Acl surgery recovery protocol

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ACL Surgery Recovery Protocol



Jon Haver, 2011

About Me

ACL Surgery Recovery Protocol

My name is Jon Haver. I have torn my right ACL twice and will use this site to share what I have learned to do and not to do during ACL surgery recovery.

So how did I get here?

Well in sep 2007 I tore my right cal playing rugby at university. It was a clean tear and was misdiagnosed, it was not until some instability while skiing that I went and got a second opinion. Eventually an MRI confirmed it was torn.

In sep 2008 I had acl reconstruction with a right hamstring graph. Recovery went well and I was able to be skiing after 4 months. Based on my doctor clearing me and feeling confident after a good winter of skiing I decided to play soccer in may of 2009... 8 months after surgery....bad idea

Re-Tear My Right ACL

My fianc?(wife now) was convinced I was pushing it too quickly to play and her exact words were "you shouldn't play but if you insist I will come because you are going to need someone to drive you to the hospital when you re-tear it" well I certainly should have listened to her. The good news is I was able to drive myself home as I would have never lived it down if I had to get a ride to the hospital.

Because I was getting married, had just started a new job(project engineer with an oil and gas company in Canada) and was still able to function ok I delayed getting surgery until a more convenient time, December 8th 2010.

My goal with this surgery and rehab is to get myself into a position where I can enjoy my key sports again Skiing, Mountain Biking, Tennis and if all goes well Soccer(eventually).

3+ Years of Knee Pain

Having suffered through over 3 years at this point of having a bad knee I am very modivated to make sure I do everything I can during my ACL surgery recovery to make sure my knee is as strong as it possibly can be.

Share what I have learned about ACL Surgery Recovery!

On this site I will share practical information including post ACL surgery exercises, ACL surgery recovery timeline and my personal story of how I deal with the recovery for a second time.

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ACL Surgery Recovery Protocol

ACL Surgery Recovery Protocol



ACL Reconstruction - Rehabilitation Protocol

Terminology

CKC: Closed Kinetic Chain; exercise with the foot in contact with a surface, ie: leg press, squats, lunge Concentric: the muscle is shortening while it is contracting (`positive contraction") Cybex Test: strength testing machine that can measure force, work, and power of muscle groups. Eccentric: the muscle is lengthening while it is contracting (`negative contraction") Extension: straightening Flexion: bending FWB: Full Weight Bearing Hamstrings: muscles in the back of the thigh Isometrics: tightening/contracting of a muscle without movement of the leg OKC: Open Kinetic Chain; exercise when the lower leg is moving freely ie: leg extension Plyometrics: exercises that enable a group of muscles to reach a maximum strength in as short a time as possible. It tries to bridge the gap between speed and strength training. Prone: lying on your stomach Quadriceps: muscles on the front of the thigh ROM: Range of Motion; amount of bending and straightening of the knee Supine: lying on your back

ACL Surgery Recovery Protocol

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ACL Surgery Recovery Protocol

0-2 Weeks

Goals: Patient education re: gait, ice, strength of repair, do's & don'ts, Increase ROM (0-90 degrees) Decrease pain and swelling Maintain flexibility of lower extremity Balance/proprioceptive re-education Strengthening: quadriceps, hamstrings, hip, calves

Gait: Weight bearing as tolerated with crutches between 2- 6 weeks. The physiotherapist will determine progression of 2 to 1 crutch. Must have full knee extension and walk without a limp before walking without crutch use.

ROM: Bike circles: high seat ? circles fwd/back -> full circles -> lower seat Slider board Heel slides Ankle pumping Prone leg hangs Modalities: Ice; Interferential current therapy; Muscle stimulation Flexibility: Calf stretches seated with towel; Seated hamstring stretches; Supine hip flexor stretches Balance/Proprioception: 1 foot standing 30-60 seconds eyes open->closed.

Strength: Quads: CKC exercises ? quadriceps tightening (isometrics) seated and in standing, weight shifting, sit to stand, static lunge, mini squat, squats on shuttle Hams: isometrics , prone knee flexion, standing knee flexion to 90 degrees Hip: standing flexion/extension/abduction/ adduction, prone hip extension, side lying adduction/abduction Calves: standing heel raises 2->1 foot, shuttle heel raises

ACL Surgery Recovery Protocol

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ACL Surgery Recovery Protocol

3-6 Weeks

Goals: Achieve near or full flexion and extension Continue flexibility exercises Normal FWB gait Maintain cardiovascular fitness Continue strengthening hams, quads, hip, calves Add on balance/proprioception

ROM: Continue as outlined Pool: walking, squats, knee flexion, step-ups & downs Flexibility: Continue as outlined Gait: Normalize to full weight bearing Cardio: Bike ,Stairmaster , Pool: swim/jog (no whip kick)

Strength: Quads: step ups 4-6-8" step fwd/lateral, ? wall squats, shuttle leg press 2->1 leg, bungy lunge, squats with pulleys Hams: seated chair walking, standing knee flexion with weight/pulleys, seated knee flexion with bungy cord, seated ham curls, reverse stair-master Hip: standing abduction/adduction/extension with pulleys/ tubing Calves: heel drops, shuttle drops, mini-tramp bouncing, single heel raises

Balance/Proprioception: standing 1 foot eyes closed -> balance board, wobble board

ACL Surgery Recovery Protocol

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ACL Surgery Recovery Protocol

6-9 Weeks

Note: Graft is at the weakest point now, Avoid OKC exercises

Reasons why open kinetic chain (OKC) exercises (ie: leg extensions especially with weight) are contraindicated after ACL reconstruction:

When the quadricep muscle contracts with the above exercises, the lower leg (tibia) is pulled forward (shears) in relation to the upper leg (femur). This shear directly stresses the reconstructed ACL graft. It is believed that these shearing forces may lead to stretching of the ACL graft that may result in increased laxity. Shearing is minimized if the force is maintained down the whole leg during muscle contraction (i.e. foot is fixed), and therefore CKC exercises are recommended.

Goals: Full pain free ROM Increase cardio fitness Continue to strengthen hip and calves Intermediate proprioception Functional quads strength Concentric-eccentric hams strength

Cardio: Bike, fitter, stairmaster, swim (flutter kick only), pool, jogging , treadmill power walking

Strength: Quads: stairmaster fwd/bkwd, bungy lunge in different directions, clock face lunges, squats with pulleys increasing weight Hams: backward walking, ham curls progress concentric - eccentric Hip: increase weight standing abduction/ adduction/ extension with pulleys/tubing, tubing kick backs, fitter Calves: as above with an increase in weight

Balance/Proprioception: balance board progressions, wobble board progressions, trampoline balance

ACL Surgery Recovery Protocol

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