Post-Op ACL

19 Pages·2015·2.37 MB·English

CONTENT

POST-OP
PHASE PHASE
ACL
ONE TWO
INITIAL POST-OP PERIOD INITIAL STRENGTH & BALANCE
REHABILITATION
06 GENERAL INSTRUCTIONS 14 PHASE 2 GOALS
GUIDELINE
09 EARLY REHAB EXERCISES 15 BRACE INSTRUCTIONS ost-operative knee. PHASE FOUR: Phase 4 of rehabilitation
P
rehabilitation is is termed “athletic enhancement”.
essential in optimizing PHASE TWO: Phase 2 focuses on This is the phase where you will work
13 CRITERIA TO PROGRESS 15 PHASE 2 EXERCISES your function and restoring your range of motion and on sport-specific movement drills.
return to sport after an you should be able to ambulate without Although you will perform some
ACL reconstruction. crutches (unless advised otherwise). exercises and movements from earlier
21 CRITERIA TO PROGRESS The process of returning to physical and Phase 2 will also focus on restoring phases, you will be working on doing
athletic activities is not based on time, it your strength and balance sense these activities at higher speeds
is based on the individual’s ability to (proprioception). There is evidence until you progress to game speed.
achieve certain milestones or criteria. to show that strength deficits have a Conditioning drills for muscular
PHASE PHASE The time needed to do this will vary direct effect on functional outcomes endurance and cardiovascular
from individual to individual. Post- and return to sport. Proprioception is a conditioning are included in this phase.
operative rehabilitation begins the day sensory modality that provides internal Being released to return to sport is a
after surgery. There are four phases to feedback on the status of the body’s collaborative decision between your
THREE FOUR the post-operative rehabilitation. Your position, movement and alignment. surgeon and physiotherapist
compliance with this program will have Various balance exercises will be used or athletic trainer.
a direct effect on your function and to help improve and recover your
return to sport. proprioception. These exercises also It is important to understand that
help to regain strength. In subsequent patients may progress through the
PHASE ONE: The goals of the first phases when jumping, cutting and rehabilitation protocol at different
MAXIMIZING STRENGTH & SPORT READINESS
phase of the rehabilitaiton process are pivoting are emphasized, it is essential paces. In order to progress through
EDURANCE to minimize pain and swelling as well that the body is in correct alignment. each phase of the rehabilitaiton
as protecting your graft. You will start protocol, you should meet the criteria
range of motion exercises and early PHASE THREE: One primary goal in that phase before you progress to
22 30 strength exercises. During the first of Phase 3 is to eliminate strength the next phase of the rehabilitation
PHASE 3 GOALS PHASE 4 GOALS
phase of rehabilitation, the goals are differences between both legs. You will program.
to increase your range of motion and be doing strenuous strength training
23 32 strength, and return to walking without exercises three to four times a week. Commitment to following the ACL
PHASE 3 EXERCISES PHASE 4 EXERCISES
crutches. There is evidence that pain Often times it may be necessary to rehabilitation program is extremely
and swelling can hinder or inhibit your do more sets and repetitions on the important to the ultimate success of
29 ability to generate muscular force in surgical leg than the non-surgical leg your ACL surgery. Do not return to
CRITERIA TO PROGRESS your leg, especially your quadriceps. to eliminate the difference. You must high risk sports/activities before you are
Thus, it is important to minimize also be careful not “overuse” your ready.
swelling and pain to help restore your non-surgical leg while doing your
The following rehabilitation guideline is intended as a guide and does not represent a fully inclusive list of all interventions strength. Your ability to get stronger strengthening exercises. Other goals
that can be used in the rehabilitation process. The therapist should use their clinical experience/judgment to help guide their is limited if your knee is swollen. It is of this phase focus on core exercises,
patient through their recovery, consulting with the referring physician should questions arise. also limited if you can’t straighten your running, agility, and jumping drills.
4 Post-Op ACL » Rehabilitation Guideline 5
ACL Injuries Acute ACL
ACL injuries can occur in any age
group. The incidence is greater in
patients who partake in high risk
sporting activities.
