Hydrotherapy in ACL Rehabilitation
Original Editor - Falcone Tseng
Top Contributors - Falcone Tseng, Chloe Waller, Kim Jackson and Wanda van Niekerk
Introduction:[edit | edit source]
Aquatherapy and Hydrotherapy are terms used interchangeably to indicate a modality of treatment performed in an aquatic environment. This page will attempt to assimilate the current literature for incorporating hydrotherapy into conventional rehabilitation of Anterior Cruciate Ligament (ACL) Injury, conservatively or alongside Anterior Cruciate Ligament (ACL) Reconstruction (ACLR).
Outcome measures of ACL rehabilitation:[edit | edit source]
- Instability episodes [1]
- Pain [1]
- Issues with:
- Swelling, walking, climbing, stairs, kneeling, squatting, running, lateral motion, cutting, jumping [1]
- Measures of knee function:
- Graft rupture (post-ACLR only) [3]
- Contralateral ACL injury [3]
- Lachman and pivot-shift [4]
- Passive range of motion (knee flexion & extension), muscle strength, thigh circumference (thigh girth, thigh muscle mass, knee joint swelling) [5][6]
- Active range of motion (knee flexion & extension) [7]
- 6 minute walk test (6MWT) [7]
Advantages of Hydrotherapy in ACL/R Rehabilitation[edit | edit source]
In principle:
- Early weightbearing [7]
- Postural and gait exercises in a supported environment [8]
- Water resistance induced muscular conditioning [8]
Outcomes of Hydrotherapy + Conventional Rehabilitation vs. Conventional Rehabilitation Only:
After 2 weeks post-ACLR, patients who underwent 3 weeks of combined hydrotherapy with conventional rehabilitation, had superior outcomes in proprioception, walking, muscle strength in the short and medium term, compared to participants exclusively in conventional rehabilitation programme [9]. Another trial found that ACLR patients placed through 9 weeks of aquatic rehabilitation immediately post-surgery had better clinical parameters in muscle strength and mass circumference, pain, swelling, and range of motion compared to those on land rehabilitation [5].
A smaller case study of 3 subjects demonstrated no risk of harm in utilizing hydrotherapy to accelerate rehabilitation of ACLR [7].
Considerations for ACL hydrotherapy rehabilitation design:
| Accelerated Hydrotherapy Programme [7] | |
|---|---|
| Goal: | Treatment: |
| Gait Retraining | Gait training |
| Quadriceps and hamstring strengthening | Closed kinetic chain exercises, Open kinematic chain exercises |
| Strengthening & endurance training | Running, Cycling, Deep-water running techniques |
| Hip and calf maintenance and strengthening | Hip exercises and calf raises, kicking and vertical kicking |
| Balance and proprioception (perturbation protocol) | Balance and proprioception exercises |
| Plyometric training | Jumping, running, shuttle runs, side steps with increased speed |
| Sports-specific rehabilitation | Agility exercises making use of a ball |
Video Examples of Hydrotherapy Protocols & Case Studies:[edit | edit source]
ACL Hydrotherapy Rehabilitation Progression Timeline, Principles, & Advantages - Hydroworx
Acute Partial ACL & PCL Injury in Male Recreational Basketball Player (conservative management) - Hydroworx
ACL-R Patellar Autograft (5.5 weeks post-op with regression) - Hydroworx
ACL-R in Female Soccer Goalie (4 weeks post-op with delayed rehabilitation) - Hydroworx
Unhappy Triad in Female Volleyball Player (8 weeks post-op) - Hydroworx
Gait Retraining and Lower Limb Mobility Exercises - Sports Med Mumbai
References:[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. The American journal of sports medicine. 2005 Mar;33(3):335-46.
- ↑ 2.0 2.1 Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. New England Journal of Medicine. 2010 Jul 22;363(4):331-42.
- ↑ 3.0 3.1 Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy. 2005 Aug 1;21(8):948-57.
- ↑ Kostogiannis I, Ageberg E, Neuman P, Dahlberg LE, Fridén T, Roos H. Clinically assessed knee joint laxity as a predictor for reconstruction after an anterior cruciate ligament injury: a prospective study of 100 patients treated with activity modification and rehabilitation. The American journal of sports medicine. 2008 Aug;36(8):1528-33.
- ↑ 5.0 5.1 Zamarioli A, Pezolato A, Mieli E, Shimano A. The significance of water rehabilitation in patients with anterior cruciate ligament reconstruction. Physiotherapy. 2008 Apr 1;16(2):3-6.
- ↑ Tovin BJ, Wolf SL, Greenfield BH, Crouse J, Woodfin BA. Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Physical Therapy. 1994 Aug 1;74(8):710-9.
- ↑ 7.0 7.1 7.2 7.3 7.4 Momberg BL, Louw Q, Crous L. Accelerated hydrotherapy and land-based rehabilitation in soccer players after anterior cruciate ligament reconstruction: a series of three single subject case studies. South African Journal of Sports Medicine. 2008 Dec 1;20(4):109-14.
- ↑ 8.0 8.1 Torres-Ronda L, i del Alcázar XS. The properties of water and their applications for training. Journal of human kinetics. 2014 Dec 1;44(1):237-48.
- ↑ Peultier-Celli L, Mainard D, Wein F, Paris N, Boisseau P, Ferry A, Gueguen R, Chary-Valckenaere I, Paysant J, Perrin P. Comparison of an innovative rehabilitation, combining reduced conventional rehabilitation with balneotherapy, and a conventional rehabilitation after anterior cruciate ligament reconstruction in athletes. Frontiers in surgery. 2017;4:61.
