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

NCT ID: NCT05342415

Last Updated: 2026-01-08

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 24 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-09-01
• Study Completion Date: 2026-01-01

Brief 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.

Detailed 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.

Conditions

Anterior Cruciate Ligament Reconstruction

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Internally Focused

Focusing on the muscles that reveal the movement.

Group Type: ACTIVE_COMPARATOR

Internally Focused Exercise

Intervention Type: OTHER

While performing the exercises participants will be instructed to focus on the muscle itself.

Externally Focused

Focusing on the result of the movement.

Group Type: EXPERIMENTAL

Externally Focused Exercise

Intervention Type: OTHER

While performing the exercises participants will be instructed to focus on the external target (towel, target line, etc.)

Interventions

Internally Focused Exercise

While performing the exercises participants will be instructed to focus on the muscle itself.

Intervention Type: OTHER

Externally Focused Exercise

While performing the exercises participants will be instructed to focus on the external target (towel, target line, etc.)

Intervention Type: OTHER

Eligibility Criteria

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

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 30 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Hacettepe University

OTHER

Sponsor Role: lead

Responsible Party

Dilara Kara

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Volga Bayrakcı Tunay, PhD, Prof.

Role: PRINCIPAL_INVESTIGATOR

Hacettepe University

Locations

Hacettepe University

Ankara, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

References

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.

Reference Type: BACKGROUND

PMID: 25232521 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 26504270 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 28791612 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 30194224 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 27003451 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 23222082 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 23710928 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 19826287 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 29533715 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 20409600 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 24054892 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 34814896 (View on PubMed)

Other Identifiers

FTREK24/31

Identifier Type: -

Identifier Source: org_study_id