Health & Exercise Forum

Part 3 of 4

Guest Columnist: Janet Caputo, PT, DPT, OCS

Even though your surgeon probably reconstructed your ACL in about 2 to 2 ½ hours, your rehabilitation phase will require a much longer period of time. Typically, regaining the motion, strength, and function of your knee following ACL reconstruction requires more than three months. And, while you may be allowed to run and jump, you may not be allowed to engage in competitive sports for 6 months.

Your post-operative ACL rehabilitation will be divided into stages. Achieving certain milestones at specified intervals will be important in gauging your progress. If certain goals (i.e. strength gains, increases in motion, and improved function) are not reached within a reasonable amount of time, your program must be re-assessed, or your performance of your program must be re-evaluated. This will be the coordinated effort between your surgeon and your physical therapist.

When your surgeon refers you to physical therapy, he/she may forward his ACL protocol to your therapist.  A protocol is a tool used by your physical therapist to design an appropriate rehabilitation program and gauge your progress.  Your surgeon’s protocol ensures not only that your physical therapist will not exceed any post-operative limitations or restrictions but also that you regain function to your knee as quickly as possible. Your post-operative rehabilitation protocol will differ slightly based on the type of ACL reconstruction you have received (refer to last week’s article) and upon your surgeon’s preference.

Post-operative rehabilitation following ACL reconstruction can be divided into 4 phases as follows:

Post-Op ACL Rehab Phase 1:

Weeks one and two focus on decreasing post-op pain and swelling and gradually increasing your knee mobility. Immediately after surgery, you will be walking with crutches and a knee brace/immobilizer to protect your knee and limit weight bearing.  After the first week, you will be encouraged to gradually wean from your crutches, as tolerated. By the second or third week, you may be allowed to walk with just your knee brace/immobilizer. The knee brace/immobilizer may be required for walking for up to 6 weeks after surgery.  Some exercises that you will be required to perform include:

•  Heel-prop: While lying on your back, place your heel on a rolled towel.  Relax your leg and maintain this position for 5 to 10 minutes, 3 to 4 times per day.
• Quadriceps Setting Exercises: While lying on your back with your knee straight, tighten the muscle at the front of your thigh by pressing the back of your knee downward. Hold for 6 seconds. Perform 3 sets of 10 repetitions, 3 times per day.
• Straight Leg Raising:  If you have difficulty performing the previous quadriceps setting exercise, perform this exercise with your knee brace/immobilizer. While lying on your back, tighten the muscle at the front of your thigh, lift your leg straight upwards towards the ceiling.  Perform 3 sets of 10 repetitions, 3 times per day. As you gain muscular control, you will be able to keep your knee straight without the assistance of the immobilizer.
• Stationary bicycle: Once you have achieved 120° of knee flexion (i.e. bending), your therapist will allow you to use a stationary bicycle for 10 to 20 minutes, 2 times a day. While performing this exercise, avoid locking your knee into full extension.

Post-Op ACL Rehab Phase 2:

By 3 to 4 weeks, you should be walking without crutches. Weight bearing exercises will be added.  Some examples are as follows:

• Mini Wall Squats: Standing with your back towards the wall, lower your body by bending your knees to approximately 45°, hold for 6 seconds, then return to the upright position. Perform 3 sets of 10 repetitions, 1 to 2 times per day.
• Step Ups: Standing in front of a 2 inch platform, place the foot of your operative leg on the platform. By pressing through your foot, raise your body up until your knee is straight, then slowly lower to the start position. Per form 3 sets of 10 repetitions, 1 to 2 times per day.
• Step Downs: Standing on a 2 inch platform, slowly bend your operative knee while stepping down with the foot on your non-operative leg. Maintain your body weight on the foot of your operative leg and control your descent. Slowly return to the start position and perform 3 sets of 10 repetitions, 1 to 2 times per day.
• Recumbent stair-stepper:  Your therapist will use this device to improve your muscle strength and endurance. When performing this exercise, avoid locking your knee into full extension.

Visit your doctor regularly and listen to your body.

CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.

Photos: Jennifer Hnatko, Photo Model: Matthew Knowles

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next week read: Part 4 of 4 on ACL injuries.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.