Effect of Different Focused Techniques on Thigh Muscle Activation After Anterior Cruciate Ligament Reconstruction

Anterior Cruciate Ligament Reconstruction Clinical Trial

Official title:

Investigation of the Effect of Externally vs. Internally Focused Techniques on Thigh Muscle Activation After After Anterior Cruciate Ligament Reconstruction: A Randomized Assessor-Blinded Controlled Trial

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05342415
• Other study ID #: KA-XXX (applied)
• Status: Not yet recruiting
• Phase: N/A
• Start date: May 23, 2022
• Est. completion date: February 23, 2023

Study information

• Verified date: April 2022
• Source: Hacettepe University
• Contact: Dilara Kara, MSc.
• Phone: 903123052525
• Email: dilaradonder[@]hacettepe.edu.tr
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 30
• Est. completion date: February 23, 2023
• Est. primary completion date: December 23, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 30 Years

Eligibility

Inclusion Criteria:

• who underwent anterior cruciate ligament reconstruction with hamstring tendon autograft for the first time

• no systemic inflammation

• agreed to participate in the study

Exclusion Criteria:

• having a chronic disease/injury in the ankle, hip and knee

• contralateral knee symptoms and/or surgery history

• other surgeries in addition to the anterior cruciate ligament reconstruction (meniscus repair, chondral surgery, etc.)

• post-operative referral of the patient more than a week later

Related Conditions & MeSH terms

• Anterior Cruciate Ligament Reconstruction

Intervention

Other:
• Internally Focused Exercise
While performing the exercises participants will be instructed to focus on the muscle itself.
• Externally Focused Exercise
While performing the exercises participants will be instructed to focus on the external target (towel, target line, etc.)

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Hacettepe University

References & Publications (12)

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. Review. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

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. Review. — View Citation

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. — View Citation

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. Review. Erratum in: Br J Sports Med. 2019 Dec;53(23):e8. — View Citation

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. — View Citation

* Note: There are 12 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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
Secondary	Knee edema	The changes in the limb circumference will be measured with a tape measure (cm).	Baseline and 1 month after surgery
Secondary	Knee range of motion	The changes in knee flexion and extension degree will be measured with a goniometer.	Baseline and 1 month after surgery