INJURY
“THE GOALS OF SURGICAL TREATMENT ARE TO
HAVE A STABLE KNEE JOINT AND TO RESTORE
NORMAL STRENGTH AND FUNCTION IN THE
KNEE JOINT.”
he anterior cruci- movement of the tibia in relation and skiing. However, there are an ACL tear. A number of patients function in the knee joint. that continuing proprioceptive
T
ate ligament (ACL) to the femur. The weight-bearing some people who tear their ACL’s who tear their ACL may also injure The chance of re-tearing your ACL exercises and continuing to
is one of the four surface of the knee joint is cov- with seemingly minor mechanisms other structures in the knee after surgery is 5-15%. There is train your landing mechanics
strong ligaments ered by a layer known as articular of injury such a jumping off the joint such as meniscus, articular actually an almost equal chance of and deceleration will reduce
connecting the femur cartilage. This articular cartilage back of a truck or stepping into a cartilage and/or other ligaments tearing your other ACL, the risk your risk of ACL injury. You should
(thigh bone) to the allows the joint surfaces to move rut in the ground. An injury to the within the knee joint. In addition, being around 10-22%. The reason continue follwing the rehabilitation
tibia (shin bone). Ligaments are smoothly. The knee joint also has ACL results from overstretching many patients have bruises of the for the greater risk on the other side guidelines even after you are
strong, dense structures made of two shock absorbers known as the or tearing of the ligament. Inju- bone beneath the cartilage sur- is not entirely known. It may be due discharged from physiotherapy.
connective tissue that stabilize a medial and lateral meniscus. These ries of the ACL range from minor face. These bone bruises may be to your anatomy, compensation for There are several ACL prevention
joint. The function of the ACL is structures help reduce the stresses strains to more severe injuries seen on an MRI and may indicate your surgical knee and/or genetic programs found on the internet. A
to provide stability to the knee and between the tibia and the femur. where the ligament is completely injury to the overlying articular risk factors. Some of these risk good resource for soccer players is
minimize stress across the knee In general, the incidence of ACL torn. Any athletic or non-athletic cartilage. factors cannot be modified, but the Fifa 11 Plus warm up
joint. The ACL limits rotational injury is greater in people who par- related activity in which the knee The goals of surgical treatment there are measures you can take to program that is available on the
movements of the knee joint. It ticipate in high-risk sports such as is forced into hyperextension and/ are to have a stable knee joint and reduce the overall risk of another Fifa 11 Plus website.
also restrains excessive forward soccer, basketball, football, rugby or internal rotation may result in to restore normal strength and ACL tear. Research has shown
6 Post-Op ACL » Rehabilitation Guideline 7
Control Pain: You will be sent home with a
prescription for a strong narcotic medication. You
PHASE
should take this medication for severe pain, as
directed on the prescription bottle label. If you had a
femoral nerve block and have not taken any narcotic
ONE medication, you may want to take the prescribed
medication dose before you go to bed as there is a
possibility that you may wake up with significant
pain when the nerve block wears off. Most patients
take the narcotic medication fairly regularly for 2
EARLY POST-OPERATIVE PERIOD
-3 days and then wean off this medication. For the
first few days, you may also find it beneficial to take
Weeks 0 - 2 ®
an anti-inflammatory such Ibuprofen (Advil ) 400
mgs every 6 hours (as long as you don’t have any
contraindications to taking this medicine) AND
Tylenol (Acetominophen) Extra Strength 2 pills every
6 hours (as long as you are not taking a medicine with
®
Tylenol in it like Tylenol with Codeine or Percocet
which also contains Acetominophen). Taking this
ELEVATE & ICE
combination of medication regularly for the first few It is very important to elevate your leg
days after surgery as well as using ice will help control and apply ice or use your cryotherapy
device on regular basis to help reduce
your pain and you may find that you do not require as
swelling and control pain
much narcotic medication after surgery.
