Patient Information Leaflet : ACL Reconstruction
Printer friendly versionThis protocol will be completed following your operation.
EXERCISE PROGRAMME: Weeks 1 – 2
1. KNEE EXTENSION: Sit on a firm surface, legs out in front of you. Put operated foot on pillow. Rest your hand on top of your thigh, allow gravity to gently pull down on your knee. Hold this position for 15-20 minutes, at least twice a day.
2. KNEE FLEXION: Sit on a low chair with feet on the floor, thighs supported. Bend the operated knee, sliding the foot as far back as you can. Slowly return leg to starting position.
Repeat ______ times, ______ times daily.
3. QUADRICEPS SETTING: With involved knee, tighten muscle on the top of your thigh as if trying to push your knee into the floor. Do not hyper-extend. Hold for 6-8 counts -- relax -- repeat.
Repeat _____ times, ______ times daily.
4. STRAIGHT LEG RAISE: Sitting with your back supported, bend your uninvolved knee and keep the foot flat on the ground. Keep your involved knee straight and slowly lift your whole leg from the hip. Hold for 6 counts -- slowly lower -- relax -- and repeat.
Repeat _____ times, _____ times daily.
5. ACTIVE KNEE EXTENSION: 90-30°: Sitting on the edge of a table or bed with knee bent to 90° straighten knee slowly until your knee is almost completely straight. Hold to a count of 6 and slowly lower. You may NOT use any weight.
Repeat _____ times, _____ times daily.
6. HIP EXERCISES:
a. Hip abduction: Lying on the uninvolved side, bottom leg bent for balance, top leg straight -- lift the involved leg up and slightly back. Hold for 6 counts, slowly lower.
Repeat _____ times, _____ times daily.
b. Hip extension: Lying on your stomach, keeping your involved knee straight, lift the entire leg up from the hip. Hold for 6 counts. Do not allow back to arch.
Repeat _____ times, _____ times daily.
c. Hip adduction: Lying on your involved side, bring your uninvolved leg behind you with your knee bent and foot flat. With your knee straight, slowly lift your involved leg up approximately 6 inches. Hold for 6 counts -- slowly lower.
Repeat _____ times, _____ times daily.
d. Hip flexion: Sitting with your knee bent as far as you are able, lift your knee up towards your chest, using your hip muscles. Hold for 6 counts.
Repeat ______ times, _____ times daily.
PRONE EXERCISES: Lying on your stomach with a small pad under your thigh, just above your knee:
a. Leg curl: Bend your involved knee as far as possible -hold for 6 counts, slowly lower.
Repeat _____ times, _____ times daily.
b. Knee flexion: Bend your involved knee as far as possible -- use your opposite leg to help bend it further. Hold for 10 counts.
Repeat _____ times, ______ times daily.
c. Knee extension: Maintain knee as straight as possible and allow it to stretch with your foot hanging over the edge of the bed -- hold this position for ______ minutes, ______ times daily.
8. PATELLA MOBILISATION:
a. Place index finger and thumb on either side of your kneecap -- gently slide up and down
b. Place index finger and thumb on either end of your kneecap
Gently slide from side to side.
Both of these mobilisations should be completed for approximately five minutes every hour you are awake.
EXERCISE PROGRAMME: WEEKS 2 – 6
1. KNEE EXTENSION: Continue to work on knee extension. Sitting with legs out straight, resting hands on top of thigh, pushing gently downward into extension 15-20 minutes 3-4 times each day.2. STRAIGHT LEG RAISE: Sitting with your back supported bend your uninvolved knee and keep the foot flat on the ground. Keep your involved knee straight and slowly lift your whole leg from the hip. Hold for 6 counts -- slowly lower -- relax --
Repeat _____ times, _____ times daily. Add weight as tolerated.
3. LEG EXTENSION 0-90º: Sitting with your knees bent, straighten knee slowly until your knee is completely straight (90°-0). Hold for 6 counts, slowly lower.
Repeat _____ times, _____ times daily.
4. Continue with hip exercise as stated on 7-10 day protocol, progressing with weight as tolerated.
a. Hip abduction
b. Hip extension
c. Hip flexion
d. Hip adduction.
5. CONTINUE LEG CURL EXERCISES
Weight may be progressed as tolerated.
