Talofa Samoa and welcome back to your weekly Physiotherapy column! Today’s column is by Oli Evans from Pro Sport Physio – enjoy!

Let me paint you a picture. A week ago, you attempted to change direction whilst playing football and felt something pop in your knee. You go down to the floor and you can already feel your knee start to swell up. You go to A&E and they rule out a fracture and tell you it’s likely a ligamentous/soft tissue injury and tell you to rest. 

You may have even gone to a physio who has told you that it is likely you may have ruptured your ACL, and we need further imaging. The MRI confirms this, and the knee specialist has told you that surgery may be the best option, but it may be a few weeks/months before they can operate. 

Now what do you do? Do you sit at home, avoid exercise and wait for the surgery knowing that you’ll get weaker by the day and that daily tasks that were already hard initially after the injury are still no better? Or do you go back to the physio and see if there is anything you can do in the meantime to build strength and get back some function? 

As you can imagine the latter is much more preferable. One of the biggest things to understand is that it is very realistic to be functional even if you have had an injury such as a full ACL rupture and there is no reason to suggest why you wouldn’t be able to get back in the gym and get strong again before you even have your operation! Within this blog today I want to go through the five non-negotiables before knee operations that will set you up for success post-op.

1. Reduce swelling

Depending on the severity of the injury you’ll likely get some swelling which may be restricting some of your range of movement. This will likely improve with time and can take time to settle but our first aim will be to reduce this as much as possible ASAP to help get the movement back in your knee to keep you functional. There are numerous ways we can help improve swelling other than icing and rest. Although rest is important in the initial stage to allow the body’s natural healing process to begin, your body also is designed to move and ensuring we perform exercises that the body is happy doing can be a fantastic way to achieve a ‘quiet knee’.

2. Restore the range of movement

Due to both pain and swelling your range of movement post-injury will likely be significantly reduced. Again, with sufficient rest, you will notice an increase in the range of movement quickly after injury. However, we will want to ensure we can get as much range of movement as possible before the operation (depending on severity) so that we can work efficiently on building strength and improving function in day-to-day tasks.

3. Increase muscle bulk

After your injury over the coming weeks, you’ll likely notice some reduced muscle bulk in your calves, hamstrings and quads. This is normal due to not regular use but is not necessarily something that you need to accept and can’t do anything about. In fact, ensuring that you have as much muscle bulk as possible before the operation and even trying to gain more muscle bulk than pre-injury will mean you will hopefully spend less time building it back up after surgery.

4. Increase strength

Strength is different to building muscle. Muscle hypertrophy (growing muscle) relates to the size of the muscle itself; strength refers to how much force we can apply to a certain muscle group. Both are as important to the other in terms of prehab. But similar to muscle bulk the stronger we get before the operation the less we’ll lose/have to focus on post-op!

5. Increase inter-muscular coordination

Get a good feel of what “good movement” feels like. After an injury such as an ACL rupture your body will feel incredibly unstable and very vulnerable in certain positions. This is normal due to a lack of physiological stability in the knee but again it is not something that you can’t do something about. If you introduce movements that involve good coordination between the foot, knee and hip into your routine now, it’ll help reassure your body that it can move in certain directions, and it doesn’t need to feel as unstable as it does. This will help improve function before the operation but will also help you postoperative when your body starts to re-learn some of the key movements it’s already developed.

• Eliana Viali is a Physiotherapist by profession and can be contacted at the following email address [email protected]