OKC exercises for ACL-R

[Taylor Blattenberger]

Short viewpoint piece from this month’s JOSPT. Funny enough, I was talking to my student about this practice pattern last week so I jumped to read it when I saw the cover.

Did you guys learn not to use OKC quad exercises for pt post-ACL-R?

Is that still how you practice now?

Does this change your practice pattern?

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[awilson12]

I actually had just read this and sent it to my student yesterday to discuss as well! We have had this discussion many, many times throughout her clinical and I have shared a lot of evidence to challenge her fears and beliefs with the “big bad wolf” of OKC after ACL-R.

I definitely used to have the mindset of staying way clear of OKC b/c had that perception based on what we learned in school and also one of my CI’s was super adamant that no one, and especially post-op ACL patients, should be doing open chain knee extensions. So based on this I leaned towards the “house built of straw” side of things vs “house built of sticks” earlier on in my long 1 year career.

But after listening to various podcasts and reading different articles over the past year I definitely have started to implement OKC post-op as I feel like this is a great isolation exercise for the quads that is safe when progressed appropriately. So, this article itself doesn’t really change anything at this point because I have already changed my practice pattern but it does add support to the ways I have changed treatment.

I particularly like how this blog post talks about implementing OKC exercises and presents a lot of evidence behind her statements- https://www.nicolesurdykaphysio.com/2020/05/10/the-case-for-open-kinetic-chain-exercises-in-aclr-rehab/

[Kyle Feldman]

I would recommend listening to the JOSPT insights podcast episode 1 with Dr Lynn Snyder-Mackler.
She hits on this and other myths in the ACL rehab world.

The ACL rehab concepts are really changing. Hopefully the re-injury rate reduces with this change!

[Taylor Blattenberger]

Thanks for the recommendation Kyle! I’ll give that a listen.

Thanks for sharing Anna. That blog post definitely expounds on the “House of Straw” and the other forces present on the ACL. I think the fear of retear is probably the hardest thing to overcome in this discussion. The more we know about biomechanics the more ammo we have to combat this.

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