Napoletan (1994) The effect of underwater treadmill exercise in rehabilitation of Surgical Anterior Cruciate Ligament Repair

Introduction to ACL Rehabilitation Challenges

The anterior cruciate ligament (ACL) rupture is a significant injury that can derail an athlete’s career. With advancements in surgical techniques and post-operative management, athletes have a viable path to return to competition. However, this path requires an intensive rehabilitation process. Traditional methods of plaster immobilization have been replaced with more aggressive approaches, including immediate passive motion and early weight-bearing exercises.

Advantages of Aquatic Therapy

Aquatic therapy, including hydrotherapy and swimming pool activities, has been integrated into many ACL rehabilitation protocols. Water’s buoyancy reduces joint stress, while its resistance enhances muscle activity, making it an ideal medium for early rehabilitation stages. However, swimming alone might not provide sport-specific activity benefits due to different body positions and muscle usage compared to non-aquatic sports.

Study Objective and Methodology

This study aimed to determine the effectiveness of adding underwater treadmill exercise to the standard post-surgical ACL rehabilitation protocol. Sixteen subjects, diagnosed with complete ACL rupture and having undergone primary reconstruction, were divided into two groups: a standard therapy group and an experimental group that included underwater treadmill exercises. The study assessed the participants’ range of motion, muscle girth, strength, endurance, and balance at four and eight weeks post-surgery.

Findings and Implications

The results indicated significant improvements in the experimental group, particularly in flexion, calf girth, and quadriceps girth of both the surgical and non-surgical legs. The standard group showed improvement only in flexion. The study suggests that underwater treadmill exercise can be a beneficial addition to ACL reconstruction rehabilitation, potentially offering advantages over stationary cycling in preventing muscle atrophy.

Conclusion and Future Directions

Underwater treadmill exercise appears to be a promising component of ACL rehabilitation, contributing to improved outcomes in muscle girth and joint flexibility. Future research should explore the exclusive use of underwater treadmill walking as a rehabilitation modality and its applicability to other conditions like post-acute fractures, chronic back pain, and arthritis.