The posterior cruciate ligament (PCL) protects against posterior tibial translation at flexion angles greater than 30 degrees in knee flexion [2. It can become injured during strenuous physical activity and lead to significant swelling.] Injuries often lead to significant pain.
PCL tears commonly occur in sports where quick changes of direction, such as soccer or football, occur rapidly. They also can occur from violently twisting the knee or hyperextending it, such as on an airplane flight.
Open Kinetic Chain Exercises
The body can be described as an intricate machine, composed of interlinked and independent segments linked by joints. When one part moves, it creates a chain reaction in surrounding joints and segments that has ripple-effect effects across other parts. Physical therapists and personal trainers rely on this concept of the “kinetic chain” to assist their clients with movement pattern reeducation, injury prevention/rehab/performance enhancement/body sculpting needs.
Open kinetic chain exercises refer to those exercises in which the most distal segment of the leg has freedom to move freely during exercise, such as lying hamstring curls, biceps and quadriceps exercises, dumbbell rowing movements or lying hamstring curls. Conversely, closed kinetic chain exercises involve restricting distal movements during movement – such as squats or lunges.
Open kinetic chain exercises may increase tibial laxity and anterior knee pain following ACL reconstruction when compared with closed kinetic chain exercises, according to a review of seven electronic databases. Other studies, however, have demonstrated their utility in developing knee extensor strength.
Closed kinetic chain exercises can increase dynamic stability, decrease shear and acceleration forces on healing tissues, stimulate proprioceptors and enhance balance and neuromuscular control. They also facilitate co-contraction between agonist and antagonist muscles for greater joint stability.
Both open and closed kinetic chain exercises offer many advantages for athletes and patients, and both should be included as part of any workout program. Their primary goals should be strengthening, balance and coordination development while decreasing knee pain; using both open and closed kinetic chain exercises together should maximize benefits from training programs.
Recreational athletes such as softball players may benefit from engaging in open kinetic chain exercises that replicate throwing movements, like medicine ball throws, chops with cable column chops or lunges with rotations. Sports rehab and personal trainers may use open chain exercises to isolate and strengthen target muscle groups before progressing on to more complex closed chain exercises – though be cautious, since overdoing it could aggravate an injured knee further.
Double-Limb Strengthening Exercises
Personal trainers in London will work with you to develop an individualized PCL injury rehabilitation program tailored specifically to your needs. Typically, the initial phase includes quadriceps re-education with or without neuromuscular electrical stimulation, supine straight leg raises with progressive resistance levels and closed kinetic chain knee strengthening exercises (squats within 70 degrees arc) focused on preventing anterior tibial translation (GTX).
As progress is made, more advanced open kinetic chain strengthening and lateral bending exercises will be added to your regime. To facilitate reintegration of the medial tibial condyle, GTX exercises should be done either neutrally rotated or externally rotated so as to not overloading the posterior cruciate ligament too severely.
Once ready for phase two of rehabilitation, patients should be able to perform light activities pain free – this includes jogging, walking, stationary cycling and interval training with a BOSU balance exerciser. GTX exercises should then be conducted using neutral knee rotation to avoid loading up on an already injured posterior tibial ligament.
Patients should only advance to the third and final phase of rehabilitation once they can demonstrate at least five millimeters of posterior tibial translation compared with their uninjured knee, at 4-6 weeks post injury. This indicates an effective rehabilitation strategy for PCL injuries.
Isolated PCL injuries typically arise as a result of direct impact to the anterior portion of the tibia or when someone falls directly onto their knee while their foot is in plantarflexed position. Common symptoms include pain confined to the posterior aspect of the knee, difficulty ascending stairs and instability.
Diagnosis of PCL injuries typically relies on the “dial” test, in which a patient lies prone and his/her knees are externally rotated from 0 degrees to 30 degrees in an external rotation test. A positive dial test signifies an isolated PCL injury while its reverse indicates combined PCL/PLC injury. At this stage, varus laxity should also be assessed; positive varus laxity can be identified using external rotation tests by extending knee to 30degrees then 90degrees flexion before being externally rotated back.
Single-Limb Strengthening Exercises
If you want to increase athleticism and reduce injury risk, building strength through unilateral exercises is key. By engaging one leg at a time during these exercises, forcing core and stabilizer muscles to work harder – forcing muscles into growth patterns; building muscle mass; decreasing imbalances and asymmetries and improving decelerative landing mechanics all help create better performance and landing mechanics.
An ACL injury can be life-altering, yet there are ways you can minimize damage and get back on your feet more quickly. Begin with managing swelling and pain using crutches if necessary and always walking on the injured limb first when walking. Once this pain is under control it’s time to start moving again: light activities like cycling and jogging should do just fine; gradually progress to more intense workouts such as full contact strength drills in order to return to sport.
Once your PCL injury has healed, it’s time to start strength training with closed-chain exercises. In particular, avoid knee extension while the ligament heals as this will place unnecessary loads and strains on it; accordingly, closed-chain exercises should not exceed 70 degrees of flexion (dangle position) for the first two weeks post injury [26].
Phase 3 involves gradually withdrawing any bracing and moving on to single-limb training. Isolated hamstring strengthening exercises should begin as tolerated; dynamic stability and proprioception work can help restore functional knee stabilization and dynamic alignment of the knee joint. Once these movements can be performed without pain or effusion, running can resume as part of your running program.
To get more information about how to rehab your PCL injury and return to sports you love, book a FREE CONSULTATION with Jazz Alessi. He is one of the leading London PCL injury rehabilitation specialists with 17+ years of experience, so he can assess your injury, suggest suitable rehab exercises, and create a personalized treatment plan.
Jumping
The PCL can become injured when the knee lands and moves laterally, as seen with jumping. Any physical activity involving jumping should be avoided by those with PCL injuries or prior tears such as jumping jacks. Jumping exercises such as this one and other jumping activities, including jumper jacks or any other form of jumping should also be avoided for anyone suffering a prior PCL tear such as football cutting motions or planting leverage for wrestling matches, among others. Jumping itself and its impact landing may cause additional PCL damages.
Jumping jacks are dynamic exercises designed to engage multiple muscle groups at the same time and promote balance and spatial awareness through proprioception, or the development of muscle fibers that sense body parts’ positions and movements. Jumping jacks make an excellent cardiovascular workout option as they don’t require expensive equipment and can be completed anywhere within your home or in open spaces.
Jumping jacks not only strengthen quadriceps, hamstrings and calves but they can also build bone density by stimulating bones to produce denser cells that can better withstand high-impact exercise such as jumping jacks. In turn, this helps prevent osteoporosis. If you’re new to jumping jacks, start slowly and increase reps gradually so as not to risk overuse injuries. Furthermore, choose an anti-shock surface like rubber or grass which can absorb shock to reduce joint stress and ensure safety during exercise. An instructor can show you the correct technique to ensure you’re taking the appropriate form and reducing any additional stress on your joints. Furthermore, it’s essential to take breaks if any discomfort arises during a workout session. Your trainer can suggest alternate exercises to provide a thorough cardio workout without jumping, such as side step jacks (where arms move out to the sides while legs front-and-back), single leg jumping jacks, which involve jumping with one leg only and switching sides each time, and single-leg jumping jacks – just to name a few!
