A guest article by our expert Mirko Eckert about pre-rehabilitation (from sports therapy) or which exercises are the perfect way to prepare yourself for cruciate ligament surgery.
There are years to forget behind amateur soccer: Covid-19 game and training bans, power struggles within associations and a manageable perception of negative trends in amateur sports by associations.
And even now, after a long winter break, the day-to-day struggles of amateur teams continue seamlessly: Because as hard as coaches have tried after this break to make a smooth start to training and a meaningful increase in the workload for their team, there is currently a hail of injuries again.
Everything from muscle to ligament injuries is currently booming. Of course, this is not a finger pointing at the trainer. It is rather a problem that is due to this unspeakably long break and short preparation time.
Cruciate ligament injuries with an average downtime of nine months are particularly painful.
What is of great importance immediately after a knee injury: the right Pre-op training.
Injuries happen quickly, multifactorially and will never be completely avoided or foreseen in soccer. Coincidence and misfortune play a major role in accidents, even though a variety of injuries could certainly be prevented preventively. This is because around half of injuries in soccer occur without direct external force.
In our blog post, you will learn EVERYTHING you need to know as a soccer player to prepare yourself perfectly for surgery plus instructions on how to train before surgery for knee joint operations.
At just over 15%, the knee joint is in second place among the most common
Injured structures in men's soccer, directly behind mostly muscular-related hamstring injuries.
However, in terms of downtime, the knee joint is at the tip and is therefore the most serious type of injury. It's no wonder that it plays such an important role in sports therapy.
In particular, ruptures of the anterior cruciate ligament (ACL) are one of the most common and devastating forms of injury of all. Whereby women have a 2-8x higher risk of suffering an ACL rupture.
Surgical reconstruction of the ligament structure is the current standard for the treatment of ACL ruptures in physically active patients.
Only around a third of athletes are able to resume their sport without restrictions in the first year after a VKB reconstruction. In the case of a large number of injuries, athletes no longer reach their competitive level despite surgery - which often results in the end of their careers. That is exactly why pre-rehabilitation and proper training before surgery are so crucial.
Even though surgery is the standard treatment method for ACL rupture, you should always seek a second opinion. Each injury is different and should be evaluated individually. Conservative forms of therapy also show comparable long-term success.
However, active athletes usually cannot avoid orthopedic surgery. The condition of the knee, the surgical method and the accompanying injuries, such as a pinched meniscus, i.e. fundamentally determine the time between trauma and surgery.
Professional athletes are often operated on within 48 hours before swelling and inflammation have fully developed.
However, there is no clear evidence to date as to whether immediate surgery within the first 48 hours is superior in the long term to delayed surgery after four to six weeks.
In Popular Sports, Cruciate Ligaments are rarely operated on the next day anyway; waiting times for MRI and consultation hours until surgery often take a few weeks alone.
A supposed unnecessary extension of the rehabilitation period? Not necessarily. If you know how, you can use the time before surgery for pre-rehabilitation and get back on the pitch faster.
After all, surgery is an extreme procedure for the body. Prehabilitation (preha for short) therefore includes specific training in preparation for surgery, analogous to rehabilitation after surgery.
The better the training status of the muscles and tendon-ligament apparatus before surgery, the faster the rehabilitation process.
An operation is always associated with a loss of strength and functionality; the initial level before surgery decisively determines the condition afterwards.
Preoperative training can reduce post-operative muscle atrophy (muscle loss) and pain. Cruciate ligament plasty, unlike stitching the cruciate ligament together, can take six to eight weeks until surgery.
The waiting time until surgery shouldn't frustrate you, but motivate you. You can actively use the time and even promote overall rehabilitation.
Conservation and a low level of activity are counterproductive in this case.
Pre-op training also has hormonal and immunological benefits. In particular, patients with a higher risk profile due to lack of physical fitness benefit from prerehabilitation, but also athletes.
The timing of an orthopedic procedure is just one of many influencing factors, whether forced or deliberately chosen, a longer waiting period should not make you feel anxious.
Studies have shown that the combination of prehab and rehabilitation for cruciate ligament reconstructions resulted in significantly improved functioning and improved quality of life even after two years of post-op.
Compared to traditional rehabilitation.
The probability of returning to the original sport is therefore significantly higher as a result of pre-rehabilitation.
In addition, the preoperative strength of the quadriceps muscles (front of thigh) appears to be a decisive predictor of the functioning of the knee joint after surgery. Grindem et al. even recommend a
90 percent leg symmetry before cruciate ligamentoplasty (2015).
In addition, restrictions in mobility can have a negative impact on rehabilitation.
Not only during orthopedic procedures, but also during visceral surgery or chemotherapy and radiation therapy, a higher general state of fitness improves recovery and prevents side effects.
The overall state of fitness is a strong predictor of the outcome and prevention of complications of a wide range of surgical procedures.
