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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:  

Goals:

  • 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

Actions:

  • 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: 

Goals:

  • 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

Actions:

  • 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:

Goals:

  • 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.

Actions:

  • Single leg squats
  • Lunges
  • 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:

Goals:

  • 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

Actions:

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


4-6 Months:

Goals:

  • 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

Actions:

  • Shuttle runs 
  • Cariocas 
  • 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

Goals:

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

Actions:

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


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