Control Swelling: Following discharge from
post-op visit. You also have
the hospital you should go home elevate your leg and “ During this phase, the goal is to control pain and swelling. It is
black stitches in the portal
G regularly apply ice to the knee (5 times per day for 20 important to keep the leg elevated as much as possible. It is also
minutes at a time). Do not put ice packs directly on important during this phase to prevent shutdown of the quadriceps sites, which will also be re-
oals:
the skin as this may cause damage to the skin. If you muscles by performing the exercises included in this rehabilitation moved. You may shower two
purchased or rented a Cold Therapy Unit, please use document. days after surgery as long as
you keep your wounds clean
this unit as directed by the manufacturer. You may chance of getting blood clots. If weight on the leg. Make sure that
and dry. Be careful not to slip, twist,
• Control Pain and Swelling get up as tolerated. As your pain and swelling de- you develop calf pain and/or short- you wear your long leg post op
or fall. It is a good idea to place
crease you can start to move around more and spend ness of breath after surgery, you hinged knee brace whenever you
• Achieve and Maintain Full Passive a stool or bench in the shower so
more time up on your crutches. Applying ice, gel should go to your nearest Emer- are up and moving around. Please
you can sit on it. This will be more
Extension packs or using the Cold Therapy Unit are very effect- gency Department immediately. DO NOT put any pillows directly
comfortable for you and will help
ive ways to reduce pain, swelling, inflammation and A blood clot cannot be diagnosed under your knee as this promotes
• Prevent shutdown of quadriceps minimize injury to your knee. Do
narcotic use. over the phone. a bent knee position. You may
not soak in a bathtub, hot tub, or
muscles Blood Clot Prevention: If you have a personal Stool Softener: While on nar- remove the initial dressing and pool until you are cleared to do so.
• Gait Training or family history of blood clots, you need to let the cotic medication it is wise to take a apply bandaids to the wounds 1 - 2
Once you are done showering pat
surgeon know before your surgery. If you are on the ® days after surgery. Please keep your
stool softener such as Colace (or the wound dry. You may develop
• Protect Reconstruction birth control pill, are a smoker and/or have an in- wounds clean and dry. Try to leave
other stool softener). Take 1 tablet a painful swelling, redness +/or
creased BMI, you may want to take one baby Aspirin the steri strips in place until your
daily with a plenty of water to help bruising in the front of your shin
daily to help thin the blood and possibly reduce the first post-operative visit. You have
ease the risk of constipation after area. If this swelling develops, it
chance of developing a blood clot. You can take this an absorbable suture under these
surgery. can be very uncomfortable. This is
in addition to the Ibuprofen. It is important to per- steri-strips but the ends of this
Caring for your knee: typically not an infection; it is the
form calf pumps and move around to help reduce the suture will be cut during your first
You are allowed to put 30% of result of blood tracking down your
8 Post-Op ACL » Rehabilitation Guideline 9
leg from the surgery. It is known as periostitis. If multiple ligaments as well as the
this occurs, make sure that the brace is not too tight, ACL recontruction: your brace will be set
as the swelling will accumulate between the straps of
around 0 - 30 degrees to 0 - 45 degrees. Your
the brace. You may find it more comfortable to open
brace should remain on your knee unless you are
your brace if you are in a protected environment and
showering or undergoing physiotherapy unless
apply ice to your shin area to reduce the swelling and
you are advised otherwise.
pain. It is also important to elevate your leg several
• If you have had an ACL reconstruc-
times a day to help reduce the swelling. Make sure
tion and/or trimming of your
you take Ibuprofen as outlined above in pain control
meniscus (meniscectomy): you may
section.
unlock your brace 1 - 2 days after surgery.
You may also notice an area of skin numbness around
your knee or down your leg. Unfortunately, this is
Please follow the specific post-operative settings that
one of the risks of having knee surgery. It does not
have been recommended for you in your post-oper-
cause any motor weakness or impair the use of your
ative instructions. Please be very careful on uneven
leg. This may or may not improve in the months fol-
ground, slippery surfaces and stairs to minimize
lowing surgery.
falling. You may remove the knee brace while doing
exercises or if you are in a safe, protected environment
(there may be limitations if you have had a meniscus
repair with sutures/anchors). The long leg post op
One of the most important goals of this phase is to ensure that you regain your full extension
hinged knee brace should be worn while sleeping for
of your knee joint. Please do not place a pillow directly under your knee joint as this will
the first week. After your first post-op visit, you may
promote a “bent knee” position in the knee joint. It is also important to walk with a heel to toe
be able to switch over to your custom fit ACL brace if
gait when ambulating with your crutches.
your swelling allows and you can comfortably fit into
the custom fit knee brace. You can bring your custom
fit knee brace with you to your first post-operative CRUTCH ANKLE KNEE
appointment. The custom fit brace should be worn at
all times when you are awake and moving around for Walking Pumps Extension
approximately 2 months post-op to protect your graft.
