ACL Case Study: What Needs To Be Strengthened?

This came to mind recently so I figured, why not write about it? I had a patient that was working to strengthen his leg and regain as much range of motion as possible before having an ACL reconstruction about one year ago. Much of our focus had been on strengthening his quadricep, as it was inhibited and considerably weakened due to his ACL having been ruptured, and regaining knee extension range of motion. Slowly, but surely, after 4 sessions, he was walking with just one crutch outdoors and felt confidently that he would meet his goal of being able to walk his daughter down the aisle at her wedding at the end of the month without crutches! 

It’s just that, he was working with a personal trainer who, though well-intentioned, had a different viewpoint on movement than I--which is fine if no harm is being done, but it does raise the question: what NEEDS to be part of the patient’s program and what MIGHT BE NICE to be included?

This patient’s personal trainer is genuinely an intelligent person and clearly demonstrates the appropriate level of empathy for his well being.  At the same time, the patient told me that she had recommended he do clamshells to “make him more stable while walking”. Nice segway into isolating muscles and how that might translate to function. For those of you who may be unaware of what a clamshell exercise is, picture yourself lying on your side with your knees bent and feet touching. You would then raise one knee toward the ceiling and feel work occurring in your glutes. Sure. Our glutes are key stabilizers for our legs while walking so, theoretically, this could help. BUT. Why not just strengthen the glutes while standing up if the patient is capable (which he is)?

That’s where I lie on this side of the debate. 

IF a weak muscle is contributing to your symptoms or movement inefficiency, strengthen it! IF it is not, you don’t need to touch it! In this case, if this person’s gluteus maximus and medius aren’t weak, why should I focus on isolating hip abductors or extensors? What I would do is focus on the activities in which this person is either feeling pain or experiencing difficulty in movement. Irrespective of which muscles are being targeted (which I understand, obviously), the emphasis should be on restoring movement patterns as a whole instead of targeting theoretical muscle groups that MAY be involved in said patterns. 

But hey. There is nothing wrong with getting stronger overall! Having an approach is better than none! I will always agree with that!