ACLR- Rehabilitation Protocol
ACLR- Rehabilitation Protocol
Phase 1: Weeks 0-2
Goals
- Protect the graft
- Reduction of pain to decrease muscle inhibition
- Reduction of swelling to reduce muscle inhibition and increase joint mobility
- Establish 0-90 degrees Range Of Motion (ROM), with the main focus on restoring extension
- Restore normal walking patterns with assistance of crutches
How do we achieve this?
ROM
Restoring our range of motion post-surgery is our primary focus. When recovering initially from surgery there is a moderate amount of swelling surrounding the knee itself and inside your knee. This makes the joint feel stiff and sore when moving, and leads to patients walking with a slightly bent knee for the first couple of weeks after surgery. This needs to be worked on consistently to regain full extension as early as possible. Regaining early full extension allows patients to return to normal gait patterns quickly, and helps increase the recovery speed for exercises and activations. The early exercises given to improve the ROM of the joint are below:
o Heel slides
o Calf and hamstring stretching
o Half-moon revolutions on exercise bike
Muscle Activation
Following surgery our muscles are often inhibited from the anaesthetics used during surgery and also from the swelling and pain in the joint. It is important to regain our muscle activation quickly to allow for stability and strength to return to the knee joint so that gait (walking) training can be normalised as soon as possible also. Muscle activation exercises are designed to work the muscles through a suitable range, and reinforce the brain’s connection to the muscle tissue for a more controlled and sustained contraction when required by the knee joint. The following is the early exercises for activation for each muscle group that aids in knee stability:
- Quadriceps
o Static and inner range quad exercises with cushion under thigh/knee
o Mini wall squats
o Static lunge holds
- Hamstrings
o Static co-contraction with quadriceps; minimal work initially as tendon will be healing
- Glutes
o Sidelying straight leg raises, flexion and extension of hip
o Standing straight leg raises
- Calves
o Double and single leg calf Raises
Proprioception (Balance)
Following surgery it is important that whilst our activations and range of motion are improving, we can feel stable and balanced on our operated knee. This is done through proprioceptive exercises that allow us to feel where our knee is in relation to other parts of our body, in particular our hips and ankle. By doing these balance exercises we can better feel what position our knee is in and also how it relates to our hip and ankle alignment. This starts very simply through the following:
- Single Leg Standing 30-60 seconds
- Tightrope line Balance 30-60 seconds
Gait
Once we have been through all of the previous exercises and treatment above, our focus is to enable you to walk more normal. This a normal functional activity in life and sometimes this can be hard to retrain if not helped with our advice to remind you what ‘normal’ feels like. This is initially done through simple exercises such as:
- Full weight-bearing with assistance of 2x then 1x crutches
- Weight Shifting exercises side to side, and forwards/backwards
Want to know more about ACL tear recovery? please give us a call at (02) 8411 2050 to find out. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.