One of the concerns of people with anterior cruciate ligament (ACL) injuries is whether they can safely return to high-level sports and activity. With or without surgery, patients generally benefit from standard rehabilitation programs designed to improve knee movement, strength, and ability. In some cases, patients can return to high-level activity. Other patients have pain or unsteadiness in their knee that keeps them from doing demanding sports or activities. Either the knee doesn't hold steady, or it actually slips out.

By adding a new form of training to the standard rehabilitation program, the authors found that a greater number of patients with ACL problems could safely return to vigorous sports and work activities. This new training regiment is called perturbation training. Perturbation training involves standing on an unstable platform. The platform shifts at pre-set speeds, and the patient has to regain balance. As the knee starts to hold better, the exercises gradually get harder. Patients will then stand on a special board with rollers while a therapist carefully pushes the knee back and forth in various directions. The training gets even more difficult by having the patients stand on one leg.

Patients who went through perturbation training had better knee stability and fewer problems with their knee feeling like it was going to slip. Also, they were nearly five times more likely to be able to safely go back to rigorous activity. According to the authors, patients who received the special training had much better long-term results than other patients.

These excellent results may partly be the result of carefully selecting the patients for the study. Some people might not be able to do these advanced forms of exercise. But for ACL patients who are up for the challenge, perturbation training seems able to move and groove them back to optimal health and ability.

Reference:

G. Kelley Fitzgerald, PT, PhD, OCS, et al. The Efficacy of Perturbation Training in Nonoperative Anterior Cruciate Ligament Rehabilitation Programs for Physically Active Individuals. In Physical Therapy. February 2000. Vol. 80. No. 2. Pp. 128-140.'