3 Months Post-Op… Still Not 100% Straight

Inspiration for these posts comes from the questions we receive from clients, those of you on our email list, and the social media support groups we help out with (Facebook and Reddit). These are excellent communities and we highly recommend getting involved during your recovery process.

This week an athlete posted the following on the ACL subreddit.

“I am now 3 months post-allograft surgery and I am still struggling to get fully straight (my right leg also hyperextends). I’m about +1 or 2 now and I need to be at least -1. All else is great. PT keeps working my extension on stretches but I am REALLY starting to suspect it’s my quad strength NOT my flexibility. Did anyone else have this problem with quad weakness leading to a bend?”

The answer to this question is yes, quad weakness (or inhibition) can lead to a slight bend in the knee.  As we laid out here, the quad and hamstring must work together in order to straighten the knee.  The hamstring must eccentrically contract (lengthen), and the quad must concentrically contract (shorten).  If either is not happening to the degree it needs to happen, you’ll end up with a bend in the knee.

As I alluded to above, it isn’t necessarily quad weakness causing the problem, but could also be quad inhibition.  After an ACL injury, the brain immediately shuts down (or inhibits) quad activation. During recovery, it’s your job to convince the brain to turn it back on.

Here’s a quick 3 minute exercise we recommend doing to assess if your quad is a primary reason for not being able to get into full extension AND start re-building the neuromuscular connections to the quad.

Sit on the ground with your legs straight out in front of you. Contract the quad as hard as you can in your non-ACL leg to straighten the knee. Use your hands to feel the vastus medialis (VMO) and vastus lateralis (VL) contract (these are the quad muscles just above your knee on the inner and outer side).  By adding the hands and sense of touch, you’ll give the brain another avenue by which to locate and re-build connections.

Try to connect your brain to what that contraction feels like on the non-ACL leg. Once you have a good feeling of what that contraction feels like, do the same on your ACL leg. Use your hands to feel the VMO and VL – are you getting as strong of a contraction?

If not, spend some time each day trying to “re-connect” your brain to contracting these muscles, using your hands and sense of touch as a guide. When you find the contraction, time how long you can hold it, and see if you can build on it each day.

Once you get really good at “finding” these muscles in the seated position (and hopefully getting to full extension), transition to a standing position and try the exercise in the article highlighted above, which will help you find the quads in standing position and hip hinge (a bigger challenge than seated).

If you’re still having trouble contracting the muscles needed to get the knee straight, it’s possible that an extra boost to the process could help. Using Accelerate ACL protocols, you can quickly identify the exact muscles inhibiting your range of motion.  Once identified, you can stimulate those muscles while working to straighten the knee, which helps to re-build the neuromuscular connections at more efficient rate.  All of this can be experienced within a 2 day trial, which you can apply for here.