Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
In recent years, it has been shown that different focuses (externally vs. internally focused) used when explaining exercises to patients after knee surgeries affect exercise performance and rehabilitation outcomes. Quadriceps muscle inhibition after anterior cruciate ligament reconstruction is one of the primary symptoms that should be treated. This study aimed to investigate the effects of different focusing techniques during the rehabilitation exercises after anterior cruciate ligament rehabilitation.
Exercises are given for the symptoms of knee edema, knee range of motion, and quadriceps reflex inhibition in the acute period after anterior cruciate ligament surgery. In recent years it has been shown that the different focuses when explaining exercises to patients affect exercise performance and rehabilitation outcomes. It has been shown that the increase in performance of some exercises that require strength and power, such as long jump and sprint, especially with the applied external focus (the method of focusing on the result of the movement). However, it has been shown that there is an increase in muscle activation with internal focus (focusing on the muscles that reveal the movement). There is no study examining the effects of focusing differences on the exercise program given after anterior cruciate ligament reconstruction, especially on muscle activation after knee reflex inhibition.
30 individuals between the ages of 18-and 30 who had undergone anterior cruciate ligament reconstruction for the first time will be included in the study. The first evaluation will be performed and rehabilitation will begin in the first week after surgery. Patients who were taken into rehabilitation after anterior cruciate ligament surgery will be distributed into two different groups by the block randomization method. The same structured exercise program will be applied to the patients in both groups. Only the commands given during the exercise will be different.
Group 1: Internal Focused Exercise: E.g; While describing the knee pressing exercise (quadriceps isometric) in the long sitting position, the command "press your knee towards the bed by squeezing your thigh muscle" will be given by showing the muscle.
Group 2: External Focused Exercise: E.g; While describing the knee pressing (quadriceps isometric) exercise in the long sitting position, the command "press the towel/cloth that we put under your knee and compress your knee" will be given by showing the towel.
Patients will be followed under the supervision of a physiotherapist in the clinic 2 days a week and exercise progression will be provided. On the other days, the exercises will be continued as a home program. In order for the patients to comply with the exercises more easily and to be reminded easily, an exercise brochure will be given to the patients with the commands written and the exercises explained with pictures.
The last measurements will be performed at the end of one month after surgery.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Internally Focused | Active Comparator | Focusing on the muscles that reveal the movement. |
|
| Externally Focused | Experimental | Focusing on the result of the movement. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Internally Focused Exercise | Other | While performing the exercises participants will be instructed to focus on the muscle itself. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Determine if different focus techniques change thigh muscle activation | Vastus medialis, vastus lateralis, and rectus femoris muscle activation will be measured by superficial electromyography | Baseline and 1 month after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Knee edema | The changes in the limb circumference will be measured with a tape measure (cm). | Baseline and 1 month after surgery |
| Knee range of motion | The changes in knee flexion and extension degree will be measured with a goniometer. |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Volga Bayrakcı Tunay, PhD, Prof. | Hacettepe University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hacettepe University | Ankara | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25232521 | Background | Saka T. Principles of postoperative anterior cruciate ligament rehabilitation. World J Orthop. 2014 Sep 18;5(4):450-9. doi: 10.5312/wjo.v5.i4.450. eCollection 2014 Sep 18. | |
| 26504270 | Background | Kim DK, Hwang JH, Park WH. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction. J Phys Ther Sci. 2015 Sep;27(9):2693-6. doi: 10.1589/jpts.27.2693. Epub 2015 Sep 30. |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
The pre-and-post measurements will be performed by researchers who do not know the group allocation.
| Externally Focused Exercise | Other | While performing the exercises participants will be instructed to focus on the external target (towel, target line, etc.) |
|
| Baseline and 1 month after surgery |
| 28791612 | Background | Cavanaugh JT, Powers M. ACL Rehabilitation Progression: Where Are We Now? Curr Rev Musculoskelet Med. 2017 Sep;10(3):289-296. doi: 10.1007/s12178-017-9426-3. |
| 30194224 | Background | Sonnery-Cottet B, Saithna A, Quelard B, Daggett M, Borade A, Ouanezar H, Thaunat M, Blakeney WG. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med. 2019 Mar;53(5):289-298. doi: 10.1136/bjsports-2017-098401. Epub 2018 Sep 7. |
| 27003451 | Background | Halperin I, Williams KJ, Martin DT, Chapman DW. The Effects of Attentional Focusing Instructions on Force Production During the Isometric Midthigh Pull. J Strength Cond Res. 2016 Apr;30(4):919-23. doi: 10.1519/JSC.0000000000001194. |
| 23222082 | Background | Porter JM, Anton PM, Wikoff NM, Ostrowski JB. Instructing skilled athletes to focus their attention externally at greater distances enhances jumping performance. J Strength Cond Res. 2013 Aug;27(8):2073-8. doi: 10.1519/JSC.0b013e31827e1521. |
| 23710928 | Background | Ille A, Selin I, Do MC, Thon B. Attentional focus effects on sprint start performance as a function of skill level. J Sports Sci. 2013;31(15):1705-12. doi: 10.1080/02640414.2013.797097. Epub 2013 May 28. |
| 19826287 | Background | Marchant DC, Greig M, Scott C. Attentional focusing instructions influence force production and muscular activity during isokinetic elbow flexions. J Strength Cond Res. 2009 Nov;23(8):2358-66. doi: 10.1519/JSC.0b013e3181b8d1e5. |
| 29533715 | Background | Schoenfeld BJ, Vigotsky A, Contreras B, Golden S, Alto A, Larson R, Winkelman N, Paoli A. Differential effects of attentional focus strategies during long-term resistance training. Eur J Sport Sci. 2018 Jun;18(5):705-712. doi: 10.1080/17461391.2018.1447020. Epub 2018 Mar 13. |
| 20409600 | Background | Wulf G, Dufek JS, Lozano L, Pettigrew C. Increased jump height and reduced EMG activity with an external focus. Hum Mov Sci. 2010 Jun;29(3):440-8. doi: 10.1016/j.humov.2009.11.008. Epub 2010 Apr 21. |
| 24054892 | Background | Kal EC, van der Kamp J, Houdijk H. External attentional focus enhances movement automatization: a comprehensive test of the constrained action hypothesis. Hum Mov Sci. 2013 Aug;32(4):527-39. doi: 10.1016/j.humov.2013.04.001. Epub 2013 Jun 30. |
| 34814896 | Background | Ogrodzka-Ciechanowicz K, Glab G, Slusarski J, Gadek A. Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial. BMC Musculoskelet Disord. 2021 Nov 23;22(1):975. doi: 10.1186/s12891-021-04862-w. |