Specialized core stability exercise: a neglected component of anterior cruciate ligament rehabilitation programs

The incidence of anterior cruciate ligament injury has continued to increase over the last two decades. This injury is associated with abnormal gait patterns and osteoarthritis of the knee. In order to accelerate recovery, the introduction of core stability exercises into the rehabilitation program is proposed. The theory underlying the use of core stability exercise relates to the neuroplasticity that follows anterior cruciate ligament injury. Neuroplasticity in lumbar, thoracic, cervical and brain regions diminish activation in the contralateral thalamus, postparietal cortex, SM1, basal ganglia-external globus pallidus, SII, cingulated motor area, premotor cortex, and in the ipsilateral cerebellum and SM1 and increase activation in pre-SMA, SIIp, and pITG, indicating modifications of the CNS. In addition, the neuroplasticity can regulate the movement of trunk muscles, for example, sternocleidomastoid and lower trapezius muscles. Core stability also demonstrates a negative correlation with the incidence of anterior cruciate ligament injury. Therefore, we propose that core stability exercises may improve the rehabilitation of anterior cruciate ligament injuries by increasing core motor control. Specialized core stability exercises aimed at rectifying biomechanical problems associated with gait and core stability may play a key role in the management of anterior cruciate ligament injury.