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Outpatient and Physical Therapy for ACL Tears

Monday, July 9, 2012 - 15:29

About a week after the surgery, the physician will inspect the knee and discuss a rehab program. This will be done on an outpatient basis and may begin one to two weeks after surgery.

Need To Know:

The rehabilitation program following ACL reconstruction is very important and has a significant impact on the outcome of the knee.

Many therapy programs follow specific guidelines and protocols developed by the physician. The following is one example of a rehabilitation program. However, programs may vary and need to be followed per physician protocol.

  1. Phase One (first couple of weeks after surgery)
  2. Phase Two (weeks three and four)
  3. Phase Three (week four to six)
  4. Phase Four (week six to eight)
  5. Phase Five (week eight to 10)
  6. Final Phase: (return to activity)

ACL Post-Surgical Program

1. Phase One (first couple of weeks after surgery)

This period of the rehabilitation is called the early rehabilitative phase. This phase focuses on decreasing the pain and swelling following surgery.

Many of the exercises described earlier are included in this phase as they aim to:

  • Improve range of motion
  • Promote muscle activity and strength

If the individual is using any form of cane/crutch for walking, this is generally discontinued at this point unless otherwise required by the surgeon.

2. Phase Two (weeks three and four)

In the second rehabilitation phase (three to four weeks after surgery), more attention is placed on joint protection as the pain has mostly disappeared and the individual may want to try more things that the knee is not ready to perform.

Key areas and examples of exercises of this phase are:

  • Being able to bend the knee zero to 100 degrees.
  • Water exercises may be recommended either at the clinic or within the home program, such as knee bending/straightening and pool walking with emphasis on forward, backward, and sideways movement.
  • Mini wall-squats may be performed, beginning by standing with the back to the wall, then lowering the body by bending at the knees to approximately 45 degrees and returning to an upright position. Progressing from standing on both legs to standing on the surgical leg only can advance this exercise
  • Stair-master machines in a sitting position are beneficial, as is the use of a stationary bicycle.
  • Emphasis on balance activities is addressed at this point. Further strengthening with step-ups is useful (forward, backward, and side-to-side using a step with a height of two, four, and six inches respectively).
  • Leg-press machines are used within a pain-free range of motion.
  • Progress using a stair-stepper from a sitting position to a standing position at three-four weeks if good quadriceps control is present.

3. Phase Three (week four to six)

Referred to as the controlled ambulation phase, week four to six includes all the former exercises plus a few more.

Key areas and examples of exercises of this phase are:

  • Aim to bend the knee from zero to 130 degrees
  • Single leg mini squats
  • Single leg bridges
  • Step up/step downs with a four-eight inch step
  • Calf strengthening and stretching
  • Increased resistance on the stationary exercise bike

This is an important time for exercises requiring improved balance both in the clinic as well as the home program:

  • While standing on a pillow or a roll of foam 6 inches thick, reach forward as far as possible with hands clasped together at 12, three, six and nine o'clock patterns without losing balance.
  • Gait training on the treadmill, using a slight incline and progressing to pedaling backwards.

4. Phase Four (week six to eight)

Week 6 to 8 is referred to as the moderate protection phase.

Key areas and examples of exercises of this phase are:

  • Full range of motion of the knee
  • Weights may be added to gradually increase resistance to existing exercises

5. Phase Five (week eight to 10)

This light activity phase at eight to 10 weeks after surgery places additional emphasis on strengthening exercises with increased concentration on balance and mobility.

Key areas and examples of exercises of this phase are:

  • Lunges, which are appropriate if the knee can bend in a pain-free manner to 90 degrees.
  • Repeatedly stepping up and down a height of four to eight inches, which is useful for developing quadriceps control.
  • Stepping exercises using the resistance of a sport cord, which can be the next progression of this exercise in this period.

6. Final Phase: Return to Activity

The final phase starts at about 10 weeks and continues until the desired activity level is reached. Key areas and examples of exercises of this phase are:

  • If necessary, fitting of a functional brace for athletic activities and /or work situations.
  • Jogging on treadmill with no sudden starts and stops can be started at this point, as well as moderate intensity agility drills using box jumps while wearing the functional brace.
  • Many surgeons will request isokinetic testing (a type of exercise where resistance is at a constant preset speed) at three and six months, with the addition of functional tests such as the timed hop, hop for distance, and cross-over hop.

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