Prehabilitation ("prehab") before ACL surgery is a critical step in optimizing outcomes. It helps reduce swelling, restore range of motion, strengthen surrounding muscles, and mentally prepare for recovery.

Here's a detailed guide tailored for athletes:

Goals of ACL Prehabilitation

1. Reduce Swelling and Inflammation
   • Decrease joint stiffness and pain.
2. Restore Range of Motion (ROM)
   • Achieve full extension and as much flexion as possible.
3. Strengthen Key Muscles
   • Build strength in the quadriceps, hamstrings, glutes, and core to support the knee.
4. Enhance Balance and Proprioception
   • Prepare your body for post-surgery rehabilitation.
5. Mental Preparation
   • Boost resilience and confidence for recovery.

1. Manage Swelling and Inflammation

• Rest and Ice
  • Elevate the leg and apply ice packs (20 minutes on, 20 minutes off).
• Compression
  • Use an elastic bandage or compression sleeve to control swelling.
• Anti-Inflammatory Measures
  • Follow your physician’s advice for medications like NSAIDs.

2. Restore Range of Motion (ROM)

• Heel Slides
  • Lie on your back. Slide your heel toward your buttocks, bending the knee as far as possible without pain. Slowly return to the starting position.
• Passive Knee Extensions
  • Sit on a chair or table with your heel supported and allow the knee to straighten fully. Use a small weight for gentle overpressure if needed.
• Calf Stretch
  • Stretch the calf muscles to promote knee extension.

3. Strengthen Key Muscles

Quadriceps

• Straight Leg Raises
  • Tighten your quad with the knee straight. Lift your leg a few inches, hold, and lower slowly.
• Quad Sets
  • Sit or lie with your leg extended. Tighten the quad to push the knee toward the ground. Hold for 5 seconds.

Hamstrings

• Hamstring Curls
  • Lie on your stomach and bring your heel toward your buttocks, keeping the movement slow and controlled.

Glutes

• Bridges
  • Lie on your back with knees bent. Lift your hips, squeezing the glutes at the top, and lower slowly.

Core

• Planks
  • Hold a plank position, focusing on a tight core and straight body alignment.

4. Improve Balance and Proprioception

• Single-Leg Stands
  • Stand on your injured leg, using support if needed. Progress by removing support or closing your eyes.
• Balance Board Work
  • Use a balance board to challenge stability.

5. Maintain Cardiovascular Fitness

• Low-Impact Activities
  • Swimming or upper-body-focused cardio (e.g., rowing machine or stationary bike without resistance) can keep you fit without stressing the knee.

6. Prepare Mentally

• Set Goals
  • Break recovery into manageable stages, such as regaining motion, walking, and eventually returning to sport.
• Mindfulness Practices
  • Use visualization techniques to picture successful recovery and performance.
• Educate Yourself
  • Learn about the surgical process and post-op rehab to reduce anxiety.

Sample Prehab Routine (3-5x Per Week)

Warm-Up (5-10 minutes):

• Light cycling (no resistance) or arm ergometer.

Strength Training (15-20 minutes):

1. Straight Leg Raises (3 sets of 10).
2. Quad Sets (3 sets of 15).
3. Hamstring Curls (3 sets of 10).
4. Bridges (3 sets of 10).

Range of Motion (10 minutes):

1. Heel Slides (2 sets of 10).
2. Passive Knee Extensions (hold for 30 seconds x 3).

Balance (5-10 minutes):

1. Single-Leg Stands (3 rounds of 30 seconds).
2. Balance Board Work (3 rounds of 30 seconds).

Cool-Down (5-10 minutes):

• Stretching (focus on hamstrings, quads, and calves).

Consult Your Surgeon or Physical Therapist

• Always tailor your prehab program to your specific injury and physician’s recommendations.
• Avoid activities that cause sharp pain, instability, or swelling.

By focusing on prehab, you’ll enter surgery stronger, more prepared, and set up for a smoother recovery process!