Exercise Program for Patients with ACL Injury

A 5-week progressive exercise

therapy program leads to significant improvement in knee function after ACL injury.

   The aim of the study is the 5-week exercise program therapy to optimize the knee function of patients after an ACL injury. In this study Eitzen et al(2010) wanted to assess changes in isokinetic quadriceps and hamstrings muscle quality with single-leg jump tests and self-assessment of knee work from pretest to post-test after completion of the workout treatment program counting potential contrast between patients classified as potential copers and noncopers Eitzen et al(2010). Another aim of the study of Eitzen et al(2010) was to look at the potential hazard of adverse events for such an serious program in the early stage. First of all, patients with ACL injury completing a 5-week a dynamic work out therapy program within the early stage after injury would essentially move forward to improve knee function assessed from isokinetic muscle strength test to single-leg hop tests and self-assessment surveys. Secondly Eitzen et al (2010) at first patients that have been classified as noncopers would improve knee function surveyed from isokinetic muscle quality tests, single leg jump tests and self-assessment questionnaires essentially more than subjects classified as potential copers. Also Eitzen et al (2010) mentioned that early after injury, patients with ACL rupture would endure a progressive workout treatment without adverse events.
   As Granal et al (2009) supported the research due to contrasting clinical practice within the administration of anterior cruciate ligaments of ACL ruptures because there is no universal agreement as to what the perfect treatment calculation for people with ACL injuries. Granal et al(2009) find out threw his researches with his clinic outpatients  that the general recommendation to people with an acute ACL injury have to go through 10 sessions of progressive workout therapy program for a period of 5 weeks after the initial disabilities are settled . before the final choice is made for either ACL reconstruction or further no operative management is made. This is often suggested for autonomous of whether patients are classified as potential copers or noncopers. Granal et al (2009) mentions that potential copers are characterized as having great knee steadiness and the capacity to compensate well after injury, while noncopers have poor knee steadiness and less potential for emolument.
  In the research, because scientists of the clinic had many contradictions they divided the ACL rehabilitation program into 3 subsequent phases. In phase 1 the main goal as Eitzen et al (2010) we see form the research is to resolve knee impairments related to swelling and ROM .As before long as Full ROM have been re-established  and knee joints have been dispended Phase 2 started. As Mangunssen et al (2010) the essential point of stage 2 is to adequate neuromuscular reactions and recover the re-establish muscle strength. Thus, the second stage emphasizes seriously into progressed neuromuscular exercises muscle strength training and plyometric exercises .Since particular evidence-based guidelines for strength work out in the early stage after ACL injuries do not exist. Patients that are between the age of 13 and 60 will participate frequently in pivoting sports to do researches in muscle strength and neuromuscular joint and the patients have to visit the clinic twice a week for the support and the training program .After the progressive 5 week training therapy programme. Patients will go through posttesting and a final decision will be taken if surgery is needed .But the majority of the patients want to return to pivoting sports training.

  Scientists found that the 5 week progressive work out treatment program has many benefits in ACL knee injuries. Because they were different treatment programs that include neuromuscular exercises and strength training. As  Eitzen et al(2010) found that from this program you can  achieve significant improvements in muscle strength and knee function even if a patient does our therapy program even for a short time there are copers that prove that there is improvements in knee function.

As Gerber et al(2007) found from 7 studies that there is no significant difference in eccentric quadriceps exercises and the duration of the programmes was between 6-12 months and the patients were training 2-3 times per week. Gerber et al(2007) however said that if the patient is training more times per week of course there will be more beneficial progress in quadriceps strength and neuromuscular improvements. But Grerber et al(2007) found that 4 of these studies applied different training programs that included (eccentric, isometric and isotonic types of training).The eccentric exercises as was shown are more effective for quadriceps strengthening after an ACL injury and as Gerber et al(2007) said quadriceps strength is an important variable for improving knee function. Isotonic strength work out have more like to perform  the neuromuscular training had better results as measurement’s for the speed and ROM  .Greater relative changes were made in isokinetic torque compared to the strength training group. We cannot relate all this studies together because all of these studies were made with different number of patient’s different methods, small number of studies were made.
   Single legged jump tests are utilized useful to do performance measurements that can capture limb asymmetries in patients that have anterior cruciate ligament (ACL) injury. As Noyes et al researched there are 4 single hop tests (Single hop, cross over, triple hop and 6m times hop ). The research that Noyes did was a process of test but at the end, there was a form with 18 questions in which the total scores of each of these sheets will have a percentage based on the answers and the highest the score gets it represents the better knee function and less symptoms. This was the deference because it was self-reported outcome measure that was 1-year therapy program. As Noyes said, the purpose of the investigation was to see if preoperative and postoperative single-legged hop tests predict the self-reported knee function. Eitzen et al found that the preoperative triple hop test predicts the knee function 2 years after the reconstruction. In this manner Eitzen et al researched the impacts of a stabilization strategies such as ACL reconstruction may affect which hop tests predict knee functions.

  We should all understand that many ACL injuries are something important that all we should take part on how to find a solution on how to prevent the injuries and how we should treat the patients with ACL injuries. We might think that a surgery will restore our function and knee facilitate will return to normal levels of activity in any case, returning to preinjury levels or go back to sport may be a short term objective after reconstruction. Patients may decrease their movement levels for a variety of reasons (having knee issues or even having the fear of reinjury. We should take the seriously already in United States of America there are more than 125,000 ACL reconstructions performs. Many clinics, Universities and organisations are trying to optimise of current rehabilitation may moreover constitute instructions, also including an external focus. During rehabilitation enhance motor learning and in turn may be more effective over internal focus instructions reacquire typical development patterns after ACL reconstructions. This rehabilitation program can have impact in the first 5 weeks of the training program. The compliance and tolerance for finding the best training program was high with few also unfavourable events also happening. All this studies and researches learned me that there is a solution to prevent the ACL injuries but also to raise a program that can fit to the patient’s   needs. Because ACL injuries can also happen to people that are not athletes and Scientists and doctors give different training programs to each patient .

References:

1. Eitzen, I., Moksnes, H., Snyder-Mackler, L., & Risberg, M. (2010). A Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury. Journal Of Orthopaedic & Sports Physical Therapy, 40(11), 705-721. doi: 10.2519/jospt.2010.3345
2. Granan, L., Bahr, R., Lie, S. A., & Engebretsen, L. (2009). Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: A cohort study based on the norwegian national knee ligament registry. The American Journal of Sports Medicine, 37(5), 955-961. doi:10.1177/03635465083301
3. 3. Magnussen RA, Granan LP, Dunn WR, et al. Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway. Knee Surg Sports Traumatol Arthrosc.2010;18: 98– 105.http://dx.doi.org/10.1007/S00167-009-0919-5
4. Gerber JP, Marcus RL, Dibble LE, Greis PE, Burks RT, Lastayo PC (2007) Safety, feasibility, and efficacy of negative work exercise via eccentric muscle activity following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 37(1):10–18
5. Anderson, AF, Irrgang, JJ, Kocher, MS, Mann, BJ, Harrast, JJ. The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med. 2006;34(1):128-135. 
6. Noyes, FR, Barber, SD, Mangine, RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19(5):513-518. 
7. Eitzen, I, Holm, I, Risberg, MA. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009;43(5):371-376.