Note before starting exercises: If you have undergone any associated procedure like Meniscus repair or HTO (High tibial Osteotomy) or OATS (Osteochondral Autograft Transfer System) please consult you doctor / Physical therapistbefore embarking on the ACL protocol (You have to compare the protocols of the different procedures and follow the one which is slower in progression for the given time period, or you may damage the associated meniscus or sensitive ligament repair)
PREHABILITATION / REHABILITATION
Before the operation it is important that you have as near to full pain free movement as possible. Ideally a few weeks before the surgery you should start exercises building up your quadriceps and hamstring strength. This trains the muscles up and makes it easier to get going after the surgery.
EXERCISES AFTER OPERATION
Phase1. (0-1 weeks following surgery)
This phase involves regaining a full range of movement (especially full extension).
It is important that these exercises are performed for short periods but regularly (rather than one longer period)
Move the foot up and down from the ankle to maintain good circulation
Sit on a firm surface and fully straighten your knee. To help the knee go straighter tighten the front thigh muscles (quadriceps). Pull your toes up towards your face and at the same time push your knee back into the floor. Hold for 10 seconds and repeat. (After 2 weeks of surgery, you should do this knee extension exercise keeping a rolled towel under the back of the heel to get backward movement of the knee joint)
Slide your heel up and down a firm surface bend- ing and straightening your knee.
Phase 2 (1-8weeks following surgery)
This phase is about improving muscle strength and continuing to improve movement back to full.
It is important to perform these exercises regularly and we recommend at least twice a day. The more effort that is put into the rehabilitation the better the recovery and quicker the return to full activities.
Straight leg raise
Lie on your front. Lift the leg straight up in the air and lower. Try and stop the downward fall of the leg by “quickly” contracting your muscles. As you progress you can add weight to your ankle.
Leg raise in side lying
Lie on your side with your operated leg uppermost. Lift and lower the leg using your outer thigh muscles. Change sides so the operated leg is at the bottom (lowermost). Lift the operated leg up and down us- ing the innermost thigh muscles.
With your knees bent push your heels into the floor and lift your bottom clear. Pro- gress to just using your operated leg.
Sit to Stand
Slowly stand up from a chair. As you progress put the un- operated leg forward so more of the work is done by the operated leg.
One leg balance
Stand on the operated leg with it slightly bent. Try to bal- ance for 30 seconds. As you progress try closing your eyes.
Stand on your un-operated leg. Bring your other heel to your bottom. Then lower your foot, try and stop the downward movement by “quickly” con- tracting your hamstring mus- cles.
Place a skipping rope along the floor. Walk along it carefully keeping your
Feet pointing forward, oper- ated leg behind you with knee straight and heel down. Lean in towards the wall, hold for 20 seconds
Stand with operated leg straight out in front of you, heel on the floor. Bend forwards from the hips and rest your hands on your bent un-operated leg keeping your back straight. Hold for 20 seconds.
Phase 3 (8-16 weeks following surgery)
At this stage phase 2 exercises can be progressed at increased speed, weight and number of repetitions. You can now start building in some exercises to help proprioception (joint stability coordination).
- Step-ups and downs
- Quadriceps stretch
- Gym work.
- Wobble board
- Single leg squats
Phase 4 (16 weeks following surgery)
Rehabilitation can now be directed at graded return to sports.
Solo sports such as hitting a tennis ball against a wall, or shooting some baskets helps build up proprioceptive reflexes in a controlled environment.
When jogging you can start to build in some direction changes initially running long curves, but as you progress making the di- rection changes more acute.
Advanced Knee strengthening
3rd to 6th month after surgery is an important time when you will be building up the thigh muscles. You could reinsure your knee if you do not build your thigh muscles to the adequate strength to support your body weight and the extra load while playing games. (The knee has to withstand more than 3 times the body weight when you do a cutting movement in football).
The important exercises are Quadriceps, Hamstring curls, Leg press and slow progression to Squats and weighted squats
Progression on each of these exercises should be graded, according to your existing strength.
At 6 months following surgery if the musculature is sufficient sport specific training exercises can be started.We would not recommend return to competitive sport until at least nine months following surgery.