Straight Leg Raise after ACL surgery

[physiobob]

Firstly some of your English words don't make sense in your post, which make it hard to get what you are saying.

Secondly, why would you choose to do a SLR exercise for an ACL (or for any problem really). Is the psoas dysfunctional? When does any body perform the action of an SLR? Maybe a dancer or Australia football player but that would be in standing.

The SLR is an over-used and mostly inappropriate exercise for just about anything I can think of. Always ask your self why you are doing an exercise. Then ask is that a problem the person has? Then ask are you doing it in a functional way that is relevant to that joint or in the way that synergy of muscles is used. The SLR is basically a waste of time!

[xplando]

I dont agree with the latter! I find the SLR (30 degrees of hip flexion) to work in a wonderful manner. that's because ur emphasizing the quadriceps to work in that range (not more than 30 degrees because u'll be recruting the hip flexors then) thus strengthening them in that range which is a good thing to do since we all know that during heel strike of gait , there is around 30 degrees of hip flexion with the knee locked. So, yes its a functional exercise in a way!

[vaibhav yadav]

SLR!!!& ACL!!!! big names bt cannot understnd y so much small to discuss abt it!!!!

after acl........... xercises depend upon the progresss n stage of tear............u want to strengthen quads....y don't u try it passively thrugh isometrics.........

SLR prevent adhesions during immobilization.............bt only do it in a cast..........if u r fond of it...............

[physiobob]

I dont agree with the latter! I find the SLR (30 degrees of hip flexion) to work in a wonderful manner. that's because ur emphasizing the quadriceps to work in that range (not more than 30 degrees because you'll be recruiting the hip flexors then) thus strengthening them in that range which is a good thing to do since we all know that during heel strike of gait , there is around 30 degrees of hip flexion with the knee locked. So, yes its a functional exercise in a way!

Don't really agree and perhaps there are better exercises than a SLR that don't have a much of an impact on the lumbar spine.

Firstly the actual Straight Leg Raise (SLR) is not a functional movement, especially in supine lying. As the primary focus on that exercise is hip flexion are we saying that post of ACL patients have weak hip flexors? Didn't we just operate on their knees?

By locking the knee in extension and lifting the leg you are using the psoas, iliacus, perhaps sartorius (balanced by some adductors to stop external rotation), and the rectus femoris. Hopefully some abdominals are working as well. Of course the other quads are working to keep the knee at zero extension. Are the quads weak? If so why? or is there an extension lag? If so is that due to weak quads? Unlikely. Is it due to inhibition? Maybe. For some reason perhaps there is a lack of connection to switch the inner range quads on, perhaps for good reason.

Importantly does the knee passively make it to full extension? Maybe hamstrings are blocking that. Prone knee flexion with eccentric lowering back int extension is useful to assist with that in the early period post op.

Activity wise standing up to a straight knee position would be more functional than a SLR exercise. In fact I though we did away with open chain exercise a long time ago for functional rehabilitation. (That's not to say they don't have a place some of the time).

Why not put them on an exercise bike to get the quads firing up. Yes this in in a certain range but then if they are inhibited rather than weak then that's fine. I'd really like to hear from someone who has a clear rationale for the SLR in relation to what there are trying to achieve with it. For my mind I'd rather than walk a few lengths of the corridor than doing 2-3 sets of SLR's on the plinth or in bed.

p.s The swing phase of gait to heel strike is a largely a passive activity and does not require a strong hip flexor. As the yield of the keen is what happens on that heel strike the hip flexor isn't going to be much us. The quads of course are but surely walking again would be the solution there.