Rehab and Performance Lab: A Medbridge Podcast

Rehab and Performance Lab Episode 16: Is Avoiding Open Chain After ACLR Slowing Your Patient’s Progress?

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Jun 13, 2025

Dr. Lynn Snyder-Mackler, a globally recognized knee rehabilitation expert with over 45 years of experience, discusses ACL rehabilitation with host Phil Plisky. They tackle the misconceptions around open-chain exercises, emphasizing that they are safe and essential for quadriceps recovery. Lynn shares insights on the importance of measuring strength objectively, and why evolving research debunks fears of graft laxity. This enlightening conversation encourages a fresh approach to early-phase rehab strategies for optimal outcomes.

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INSIGHT

Quad Strength Predicts Outcomes

Quadriceps weakness after intra-articular knee injury is common and profound.
Early quad recovery predicts short- and long-term outcomes including re-injury and OA risk.

ADVICE

Measure Isolated Quad Strength

Measure isolated quadriceps strength rather than assuming closed-chain tasks reflect quad recovery.
If you aren't measuring quad strength you don't know if your rehab is working.

INSIGHT

Open Chain Fear Was Misplaced

The isokinetic-era fear of open-chain exercise causing graft laxity was misplaced.
Early research showed similar ACL strain for open- and closed-chain tasks, so avoidance was over-generalized.

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Dr. Lynn Snyder-Mackler, a globally recognized expert in knee rehabilitation with more than 45 years of clinical and research experience, joins host Phil Plisky for a deep dive into one of rehab’s most persistent debates: open-chain strengthening after ACL reconstruction. Phil and Lynn get candid about outdated fears, persistent myths, and what the research really says about quad recovery. Together, they challenge the status quo and invite you to rethink your early-phase rehab strategies. Don’t miss this conversation packed with practical insights that could change how you guide your patients post ACLR.

Learning Objectives

Analyze the evidence around the most effective ways to strengthen the quadriceps after ACL injury

Apply evidence-based, practical strategies to actionably address quadriceps weakness after ACL injury

Solve patient case scenarios involving quadriceps weakness after ACL injury

Timestamps

(00:00:00) Welcome
(00:01:17) Introduction to ACL rehabilitation and strengthening
(00:02:10) The evolution of ACL surgery and rehabilitation
(00:05:39) The importance of quadriceps strength
(00:08:57) Open vs. closed kinetic chain training
(00:14:10) Debunking myths around open kinetic chain exercises
(00:19:12) The role of measurement in rehabilitation
(00:22:18) Quadriceps strength and osteoarthritis
(00:25:44) Understanding strain in rehabilitation
(00:27:14) Understanding tendon and ligament healing
(00:33:22) Rehabilitation strategies for ACL reconstruction
(00:44:36) Key takeaways for clinical practice

Rehab and Performance Lab is brought to you by Medbridge. If you’d like to earn continuing education credit for listening to this episode and access bonus takeaway handouts, log in to your Medbridge account and navigate to the course where you’ll find accreditation details. If applicable, complete the post-course assessment and survey to be eligible for credit. The takeaway handout on Medbridge gives you the key points mentioned in this episode, along with additional resources you can implement into your practice right away.

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