Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial

This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose–response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.

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“…Seven studies160–166 investigated the effect of contralateral limb strength training on the injured limb outcomes after ACL surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies [160][161][162][163][164][165][166] investigated the effect of contralateral limb strength training on the injured limb outcomes after ACL surgery. Summary ► There is conflicting evidence for an effect of cross-training on quadriceps strength at the early and intermediate phase.…”

Section: Cross-educationmentioning

confidence: 99%

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

et al. 2023

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“…One possible application of this phenomenon can be found in the field of exercise and rehabilitation, where one may train the intact side if the opposite homologous (contralateral) limb cannot be trained due to injuries or diseases (e.g., surgery-induced immobilization, stroke). However, as a relatively novel tool, mixed findings have been reported in recent literature [ 4 , 5 , 6 , 7 ]. One big challenge to moving this research forward is identifying the specific exercise mode that can induce the largest magnitude of the contralateral cross-education effect.…”

Section: Introductionmentioning

confidence: 99%

Effects of Unilateral Neuromuscular Electrical Stimulation with Illusionary Mirror Visual Feedback on the Contralateral Muscle: A Pilot Study

Vala

Walker

et al. 2023

IJERPH

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We aim to examine the cross-education effects of unilateral muscle neuromuscular electrical stimulation (NMES) training combined with illusionary mirror visual feedback (MVF). Fifteen adults (NMES + MVF: 5; NMES: 5, Control: 5) completed this study. The experimental groups completed a 3-week NMES training on their dominant elbow flexor muscle. The NMES + MVF group had a mirror placed in the midsagittal plane between their upper arms, so a visual illusion was created in which their non-dominant arms appeared to be stimulated. Baseline and post-training measurements included both arms’ isometric strength, voluntary activation level, and resting twitch. Cross-education effects were not observed from all dependent variables. For the unilateral muscle, both experimental groups showed greater strength increases when compared to the control (isometric strength % changes: NMES + MVF vs. NMES vs. Control = 6.31 ± 4.56% vs. 4.72 ± 8.97% vs. −4.04 ± 3.85%, p < 0.05). Throughout the training, even with the maximally tolerated NMES, the NMES + MVF group had greater perceived exertion and discomfort than the NMES. Additionally, the NMES-evoked force increased throughout the training for both groups. Our data does not support that NMES combined with or without MVF induces cross-education. However, the stimulated muscle becomes more responsive to the NMES and can become stronger following the training.

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“…There are very little data from randomized clinical trials that have employed a cross-education intervention in patients. Of those that have, there is evidence 45,56,60 showing cross-education provides superior adaptations compared to standard care, whereas others 83,84 show similar outcomes with or without unilateral training. Differences in exercise design and prescription likely account for some of the disparity in these clinical trials.…”

Section: Introductionmentioning

confidence: 99%

“…Differences in exercise design and prescription likely account for some of the disparity in these clinical trials. 56,60,83,84…”

Section: Introductionmentioning

confidence: 99%

Exercise prescription and strategies to promote the cross-education of strength: a scoping review

Voskuil

Andrushko

Huddleston

et al. 2022

Preprint

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Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial

Cited by 14 publications

References 30 publications

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

Effects of Unilateral Neuromuscular Electrical Stimulation with Illusionary Mirror Visual Feedback on the Contralateral Muscle: A Pilot Study

Exercise prescription and strategies to promote the cross-education of strength: a scoping review

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