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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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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

Conditions
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Anterior Cruciate Ligament Reconstruction

Intervention / Treatment
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* Other: Internally Focused Exercise
* Other: Externally Focused Exercise


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Internally Focused<br>Focusing on the muscles that reveal the movement. | Other: Internally Focused Exercise<br>* While performing the exercises participants will be instructed to focus on the muscle itself.<br>|
| Experimental: Externally Focused<br>Focusing on the result of the movement. | Other: Externally Focused Exercise<br>* While performing the exercises participants will be instructed to focus on the external target (towel, target line, etc.)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | 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 | 

Secondary Outcome Measures

| Outcome Measure | 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. | Baseline and 1 month after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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external focus, internal focus, knee rehabilitation, electromyography