This blog is for those who had ACL Reconstruction surgery. It discusses why we do the squats and deadlift as tools in addressing Post ACL Reconstruction cases. Readers looking for detailed discussion about the mechanism of injury, anatomy of the knee, and types of surgical intervention are advised to look into other sources since this would be outside the scope of this short blog. This NOT a guideline. For those who plan NOT to have ACL tear, read on too. Other related blogs will be posted soon.
Options in managing Post ACL Reconstruction
If the ACL is torn, the athlete/ patient has two options: either to have a conservative approach or to undergo surgery. The conservative approach means the knee would still be unstable. It may be ok to have this option if there are no other associated structures in the knee which were damaged and there is minimal instability. After a thorough discussion with their surgeon, athletes or patients who plan not be physically active anymore, may choose this option. The surgical intervention option presents the athlete with a more stable knee. Every procedure entails risk, and granting that there are no secondary complications, most of the outcome would depend on how well the surgical intervention was able to restore the previous function of the torn ACL. The rehab that follows as well as any strength training that follows later, would work on the foundation established by the success of the surgery. But no amount of Strength Training would change the knee anatomy into a very efficient and stable knee. It cannot change the inherent knee anatomy, the Q angle, patellar angle, etc. Strength Training and Conditioning, if done well, would serve to strengthen the knee – the structures that make up the joint, and the muscles that move it. A much stronger knee is more able to resist high amount of forces. Strong and powerful lower limb musculature enables the limb to generate sufficient amount of force repeatedly when needed. An appropriate conditioning work would enable the athlete to sustain a high amount of work before fatigue sets in. Fatigue affects the quality of movement and the crucial split second decisions in the playing field. If the athlete is physically prepared with a good strength training and conditioning program, he or she is able to resist fatigue better and able to absorb and deflect impact forces more efficiently. This lessens the chances of re-injury. It does not take away pain, but if the knee functions well, if the running and jumping mechanics are more efficient, then the pain caused by small damages brought about by inefficient movement, would most likely be lesser. For both options, arthritic changes may soon manifest later in life. Weakness brought about by degenerative changes would be lesser too if the athlete invested in keeping himself/herself strong and fit in earlier years. This can be addressed by a good Strength and Conditioning training program.
After Physical Therapy (or Physiotherapy), a good Strength and Conditioning training program that addresses the particular needs of the athlete is imperative if the athlete is expected to perform better. In one case, the Strength and Conditioning training was started immediately when the athlete was discharged from the hospital. But of course, this was under the surgeon’s recommendation and the involved knee was not yet trained. Training prevented a sudden drop in fitness level while awaiting for the involved knee to recover enough. Most of the athletes who we worked with were able to resume normal training after 6 months. An exceptional athlete managed to go back to training and compete for their major competition in less than 6 months. And it is also worth mentioning that the Athlete, Surgeon, Physical Therapist, Strength and Conditioning Coach, other support staff, and the sports team were all working very well together in this particular case. It was a huge team effort. The effort paid off when the athlete and her team emerged as champions in that major competition.
Why Squats and Deadlift?
These two exercises are used to increase strength. They require some amount of technique, they use the whole body, and are ground based. Executing them requires coordinated movement of several major joints, and they require that the torso (or core as it is popularly termed especially in the commercial side) is in a good position, and is able to maintain a stable position under tension while the squatting or deadlift movement is completed. They require some amount of balance and a lot of proprioceptive awareness. They require a decent amount of mobility and flexibility, and they are fundamental movements. In short, the squat and deadlift are very useful and effective.
These are two main exercises that, when executed well with sufficient load and range of motion, would address a lot of issues. They may look plain and unsophisticated as compared to the standing on a pink balance disk while the other leg is hanging on a yellow TRX exercise, but they work. They require a lot of effort to do if a sufficient load with sufficient range of motion is used. That is one reason why they work.
What does the squat and the deadlift do?
A lot! Knee injuries happen when impact or landing forces are higher than what the knee can absorb and deflect. Training the body to be in a good position even under tension helps it to react in the same way under playing conditions. That is what squatting and deadlifting requires – the lifter to assume a good posture and stance before the lift, during the lift and after the lift. The squatting and deadlifting positions are very similar to almost all athletic movements. Squatting and deadlifting are done in a controlled environment and load. Granting that the lifting technique is good, and the load and range of motion is higher than what is usually encountered in the playing field, then athlete is able to keep up with the demands of his/her sport. That principle is what enables athletes, with repaired knees, perform very well upon returning to training and competition. Some of them even performed better after retraining probably due to better biomechanics ingrained in strength training.
Is it that simple?
Yes and no. Squats and deadlifts are complex exercises that takes time to learn. They do a lot for the athlete who wants to perform well after an ACL repair. If executed properly with sufficient load and range of motion, these two exercises do wonders. These two exercises address fundamental components which are usually wanting in injured and injury prone athletes. We do not need to look for very complicated exercises with fancy routines. All the other fancy exercises also have their uses but they can not replace the squat and deadlift. If squats and deadlifts make the main course, the other exercises are side dishes. Enjoy your meal!
Val R. Jr., PTRP, CSCS
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