If you're feeling your way through the ACL prehab process, you may have heard a few goals to strive for before heading into surgery from your doctor. These often include:
- Normal gait
- Knee extension range of motion = 0°
- Knee flexion range of motion at least 120°
- Perform 20 straight leg raises with no lag
- Minimal effusion/swelling
Hitting these goals WILL put you in a much better position than if you were to avoid prehab altogether. However, much more can be achieved during the prehab phase.
The overarching goal we recommend is to get yourself as close to 100% as possible before surgery. Doing so will:
- Increase your chances of an optimal recovery on the back end
- Increase confidence heading into surgery (which also plays a role in recovery)
- Potentially set you up to have a conversation with your doctor about whether you even NEED surgery
What Would Heading Into Surgery Close To 100% Really Look Like?
If we're truly beginning the prehab process with the end goal in mind, here are the targets we would strive to hit.
Note: Some of what you can and cannot do may be dictated by your doctor or physical therapist — always stay within their recommendations. Additionally, you may not hit all of these ACL prehab goals before surgery, and that's okay. But as they say: if you shoot for the moon and miss, you'll land upon the stars.
Full Range of Motion
Not just 120° of flexion and 0° extension — FULL flexion. Ideally, you can bend and straighten the injured knee as far as the non-injured knee. This is one of the basics, but being at 100% means achieving complete symmetry.
No Swelling
Your knee should have minimal to no swelling. Persistent swelling indicates inflammation and can inhibit muscle activation, particularly in the quadriceps.
No Pain
You should be able to perform daily activities and exercises without pain. Some discomfort during challenging exercises is normal, but sharp or persistent pain is not.
Ability To Activate The Quad
After an ACL injury, your nervous system shuts down your quad. You need to be able to voluntarily contract your quad muscle without compensation. This is critical for post-op recovery.
Strength
Your injured quadricep and hamstring should be at least 90% as strong as the opposite leg. This can be measured using a Biodex or dynamometer at your PT clinic. If you haven't chosen a PT yet, search for a clinic that has a Biodex isokinetic testing system.
Hop Tests
A series of hop tests can assess how confident your body is in using the injured leg in dynamic, explosive movements, as well as test landing form and balance. Target at least 90% symmetry from side to side with these tests.
Lack Of Compensation
After an ACL injury, the body finds all different kinds of ways to compensate to try to reduce stress on the affected knee. When you are at or close to 100%, those compensations will no longer be present. A trained eye and a few simple exercises can help determine if your body is still compensating.
Full Confidence
If you've hit each of the goals above, it's likely that you're feeling pretty confident again on the injured knee. Your attitude heading into surgery can be a predictor of how successful you'll be with recovery AFTER surgery. Your confidence can be measured using the ACL-RSI questionnaire. Generally, a score of 80-90% is considered consistent with an athlete who does not have a knee condition.
Most people don't hit all 8 of these goals before surgery. But the closer you get, the better your post-op recovery will be. Even hitting 5-6 of these puts you ahead of 90% of people going into ACL surgery.
How Do You Hit These Goals?
Hitting these prehab goals requires:
- Consistency - Daily work, not just 2-3 PT sessions per week
- Expert guidance - A PT or trainer who understands high-level prehab
- Technology - Tools like the Volta X to accelerate muscle activation and ROM
- Mindset - Belief that you can get back to 100% before surgery
The Accelerate ACL program is designed specifically to help athletes hit these 8 goals before surgery. Using the Volta X and virtual training, clients typically see 25% improvement per session.
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