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Knee Rehabilitation – Part 2

knee 2

Rehabilitation of ACL injury post surgery

After surgery for my ACL reconstruction I followed a 12-16 week rehabilitation program focused on rehabilitating the knee from post surgery back to everyday lifestyle and the ability to play sport again.

Week 1

Week 1 of the rehabilitation program is what happens directly after surgery. During this period it is important to follow the basic RICE rule to enable swelling of the knee to go down and to work towards basic range of motion of the knee (0 degrees- 90 degrees).

Focus of week one:

–                      Allow swelling of the knee to come down

–                      Focus on being able to bare weight on knee operated on

–                      Slowly progress to not needing the crutches when walking around on flat surfaces (use when necessary to prevent risking further injury)

–                      Regaining basic range of motion of the knee joint (e.g. ability to bend knee to 90 degrees and ability to straighten leg to 180 degrees or as close as possible

–                      Working on building strength of knee back (e.g. single led stands, adding small squats while maintaining good control)

 

Week Two to Four

During this period you should be looking to work with a physiotherapist to gain a better perspective and direction of how to approach your rehabilitation post surgery. They give you good direction in terms of specific exercises, how knee is coping with exercises, when to push program up or when to hold back to allow knee recover further. You should be aiming to spend more time walking around without using crutches. Look to increase walking time outside up to 15-20 minutes per day (ensuring that the surface is appropriate for good knee control). Practice walking sideways and backwards making sure that control of knee is good.

Focus of week two – four:

–                      Continue to work on range of motion of the knee joint (by this stage you should be able to straighten knee 180 degrees without difficulty/ bending the knee with ease to 90 degrees with the support of the non operated knee)

–                      Progressing the standing exercises for strengthening knee to not needing to hold onto anything for support, increasing time spent on one leg and doing small knee bends with eyes closed (helps to engage the small muscles in the knee to work again)

–                      At this stage working on the hamstrings for strengthening should be brought into the rehab program

–                      Ensuring that without difficulty once knee can bend and extend through ranges of motion bring in light cycling, building up the time each day without too much resistance at this stage

–                      If you have access to a pool it can be helpful in early stages of rehab e.g. aqua jogging and light kicking (avoid breast stroke kick as this involves abnormal knee movement)

–                      If you have access to a gym refer to physiotherapist of exercises suitable for this stage of rehab program (should be working on light building up of knee muscles again)

Week Four to Ten

–                      During this period you should be able to maintain 30 minutes cycling (per session) adding in some resistance for short periods to work muscles harder

–                      You should be walking up to 30 – 40 minutes each day, increasing stride length and speed when comfortable. Also start walking large figure eight circles decreasing size and increasing speed when confident (refer to physio for further exercises and recommendations)

–                      During this stage some people may be ready to start jogging lightly (8 – 10 weeks post surgery). Ensure that the ground is even and jogging is done in a straight line (keeping stride short and slow to avoid limping)

–                      Further work in the gym should be done with your physiotherapist on strengthening exercises for the knee and hamstrings

–                      During this stage the physio will ensure all is going ok with knee (e.g. walking alignment of knee, strengthening of knee and ensuring balance is back to good control

Week Ten to Sixteen

During this stage you are at the end of the rehabilitation program. By this stage the knee should be back to full strength or close to it.  You should be cycling for up to an hour or more on the open road doing lots of hill work to build muscle strength.  Running should be increased (time, speed and distance) also including changes of direction and agility.  From this point focus needs to be on finishing rehabilitation (when time is right entering competitive sports training and then competitive contact sport)

Focus of week ten – sixteen

–                      Cycling should be done up to five days a week each session being one hour or more. It needs to be challenging e.g. adding hill work, increasing speed and increasing distance

–                      Running should be increased in distance, speed and agility

–                      During this stage work in the gym should be largely based on plyometric exercises (e.g. squat jumps walking lunges etc.). Also weights should be added during this stage to challenge you and further build muscle. Refer to physiotherapist’s advice of type of exercises to do during this stage.

–                      If looking to go back to playing sport your physiotherapists should look to add in general sports type exercises to ensure that you are ready for sport specific training  (e.g. coordination drills, balance, hopping, jumping, landing, running and plyometrics)

–                      You can start training for competitive sport after 6 months from surgery once you are confident jogging and passed a fitness test

–                      You may be ready for competitive contact sport by 9 months following surgery

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