NEUROMUSCULAR ELECTROSTIMULATION (NMES)
NMES is used in the first few weeks after ACL surgery or trauma to combat Arthogenic Muscle Inhibition (AMI). Recent studies have also shown significant benefits of NMES for the Leg Symmetry Index (LSI), an important marker for return to training (>90%). The most benefit coming when it is combined with visualisation, motor reprogramming, proprioception and muscle strengthing exercises, especially during the transition from physical therapist to physical trainer (Labanca et al 2022). 10
The combination of NMES and resistance exercise has also been shown to be beneficial for treating patella tendinopathies (Labanca et al 2022). 11
Use of cryotherapy First, the RICE will be implemented, including the use of Compressive Cryotherapy (Knee Universal Excell Ice DonJoy®). This is the gold standard method for immediate post-operative care. It combines the effect of cold with intermittent or static pressure. The advantage of adding compression is that it is significantly more effective for draining effusion and oedema than cold alone, improving patient satisfaction and functional recovery. Standard recommendations include regular and repeated applications, often 3 times a day for 20 to 30 minutes, especially during the first 10 to 15 days. During rehabilitation sessions, the therapist will use it just before and/or after the sessions, as pain and oedema tend to increase after exercise.
Given the choice, Photobiomodulation therapy (PBMT) should be prioritized over cryotherapy due to its broader and more effective range of action (Fisher et al 2019). 12
Rehabilitation exercises Rehabilitation is essential: it aims to quickly restore full joint range of motion, particularly extension, which is essential for normal walking and the prevention of arthrofibrosis. Early rehabilitation includes gentle passive and active mobilization, followed by strength training, proprioception, and specific return to sport exercises. 13
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