Repeat ______ times, _____ times daily.
6. TOE RAISES: Standing on both feet, raise up on your toes; hold this for 4 counts -- slowly lower. As the leg becomes stronger, progress to standing only on the operated leg only. Raise up on your toes.
Repeat _____ times, _____ times daily.
7. PARTIAL STANDING SQUATS: 45-90° with trunk flexed. Starting position is sitting in a chair, bend forward at the waist, use both legs equally to stand half-way up but do not exceed 45°. Use body weight only, i.e. no added weight.
8. Functional Activities:
a. Stairmaster with gradually increased resistance
b. Stationary bike with gradually increased resistance
c. Swimming - flutter kicks allowed but no flip turns
d. Nordic track
e. Wobble board
f. Step ups: stand facing the step, use rail for safety as needed. Position toes and kneecap pointed straight ahead. Step up onto stair and slowly lower back to starting position. Use the operated leg to stand onto the step and to stand off the step
Repeat _____ times, _____ times daily
g. Sport cord straight line walking, forward/backward.
GENERAL EXERCISE PROGRAMME: WEEKS 6 – 12
1. Continue with straight leg raises, increase weight as tolerated2. Continue with hip exercises, increase weight as tolerated:
a. Hip flexion
b. Hip extension
c. Hip abduction/adduction
3. Continue with toe raises
4. Continue with partial squats 45-90° both sitting and standing.
FUNCTIONAL ACTIVITIES:
1. If you have access to a health club you may begin to work on the following equipment:
a. Leg curl machine
b. Multi-hip machine
c. Leg Extension machine ( 90-30° only)
Begin with one to two sets of 10 repetitions each. If working out on equipment, every other day of training is recommended for those machines. Other exercises may be continued to be done daily
2. Continue with stationary bicycle increase resistance as tolerated
3. Continue with Stairmaster with increased resistance
4. Continue with swimming
5. Continue with Nordic track, wobble board and step-ups.
EXERCISE PROGRAMME: MONTHS 3 – 6
1. Continue with straight leg raise2. Continue with hip exercises
3. Continue with toe raises
4. Wall squats – 0-45°: stand with back to wall, then bend forward at waist, slide down wall to 45°. Hold this position with weight evenly distributed on both legs for 15-30 seconds. Return to starting position
Repeat _____ times, ______ times daily.
ACTIVITIES:
1. Health club equipment you may continue to work on:
a. Leg curl machine
b. Multi-hip machine
c. Leg extension machine 90-30° only
d. Leg press machine 0-45°
Begin with one to two sets of 10 repetitions each. If working out on equipment, every other day of training is recommended for those machines. Other exercises may be continued to be done daily
2. Continue with stationary bicycle increase resistance as tolerated
3. Continue with Stairmaster with increased resistance
4. Continue with swimming
5. Continue with Nordic track, wobble board and step ups
6. You may begin jogging up to half speed maximum if range of motion and muscle control are adequate. Limit yourself to level and even surfaces
7. You may bicycle outside beginning on level areas at a low resistance.
EXERCISE PROGRAMME: MONTHS 6 – 9
1. Figure of 8 runs: Begin by jogging in a large figure of 8 patterna. progress both clockwise and counter clockwise directions
b. progress by increasing speed
c. progress by decreasing size of figure of 8
2. Side steps: Begin by walking sideways, take one foot and cross it
behind the other, alternate legs. Increase speed as tolerated
3. Lateral shuffles: begin by taking large step sideways, slide feet together. Increase speed as tolerated
4. Jumping rope
5. Backwards run
6. Plyometrics: your therapist will instruct you in work/sport specific drills.
ACTIVITIES:
1. Health club equipment you may work on is unchanged from previous programme but with no restriction in range of movement or duration
a. Leg curl machine
b. Multi-hip machine
c. Leg extension machine.
d. Leg press machine – 0-45°
Progress to two-three sets of 10 repetitions each. If working out on equipment, every other day of training is recommended for those machines. Other exercises may be continued to be done daily
2. You may begin jogging up to full speed maximum if range of motion and muscle control are adequate. Limit yourself to level and even surfaces
3. Return to sport as comfortable. Initially undertake practice/non competitive sport until confidence returns.