Generally, it is recomended that you wear the custom
BraCe: fit knee brace for high risk activities for at least 12 1 Please walk with a heel 2 The foot and ankle 3 Passive extension of the
months (or more) after your ACL surgery. to toe gait using your should be actively knee by using a rolled
Your brace will be locked at zero degrees (full exten-
crutches and your post- “pumped” up and down towel under your heel.

sion) when you leave the operating room.
operative hinged knee 10-20 times every hour. Note the towel must be
follow-uP: A follow-up visit should be scheduled
brace. You should aim to put 30% This will help reduce swelling in high enough to raise the calf and
After 24 - 48 hours, you may unlock your brace to around 2 weeks following your surgery. If you do not
weight on your operative leg un- your lower leg and may help reduce thigh off the table.
whatever setting has prescribed by your surgeon. If have an appointment, please contact the office.
less instructed otherwise. In order the risk of blood clots in your leg. • Remove the knee brace from
you have a brace similar to the one in the picture your knee every 2 - 3 hours
to get a sense what 30% of your It is also helpful in maintaining
above, you need to click the red unlock button on Dr. Coady: 902-473-2575 while awake. Position the heel
weight is, place your foot on a scale tone in your lower leg muscles.
both sides of the brace. The brace is generally set Dr. Wong: 902-473-7626 on a pillow or rolled blanket
and place roughly 1/3 of your body with the knee unsupported.
from zero degrees to 90 degrees. The brace may be
weight on your foot. Please aim to • Passively let the knee sag into
set at a different setting if you had suturing or your
During this visit your sutures will be removed, your walk with a heel-to-toe gait. full extension for starting at 1
meniscus or a multi-ligament reconstruction of your wounds and your range of motion will be assessed minute and increase to 5 min-
knee. utes. Relax your muscles, and
(especially full extension). Instructions will be pro-
• If you have had suturing/anchoring vided to you regarding your weight bearing status and gravity will cause the knee to
sag into full extension. Do not
of your meniscus and/or repair of progression as well as your brace during this visit.
hyperextend your knee.
Copyright Dalhousie Orthopaedics
10 Post-Op ACL » Rehabilitation Guideline I Q Wall
sometrIc uadrIceps
c
ontractIon
This exercise may be performed in a Slides
sitting or laying position (1). Start by fully
straightening your knee. Tighten the muscles
in the front of your thigh (quadriceps) and
hold the contraction for 5 - 10 seconds (2). ie on your back and foot up until the knee is fully
L
Repeat this six to ten times. Please do these
place your operative extended. Repeat 15-25 times, and
exercises every hour that you are awake. At
foot up on the wall. perform 3-5 times per day.
first, you may have difficulty initiating this
isometric contraction but please continue to Slowly slide your foot You can incorporate an isometric
try to do this exercise and eventually it will down the wall as far as possible. leg press while in this position.
become quite easy to perform. This exercise is
You may use your other foot to Bend your knee to 90˚ then push
very important to perform early in your rehab
to minimize quadriceps muscle wasting. push the involved foot farther into the wall for 10 seconds. You
down the wall. You will feel some should feel the muscles in your
pressure in the front of the knee. thigh tightening. Repeat 15 times.