This is achieved, among other things, by reducing bed rest and hospital stay
Since there is a reduced activity level despite active prerehabilitation, attention should also be paid to nutrition.
If the forced break leads to an increase in body weight, this can have adverse consequences.
An increased body mass index (BMI) also has a negative impact on your rehabilitation. The supply of nutrients to the organism is also very relevant for healing.
Preha can also have psychological and psychosocial benefits. Educational content that contributes to improving pain perception should also be integrated.
The clinical evidence on prerehabilitation is still in its infancy and shows mixed results all in all.
But the majority of study results show great, untapped potential. To date, there are no evidence-based therapeutic standards.
Professional prerehabilitation should be considered in future as a supplement to conventional rehabilitation in order to increase the functional results of a surgical procedure and to minimize risks.
Ideally, supervised and individual pre-rehabilitation takes place.
Physio and Sports Therapists or a Qualified Personal Trainer are the contact points for pre-rehabilitation.
Our B42 experts also support soccer players in their individual pre- and rehabilitation via our performance call.
However, if you do not have the means and options, you can also take initiative yourself.
In addition, both pre-rehabilitation and rehabilitation offer an excellent opportunity to implement long-term changes and optimization processes in lifestyle and training. Come back stronger!
The training should always be adapted to the patient's fitness level; the following exercises are aimed specifically at active athletes with knee trauma.
In general, the following applies:
• Move outside the painful area. A slightly uncomfortable feeling or a pull in the joint is okay, but shooting pain should be avoided per se.
• At the beginning, the movement amplitude may well be smaller than shown in the videos.
• You should also check your individual suitability for the exercises with your treating orthopedist or physiotherapist.
STAY FIT AND INJURY-FREE! With the B42 app for soccer players.
Your knee needs movement: we recommend daily training sessions; also possible several times a day (if symptoms worsen significantly, reduce the volume)
Complementary physiotherapy treatment is recommended
• Rub your knee with a towel over a large area with gentle pressure
• 1 set
• Work actively to extend the knee
1 set - 15-20 reps
• Active knee flexion and extension
• On smooth surfaces, it is a good idea to use a towel under your heel
1 set - 15-20 reps
• Try to get both knees to the ground; arm support is allowed
1 set - 5 repetitions per side - on both sides
• Here too, work into an active knee extension
• Choose the range of motion as large as your current mobility allows
1 set - 5 repetitions in each direction - on both sides
• One-legged stand with a slightly bent knee
• If your monopod doesn't challenge you enough, you can try with your eyes closed
1 set - 30 — 45 seconds per side - on both sides
• Lie on your back and place your hands on the lower Costal Arches
• Breathe deeply in and out exclusively through the nose
• Follow the rhythm 2-2-4-2 or 3-3-6-3 As a progression:
That means: Breathe in for 2 seconds — hold for 2 seconds — breathe out for 4 seconds — hold for 2 seconds
Perform the breathing technique for 5-10 minutes at a time
If the joint is largely swollen, (almost) complete extension and at least 90° flexion is possible, you can move on to phase 2.
In general, the following applies:
• Three training sessions per week with a break of approx. 48 hours
• Warm Up & Cool Down can still be completed (several times) a day
• Work actively to extend the knee
15-20 repetitions
• Here too, work into an active knee extension
• Then select the range of motion as large as your current mobility allows
5 Repetitions in Each Direction - on Both Sides
• Balance on one leg
• Then stretch the toes of the free foot as far as possible in the directions of an inverted Y
• The heel of the mainbone stays on the ground
3-4 repetitions in each direction - on both sides
All exercises are performed on both sides of the body to take advantage of the cross-education effect, a phenomenon in which one-sided training increases strength on the untrained side.
Start with 6-8 repetitions and increase progressively from training session to
training session.
If you have achieved 15 repetitions, you can add an additional weight
Use.
• Sit on a chair and now actively stretch your knee
• Hold the stretched position for 3 seconds
• Balance on one leg
• Now push the heel of the free foot as far back as possible, the supporting leg is slightly bent
• Then bring your knee forward-up and actively stretch your supporting leg
• Hand support is permitted if there are problems with balance control
• Get in a supine position and place one foot on the ground with your knee bent
• The opposite leg is lifted and actively raised towards the chest
• Then press your foot actively into the ground and lift your hip
• Hold the top position for a moment
Optionally, you can also train on a stationary bicycle ergometer.
In addition, it would be possible to increase the effectiveness of strengthening exercises using blood flow modulation/restriction.
• Lie on your back and place your hands on the lower Costal Arches
• Breathe deeply in and out exclusively through the nose
• Follow the rhythm 2-2-4-2 or 3-3-6-3 As a progression:
That means inhale for 2 seconds - hold for 2 seconds - exhale 4 seconds - hold for 2 seconds
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Rehab and prevention training for your team
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