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ACL Surgery Rehab Exercises

Recommended ACL Surgery Rehab Exercises

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Updated June 02, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Orthopedic arthroscopic ACL replacement
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If you've had arthroscopic surgery to repair your ACL (anterior cruciate ligament), you will most likely be referred to physical therapy for specific rehabilitation exercises that are most appropriate for you.

Recommended ACL Surgery Rehab Exercises

While you should always follow the rehab program prescribed by your doctor or therapist, the following general rehab protocol provides an overview of the type of exercises and the progression you can expect following surgery for an ACL repair.

The majority of ACL surgery patients will be prescribed a specific rehab exercise program that focuses on regaining range of motion and gradually bearing weight on the knee. The goal of the initial rehab phase is to gain full flexion and extension of the knee joint and then build balance and strength.

ACL Rehab Exercises for Weeks 1-2

You should meet with your physical therapist for an initial evaluation and to learn how to perform your home exercise program. In most cases, you will be advised to focus on range of motion exercises and gradual weight bearing on the knee.
  • Slowly wean yourself off crutches and begin bearing weight as tolerated.
  • Build range of motion (ROM) to zero to 75 degrees in the knee.
  • Work toward achieving full knee extension.
  • Begin passive knee extension exercises: Sit in a chair and place your heel on another chair of equal height. Relax your leg and allow your knee to straighten. Rest in this position 1-2 minutes several times a day to stretch out the hamstrings.
  • Begin straight leg raises to build strength.

ACL Rehab Exercises for Weeks 2-4

In weeks two through four you will continue to increase your ROM, increase quadriceps strength, and perform easy balance exercises.
  • Build range of motion (ROM) to zero to 110 degrees.
  • Start heel slides: Sit on the floor with legs outstretched. Slowly bend the knee of your injured leg while sliding your heel/foot across the floor toward you. Slide back into the starting position and repeat 10 times.
  • Start isometric contraction of the quadriceps: Sit on the floor with your injured leg straight and your other leg bent. Contract the quadriceps of the injured knee without moving the leg. (Press down against the floor). Hold for 10 seconds. Relax. Repeat 10 times.
  • Start half-squats, partial lunges, and calf raises as tolerated and as directed.
    • Half-Squat: Stand holding a sturdy table with both hands. With your feet placed shoulder’s width apart, slowly bend your knees and squat, lowering your hips into a half-squat. Hold 10 seconds and then slowly return to a standing position. Repeat 10 times.
    • Partial Lunges: Stand holding a sturdy table with both hands. With your feet placed shoulder’s width apart, take a half step forward, keeping your weight evenly distributed. Slowly bend your knees and sink down slightly. Hold 10 seconds and then slowly return to a standing position. Repeat on the other side. Do 10 times per side.
    • Heel Raises: While standing, place your hand on a counter or back of a chair for balance. Raise up onto your toes and hold for five seconds. Slowly lower your heel to the floor and repeat 10 times.
  • Begin stationary bicycling, water exercise (swimming), and upper-body strength training as directed.
  • Begin balance and proprioception exercises as directed.

ACL Rehab Exercises for Weeks 4-6

During the next two weeks, you will continue to build ROM and balance while you add some resistance to your strengthening exercises.
  • Continue building ROM per your therapist's directions.
  • Increase strength-building exercises with resistance (hold light hand weights, use elastic tubing or stretch cords as directed)
  • If directed, begin prone knee flexion exercises: Lie on your stomach with your legs straight. Bend your knee and bring your heel toward your buttocks. Hold for five seconds. Relax. Repeat 10 times.
  • Begin single-leg exercises, such as one-leg half squats and climbing stairs.
  • One Legged Balance: As tolerated, stand unassisted on the injured leg for 10 seconds. Work up to this exercise over several weeks.
  • Begin core stabilization exercises as directed.
  • Continue balance and proprioception exercises.
  • Increase the intensity of aerobic exercise to increase heart rate.
  • Begin using endurance equipment such as the stair climber or elliptical trainer if tolerated.

ACL Rehab Exercises for Weeks 6-8

During these weeks, you will progress with the previous exercises. Generally, your therapist will recommend lateral (side-to-side) stepping and lateral step-ups and step-downs. Because everyone progresses at their own pace, it's important to follow your therapist's instructions regarding these exercises, your progression, and limitations.

ACL Rehab Exercises for Weeks 8-12

Continue building strength and range of motion in the next month according to these general guidelines:
  • Build strength during knee flexion.
  • Knee extension strengthening exercise: You may be given an elastic band for this exercise. If so, loop one end of the band around a table leg and the other around the ankle of your injured leg. While facing the table, bend your knee to 45 degrees against the resistance of the tubing, then return to the starting position.

ACL Rehab Exercises for Weeks 12-14

By this time, many patients are ready to begin light jogging. Agility and plyometric exercise may also be introduced.

A follow-up with your surgeon or physician to perform functional testing will determine the success of the rehab program. You may be cleared for activity and provided with a specific return to sport guideline.

After undergoing surgery for an ACL repair, it is especially important that you follow the ACL injury prevention guidelines to reduce your risk of a future injury.

Source

ACL Injury Guide. http://www.mayoclinic.com/health/acl-injury/AC99999/PAGE=AC00007. Mayo Foundation for Medical Education and Research (MFMER). Nov. 15, 2007

Santa Monica Orthopaedic and Sports Medicine Research Foundation,ACL Injury Prevention Project. Accessed 10-9-2009.

Tammy White, MS, PT, and Phyllis Clapis, PT, DHSc, OCS. Anterior Cruciate Ligament (ACL) Injury Rehabilitation Exercises. Sports Medicine Advisor. 2-9-2009.

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