Hold for 5-10 seconds. Now slide
Heel Slides
With Assist
hile lying on your slide the foot back until the knee
MUSCLE STIMULATION W
back with your brace is fully extended. Repeat 15-25
If you have a personal muscle
stimulator unit, you may use it as off, place your good times, and perform 3-5 times per
directed by the manufacturer post- foot in front of your day.
operatively. If you do not have one,
foot on the operative leg and
muscle stimualtion will be used
gently bend your knee as far as
during your physiotherapy sessions
in addition to other modalities. possible towards your hips. At
this point it is normal to feel some
PhySiotheraPy: Rehabilitation “ It is extremely important to start activating your pressure in the front of the knee.
after patellar stabilization surgery Hold this for 5-10 seconds. Now
quadriceps muscles as quickly as possible after surgery.
requires careful monitoring by
You may find it difficult to contract your quadriceps muscles
a physiotherapist. This protocol
initially, but with steady practice, it will return. This should be
is not meant as a home exercise
Hip
your main focus during PHASE ONE of your rehabilitation.
program. Each patient should have
a discussion with their physiother-
Adduction
apist about how to best utilize the P M
atellar obilizations
physiotherapy visits that they can
P alpate the edge of your
afford. Patients will generally need
patella (kneecap) with
While lying with Progress to 30 times holding
physiotherapy care and guidance your fingers. Then gently P
glide the patella in four your knees bent as each contraction for 10 - 15 secs,
for 6 - 12 months post-operatively.
directions; up, down, shown, squeeze a resting for 5 secs between reps.
The patient should be seen by the to the inside (medial) and to the
soft ball or a pillow
physical therapist one time per outside(lateral). Try not to tip or tilt
the patella, but slide it. Hold for 2 between your knees. You should
week. If ROM is severely limited,
seconds at the end of each glide. This feel your inner thigh muscles
the patient should be seen 2 - 3 will prevent scar tissue from forming contracting (tightening) when you
around the patella. This exercise is
times per week and the MD should are doing this exercise. Perform
particularly important if you had
be notified an autograft patellar tendon graft to this exercise 5 - 10 times holding
reconstruct your ACL. Glide in each each contraction for 5 seconds.
direction for 1 minute, and perform
3-5 times per day.
s p K F :
IttIng assIve nee LexIon
Sitting with knees flexed to 90
B C
degrees, place your “good leg”
13
foot in front of your operative
leg foot. Gently push backwards
to passively flex your knee Post Op Hinged
past 90 degrees. Perform this
Knee Brace
exercise at least 3 - 4 times per
day with 5 - 10 repetitions each
time.
s p K e :
IttIng assIve nee xtensIon
B C
Sitting with knees relaxed. Place
your good foot under operative
leg (1) and slowly bring your EXERCISES
knee into full extension (2).
Perform this exercise at least
• You may do hip exercises as tolerated.
3 - 4 times per day with 5 - 10
repetitions each time. • You may do straight leg raises with brace
locked in full extension. You need to be able to
contract your quadriceps muscles well before you
attempt this exercise. Do not do this exercise at
L H e :
yIng Ip xercIses
this stage without locking the brace in extension.
B (1) Lying on your side, lift leg C
• You can also perform resisted ankle exercises
upward and hold for 5 seconds.
using a Theraband® (resistance band).
(2) Lying on your stomach, lift
leg upwards, tightening your
gluteal muscles and hold for 5
seconds.
returning to SChool/work:
CRITERIA TO PROGRESS TO
Repeat both of the exercises 1) As far as returning to school, when
5 - 10 times per day (10 reps). you are comfortable and you can safely PHASE TWO
maneuver around, you may return to
school. You may need to use an eleva-
tor at school initially if this is available.
standIng mInI-sQuats: Please be careful on uneven and slip-
Choose between (1) or (2) B C pery surfaces. • Minimal pain to allow for exercise
2) In terms of returning to work, please
(1) Stand upright with hands
discuss this with your surgeon. If you progression
supported on a table OR (2)
need to drive to get to work, you will
Stand upright against a wall .
need to have someone drive you until • Full Knee Extension
Tighten your core, gluteal and
you are safe to drive on your own. This
hamstring muscles. Gently • Ability to activate quadriceps muscles
will depend on which leg is operated
squat down 30 - 45 degrees and on, whether you have a standard or
• Able to progress to full weight bearing
hold for 5 seconds. Repeat 5 - automatic vehicle as well as on your
10 times. Do not let your knees progress with the rehab.
extend past your toes.
