Who’s afraid of the big bad wolf? Open-chain exercises after anterior cruciate ligament reconstruction

Review written by Dr Christina Le info

Key Points

  1. Open-chain exercises are safe to perform after an ACL injury or ACL reconstruction.
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BACKGROUND & OBJECTIVE

Raise your hand if you were taught at university that prescribing open (kinetic) chain exercises for a patient fresh after an anterior cruciate ligament (ACL) reconstruction was an absolute no-no. Raise your hand if you believed it to be true and, for at least some period of time as a physiotherapist, you haven’t prescribed an open-chain exercise to a post-operative ACL patient.

If you’re anything like me, you raised your hand and didn’t put it down. If you’re anything like me, you stuck to closed-chain exercises exclusively for part of your career.

We know that quads are queen. Increased quadriceps strength is associated with better self-reported outcomes, return to sport, and mitigation or prevention of knee osteoarthritis (1). What is an effective way of targeting the quads? Open-chain exercise.

This viewpoint paper challenges the two most commonly cited arguments against open-chain exercises and highlights the potential benefit of incorporating them into your ACL rehabilitation programs.

Increased quadriceps strength is associated with better self-reported outcomes, return to sport, and mitigation or prevention of knee osteoarthritis.
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Walking produces 2-3 times the strain on the ACL compared to an open-chain leg extension exercise.

MYTH I: OPEN-CHAIN EXERCISES STRETCH ACL GRAFTS

You may have heard this one before: doing open-chain exercises places undue strain on the ACL and inevitably will result in a loose graft. But did you know that walking produces 2-3 times the strain on the ACL compared to

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