s range of motion before we operate. Surgery is invasive by nature—it adds insult to the already injured knee.”

Building strong quads

Maximizing quadriceps strength prior to surgery is equally important. “The quadriceps muscle shuts down significantly after any type of knee injury,” Dr. Skendzel explains. “After ACL surgery, the quad just doesn’t want to work. It atrophies quickly following the triple assault of injury, inflammation, and surgery.”

Patients have a number of options to strengthen the quadriceps before they undergo surgery. “Resistance biking on an upright stationery bike is one of the best things you can do to build or regain quadriceps strength,” says Dr. Skendzel. “Isometrics exercises are also great.”

What the research shows

“The data regarding the effect of pre-surgical therapy on recovery times and outcomes varies,” says Dr. Skendzel, “but there’s no question that commitment to a regular therapy program with a skilled therapist is key to optimal patient outcomes. For most motivated patients, success relies on a combination of ACL therapy sessions and therapist-guided exercises that patients can do at home between therapy visits. Regaining knee function takes work, but we are guiding our patients every step of the way to help them to the best possible outcome.”

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  • Jack Skendzel, M.D.

    “An active lifestyle requires superior physical function, and I understand that my patients have exceptionally high standards for their performance and joint health. My goal is to return patients to optimal function so that they can continue to perform and master their personal athletic goals.”

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  • Heide Baker, DPT

    “Our bodies are designed for movement. Keep moving, focus on improving posture and reducing stress.”

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  • Katelyn Bauer, PT, DPT

    “Listen to your body, if you experience pain and it continues to worsen with certain movements/activities, you probably shouldn’t be doing it. Do not prolong going to see a doctor when injured, the longer you let an injury go, the longer it takes to get better.”

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  • Paul Hendrickson, PT

    “Life has its many challenges; ‘it is what it is.’ So live life with less worry, follow your instincts and pursue what you love in life.”

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  • Cassie Erickson, PT, DPT

    “I respect how an active and healthy lifestyle is important to not only our physical health, but mental health as well, and I strive to help patients return to their regular activities as quickly and as safely as possible. I don’t always believe in the “No pain, no gain” mentality. It is important to be able to identify and distinguish between “good” pain and “bad” pain when it comes to exercise and rehab.”

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