Copyright Dalhousie Orthopaedics
14 Post-Op ACL » Rehabilitation Guideline 15
Control Pain: It would be anticipated that you
should wean off any narcotic medication by this stage.
PHASE
If necesary, use an anti-inflammatory medication such Strength & Balance
® ®
as Ibuprofen (Advil , Motrin ) 400 mgs every 6 hours
This phase emphasizes progressive
(as long as you don’t have any contraindications to
activation of the quadriceps muscles
®
TWO taking this medicine) and/or Tylenol Extra Strength
as well as the other muscles in the
(Acetominophen) 2 pills every 6 hours (as long as you
lower leg. It also emphasizes core
are not taking a medicine with Tylenol in it such as
® strengthening and balance.
Tylenol with Codeine or Percocet which also con-
tains Acetominophen). Do not take more than the
Initial Strengthening and
allowed dosages per 24 hours for these medications.
Balance Phase
The need to take this medication should diminish
significantly during this phase.
Weeks 3 - 8 Control Swelling: It is still important to apply
ice regularly or continue to use your Cold Therapy
Unit. If you still have significant swelling in your leg,
you should continue to elevate your leg. Applying
ice or using the Cold Therapy Unit is a very effective
way to not only help with swelling but it is also very
helpful with pain control.
Caring for your knee:
Once you have had your sutures removed, you may
shower or bathe in a bathtub and you do not need to
cover your wounds. Continue to be very careful not
to slip, twist, or fall. If necessary, you may want to
G continue with a stool or bench placed in the shower so BraCe: range of motion: exerCiSeS:
you can sit. Patient who had suturing of their menis- • ACL Reconstrucion: You can • ACL Reconstruction: You During this phase it will be import-
oals:
cus need to be especially careful. transition into your custom fit should aim to achieve at least ant that you work on strengthening
weight Bearing: ACL brace whenever you can fit 90 degrees of knee flexion by of your quadriceps, hamstrings and
into it. You do not need to wear 2 weeks post-operatively and your gluteal muscles. You will also
• ACL Reconstruction: You may progress to
your brace while sleeping. 120 degrees of knee flexion by 6 be working on exercises that will
full weight bearing with crutches. When you are
• Control Pain and Swelling
weeks. It is anticipated that you help you regain your core strength
safe, have a normal walking gait and have good
• Progress to full weightbearing quadriceps control, you may discontinue the use • ACL Reconstruction & should have near normal range as well as your proprioception/bal-
Meniscus Repair with Su- of motion by 6 - 8 weeks posop- ance. Please follow the following
of your crutches.
• Quadriceps muscle strengthening,
tures/Anchors: Continue eratively. exercises. Of note, patients who
• ACL Reconstruction & Meniscus Repair
especially VMO wearing the post-op hinged • ACL Reconstruction & have had a meniscus repair with
with Sutures/Anchors: You may progress to
knee brace day and night. Meniscus Repair with sutures/anchors will progress at a
• Gradual range of motion improve- 50% weight bearing and increase to WBAT over
please follow the follow- Sutures/Anchors: Although slower rate due to the recovery pro-
the next 2 - 4 weeks as directed by your surgeon.
ment (0 → 900 by week 6) ing recommendations unless your brace will be set as out- cess involved in having a meniscus

advised otherwise:
lined above, under the guidance repair.
In order to stop using crutches, you must be able to
• Continue to protect reconstruction ▶ 0-30 degrees for weeks 0 - 2
of your physiotherapist, you
walk without a limp while using crutches. Continue
▶ 0-45 degrees for weeks 2 - 3
may remove the brace to gently
to use your crutches until you can fully weight bear
▶ 0-60 degrees for weeks 4 - 5
progress your range of motion
and have good quadriceps control.
▶ 0-90 degrees for weeks 5 - 6
as tolerated. You need to be

careful of squatting/kneeling.
