exercise and fears of re-injury: a longitudinal study of psychological factors
related to activity after anterior cruciate ligament reconstruction
MA, Cao X, White LM, Hurtig M, Kunz M, & Marks PH. BMC Sports Science, Medicine and Rehabilitation. 2015, 7:4.
exercise importance, and age are associated with return to activities after an
anterior cruciate ligament reconstruction.
exercise and fear of re-injury are very important when recovering from anterior
cruciate ligament (ACL) surgery. Short-
and long-term outcomes of successful return to activity and previous levels of
activity may be affected by these perceptions.
The authors of this study investigated perceptions of exercise and
re-injury fears pre-surgery and annually up to three years post-surgery in 95
participants. Over half of the injuries
were reported from soccer, skiing, and basketball and largely in recreational
athletes. At baseline and each annual
visit the participants answered questionnaires about physical activity (Minnesota Leisure-time Physical Activity Questionnaire),
perceived importance of exercise (Exercise Identity Scale), pain (Knee Injury and Osteoarthritis Outcome Score, KOOS),
fear of re-injury (ACL-Quality of Life Questionnaire),
as well as sports and recreation activity limitations (ACL-Quality of Life Questionnaire).
Exercise importance perceptions remained constant at all time points. Pain, activity limitations, and re-injury
fears decreased over time, achieving relatively low levels by 2 years
post-surgery (see chart). On average, while
participants reported high function and minimal pain their time spent in sports
and recreational activities was diminished and never returned to pre-injury
levels three years post-surgery, regardless of fear of re-injury. A decrease in fear was associated with time
spent in activities, specifically activities with a higher risk of knee injury. Age was also associated with time spent in
activities, with younger participants reporting more time spent in activities
with lower and higher risk of knee injury while older participants reported
more time spent in household activities. Greater exercise importance at any time point
was associated with more time spent in activities with lower and higher risk of
of re-injury decreases over time and is associated with greater time spent in activities
with a higher risk of knee injury while exercise importance remained relatively
constant over all time points.
Furthermore, a greater perception of exercise importance is associated
with time spent in physical activity.
Intervention efforts should be targeted towards decreasing fear of
re-injury as well as emphasizing exercise importance, even after completion of
ACL rehabilitation. Clinicians could
implement high-risk activities in a supervised and controlled environment as a
strategy to help participants gain confidence.
The authors also found that age was related to different types of
activities a patient engaged in. As individuals age, they typically have more
responsibilities (e.g., employment, family lives) which may naturally result in
changes from activities with higher risk of injury to activities with lower risk
of knee injury. Further research
regarding normal role changes as people age may be beneficial in determining if
a knee injury prematurely coerces individuals to make these role changes
earlier. However, exercise importance is
critical to long-term joint health and these individuals need to be reminded
that they should find time to exercise. This
study highlights that fear of re-injury may not be the only limiting factor
when attempting to return to pre-injury activity levels. Clinicians should
focus on reinjury fears as well as educate our patients about the importance of
exercise for maintaining long-term health.
you currently do anything during your ACL rehabilitations to address
psychological perceptions? What are some
common tasks that you see that cause fear within the patients that you have
returning from ACL injury, and what activities do you do to try to mitigate
by: Nicole Cattano
by: Jeffrey Driban
Gignac MA, Cao X, White LM, Hurtig M, Kunz M, & Marks PH (2015). Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction BMC Sports Science, Medicine and Rehabilitation, 7:4.