🦀 PT Crab Issue 93 - Fall, Sit, Squat.

Hey y’all. I just want to say, May the 4th be with you, and that I’m finally getting caught up on the Star Wars movies. I’ve heard a lot of salty takes on the most recent three and they have their flaws (I hate angsty stuff and hoo-boy Kylo is angsty) but I just watched The Last Jedi and I’ve gotta say it’s pretty good. No takes on The Rise of Skywalker yet though, as I’m yet to see it. Maybe this weekend, who knows?

In other, more pertinent news, this week’s article is about what pre-op exercise does for ACLR rehab. It’s a systematic review that I systematically review and you can systematically review it as well as long as we all have our systems. Ummm, sure. I guess that works.

King Crab supporters got two more articles this week, as usual. One on geriatric fall prediction based on medication status and a second on the cognitive differences between 6 month olds who can sit and those who can’t. Become a supporter by subscribing here. It keeps PT Crab going, is just $5 per month, and marks you down officially as a wonderful person.

Pre-Op Quads for ACLR? IDK

The Gist - This systematic review from the Journal of Physical Therapy in Sport wanted to see what effect pre-op quads exercises had on ACLR outcomes. They found 10 studies to work from, 6 randomized and four prospective, leaving an overall level of evidence as “limited”. The pre-op exercise programs focused on the quads in a heterogeneic way, with the majority using isotonic (e.g. normal) exercises with leg press, knee extension, and leg curls as the common ones. They all used some form of OKC exercise as well but varied in intensity, range, etc. They also differed in duration, with some as short as 5 weeks and others as long as 16.

Overall, the collection of studies showed that quad strength did increase in basically all exercise conditions (duh, cuz exercise), but there’s limited evidence that this increase in strength improved ACL rehab. A couple of the studies showed that the increased quad strength carried over to 12 and even 24 weeks post-surgery, but there’s not a wealth of evidence to say that it’s useful for the rehab process. This doesn’t mean it’s not, but we don’t technically know yet. The evidence level is “poor” according to these reviewers. But check out the individual studies for more detail.

Tell Me More - Or I suppose you could look here for the detail, I guess. One detail annoyingly missing is any discussion of adverse events, you’d have to look at individual studies for that, the reviewers didn’t stick them in. Speaking on the whole, there were a total of 457 participants in the studies, with 303 identified as male and 134 female aged anywhere from 15 to 57. From here, I’m just going to grab interesting bits from the studies that the authors highlight:

Hartigan et al. (2009) measured quadriceps MVIC at baseline before randomising 10 sessions of quadriceps strength and additional perturbation exercise and again 6 months post ACLR. Data show quadriceps strength increased significantly (p = 0.002) post ACLR compared to baseline in both groups.

Kim et al. (2015) reported significant (p = 0.033) quadriceps peak torque increases 3 months post ACLR in the preoperative group compared to the no-preoperative group. No data were recorded after the 4 week preoperative intervention prior to ACLR.

Shaarani et al. (2013) measured quadriceps peak torque before, after 6 weeks of preoperative intervention and 12 weeks post ACLR. Data show both intervention and control groups significantly improved quadricep peak torque during the preoperative period, but no between group difference over any time point was shown

Those quotes above show the mix that we’re working with. Two ups, one neutral, and there are 7 others to choose from too. If you’re treating ACLs, this paper is a goldmine for other related articles, so do check out the collected studies and references for more.

Paper? Yupp.

And that’s the week! Do continue to share PT Crab with friends, colleagues, frenemies, work-wives, work-husbands, distant crushes, and that one PT who’s just always there. We all know that person. Why are they always working late? Do they like it? Are they bad at documentation? Do they have trouble at home? Are they actually just streaming Star Wars on their work laptop all time time? Why don’t you ask them? And mention PT Crab while you’re doing it. I appreciate you.

Bye!

Here’s this week’s bibliography:

• Potts, G., Reid, D., & Larmer, P. (2022). The effectiveness of preoperative exercise programmes on quadriceps strength prior to and following anterior cruciate ligament (ACL) reconstruction: A systematic review. Physical Therapy in Sport, 54, 16–28. https://doi.org/10.1016/j.ptsp.2021.12.004