Copyright Dalhousie Orthopaedics
he exercise bike is one of the safest and
T most effective ways of building up the
muscles in your leg as well as improving 17
your endurance. A recumbant bike
might be easier to use initially if you
have access to one. Set the seat height so that when
you are sitting on the bicylcle seat, your knee is
almost fully extended with your heel resting on the
pedal. You may be only able to partially pedal the
bike initially. Keep working on it until you are able
to pedal freely. Start with 5 - 10 minutes on the bike
with little resistance. As your mobility and strength
in your leg improve, you may start increasing the
resistance on the exercise bike as well as the amount
of time you spend on the bike.
An elliptical machine is also a great way to build
muscle strength and endurance. It is a low impact
activity that has the added benefit of working your
PHASE
upper and lower body.
p H :
rone angs
TWO
If you are having difficulty regaining full extension
in your knee, please do this exercise. Lie on your
p H :
rone angs
stomach with your brace off and your knees and
lower legs hanging off the bed or table. Try to keep
your hips down on the table. You may place a small
&
STRENGTH BALANCE
weight on your ankle or use the other foot to apply
some downward pressure onto the heel to increase
the stretch. You should feel some stretching and mild
discomfort in the back of the knee. Hold this for 30 to
60 seconds, rest for 30-60 seconds, repeat 3-5 times
consecutively, and perform 3-5 sessions per day.
Elliptical
g s :
LuteaL Queezes
Lying on your back with your arms rested
by your side. Squeeze your buttocks (gluteal
muscles) and lift them upward off the bed. Use “ During phase two, the R emember to allow progress at a different rate. Patients
your gluteal muscles to do the work. Support focus is on regaining pain and swelling to who have had a meniscus repair with
be your guide on how sutures/anchors and patients who have
the weight on your shoulders, do not strain your your range of motion in your
you progress through had multiple ligaments repaired will
neck. Hold for 5 to 10 seconds and then lower.
knee as well as working on
the rehabilitation progress through the rehabiliation
Start with one set of 10 and gradually increase to
regaining your lower leg process. The rehabilitation phases program slower initially than patients
two sets of 15 repetitions. gLuteaL sQueezes:
strength and balance. serve as guidelines for you and who do not.
you may take longer to achieve the
proposed guidelines. It is important
to understand that each patient may
Copyright Dalhousie Orthopaedics
Continue working on your hip Hip
and gluteal exercises as outlined in
phase I. Lie on your side on a flat Abduction
19
surface. Holding your leg straight,
lift off of the bed / flat surface. Hold
and squeeze your gluteal muscles
for 2 - 4 seconds then lower back to
the resting position. Contract your
abdominal muscles and keep your
core engaged. Repeat 5 - 10 times.
Start by standing on a flat surface.
Stand tall with your abdominal
muscles tightened. Rest your
Balance hand(s) on a sturdy object for
balance. Raise your heels a few
Exercises inches off the ground. Hold the
position for 3 - 5 seconds, lower
Calf and repeat 10 - 15 times. As you

get stronger, you may perform this POOL PROGRAM: A pool program is an excellent way to recover from your ACL surgery.
exercise on the edge of a stair or
Raises You may do the flutter kick, easy jogging in waist deep water and/or running in deep water
using a platform.
with an aqua-belt. Avoid doing the whip kick and flip turns in the pool initially while you are
recovering from your surgery.
Stand with you back flat against a
Wall
sturdy wall and place a lightweight ball PHASE II
between your thighs (just above your EXERCISES
knees). With straight legs, walk your Squats
Balance
feet forward until they are roughly 12
inches in front of the wall. Keep your
With Ball
Ebacxk flate agairnstc the iwsall aend sqsueeze
against the medicine ball with your
inner thighs as you bend your knees to
Squeeze
squat down. Make sure that your knees
don’t extend past your toes. Hold this Strength & Balance
STRENGTH
squat for 20 seconds,
&
BALANCE
Single Weight Shifting: START with this
balance exercise first. Stand with both
feet on the ground. Slowly shift your
Leg weight from your non-operative leg to
Balance your operative leg. Slowly increase the
amount of weight supported through
Stance
your operative leg.
Exercises
Single Leg Stance: Once you are
comfortable with weight shifting to
Single Leg your operated leg, you can progress to
Stance balancing on one leg. Stand on your
operative leg for 5 seconds and slowly
increase the amount of time you can
balance to 20 seconds. Repeat 5 times.