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ACLR Rehabilitation Therapist information

My Protocol for Physio and Rehab Regime

Outpatient Physiotherapy

Patient should be seen by physiotherapist 1 week post surgery

Week 1:

Eliminate swelling/inflammation
Adequate analgesia
Regain active quads and VMO control
Be able to perform SLR with no lag
Restore patella mobility
Maintain full hyperextension
Restore normal gait pattern
At least 90 degrees knee flexion
Patient confident with rehab process and goals

Patient education regarding rehabilitation
Patella mobilisations
Maintain 0-90 ROM
Quad strengthening- Closed chain- mini squats
Hamstring/ glut strengthening- Closed chain- Shoulder bridges (double leg)
Hamstring stretches, inc prone knee hangs
Calf raises (bilateral)
Hip Abduction/Extension, +/- theraband
Gait re-education, progress to FWB
Patient should then be seen at 2 weeks for removal of clips

Weeks 2-6:

Wean off crutches if not done so already
Eliminate any remaining swelling
Maintain full hyperextension
Gradual increase of knee flexion to full
Restore proprioception/ neuromuscular control, without torsional forces
Gradual return to normal ADLs
Return to driving when safe
Short haul flights only if essential

Remove clips
Advice on scar massage
Continue to strengthen quads- Wall squats, step ups/ step downs
Progress shoulder bridges onto gym ball/ single leg
Progress calf raises to single leg
Address any trunk / pelvic muscle imbalance
Proprioceptive re-ed: rope walking, heel/toe walking
Static bike
At week 6 there should be a follow up ACL clinic appointment with X-ray on arrival

Weeks 6-12:

Swimming, but no breaststroke until 3 months
Free cycling
Full squat
Unrestricted walking
Progress single leg strength
Progress proprioception wobble board, trampette, reaching out of base of support
Jogging on trampette with no pain/swelling
Hopping without pain or swelling
Maintain flexibility

NOTE: Exercise will progress during this stage, but the graft is at its greatest risk of failure during this stage as it is going through the process of revascularisation and ligamentisation.

Single leg squats
Single leg sit to stand
Wii fit
Skipping Jogging on trampette
Plyometrics- Progress from double leg to single leg
Can begin free cycling
Can return to golf 10-12 weeks
Open chain tibial rotation exercises
Able to fly long and short haul if necessary
Week 12- ACL clinic appointment and can return to physically active

Weeks 12-16:

Enhance lower limb confidence and function
Increase functional activities and endurance/general fitness
Maintain motivation
Able to hop and jump with good control and no exacerbation of symptoms
Able to walk 15 mins everyday pain free with no swelling immediately after and the next morning
Start running and gentle sport specific training

Progress plyometric work
Quick feet
Pivoting exercises/ figure of 8
Gentle sport specific exercises

4-6 Months:

Increase speed of balance reactions and improve coordination
Advice about returning to chosen sport and exercises to continue with
Prepare physical and psychological ability to complete return to sporting activity
Progress sport specific exercises and drills

Shuttle runs
Changes of direction at speed
Work on slopes (inclined bench- up, down, sideways, gradually increase speed and angle)
Work to fatigue point
Increase sport specific training gradually. Non competitive

6 Months- Return to sport

Return to training for chosen sport and may have started to integrate into competitive game

Advise 3 months training prior to full competition to retrieve skill levels and regain confidence
Emphasise importance of warm up and cool down