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Health & Exercise Forum

Final Rehab Following ACL Reconstruction: Part 4 of 4

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Apr 9, 2012

Dr. Mackarey's Health & Exercise ForumPart 4 of 4

Guest columnist: Janet Caputo, PT, DPT, OCS

The past three columns have demonstrated the lengthy rehabilitation process following an ACL reconstruction.  The first four weeks after surgery can be a little uncomfortable and repetitive. The program focuses on controlling pain and swelling, increasing tolerance for weight bearing, restoring knee motion, and developing muscular control.  Then the FUN begins!  After four weeks, your knee should have healed enough to allow your therapist, with your surgeon’s approval, to add more challenging exercises to enhance balance, coordination, and agility.   These exercises will be added over the next 8 to 12 weeks in two phases, as described below.

ACL Rehab Phase 3

During weeks 5 to 12, the exercises mentioned last week (i.e. Phase One and Phase Two) will be progressed by adding weights and increasing step height.  Additional exercises may be added:

  • Unilateral Stance: Try to balance while standing on your operative leg only.  Initially you may only be able to balance for a few seconds.  As your balance improves, try to balance for longer periods, gradually increasing to 30 seconds.  Repeat 3 times and perform this exercise 2 times per day. Bouncing a ball on the floor or against a wall while performing this exercise increases the challenge.
  • Alphabet and Unilateral Quarter Squats: Once you have mastered balancing on your operative leg, you may try:
    • Alphabet: Standing on your operative leg, place your non-operative foot on an exercise ball. Keep your operative slightly bent and roll the ball with your non-operative foot as if you are drawing the letters of the alphabet with the ball.  Repeat 2 times per day.
    • Unilateral Quarter Squats: Perform the mini wall squats described in Phase Two while standing on your operative leg only.  Once this becomes easy, increase the difficulty by using an exercise ball.  Stabilize an exercise ball between your back and a wall.  Cross your arms over your chest.  Take a step out from the wall. Place your feet hip width apart and straighten your non-operative knee.  Slowly lower yourself down until your operative knee bends to 45° and then slowly return to the start position.  To further increase the challenge, hold the 45° bend for several seconds.  Perform 3 sets of 10 repetitions, 1-2 times per day.
  • Elliptical Trainer: This excellent endurance exercise that simulates running may be substituted for the bicycle and recumbent stair-stepper.  Begin this exercise with minimal resistance and for a short duration.  Slowly increase resistance and duration as tolerated. Avoid locking your knee into full extension when performing this exercise.
  • Treadmill: Treadmill training enhances gait, balance, and coordination.  Try to walk on the treadmill forwards, backwards, and sideways.  Begin at a comfortable pace, and increase speed and duration as tolerated.

ACL Rehab Phase 4

At 12 weeks post-op, sport specific activities are allowed as long as sufficient strength and balance have been achieved.  Jogging, agility drills, and a functional running program will be initiated and progressed as tolerated.

  • Jump and Plyometric Training: Perform double-limb hops on a mini-trampoline and progress as tolerated to a maximum of 30 repetitions.  Perform double-limb jump rope and progress as tolerated to a maximum of 20 repetitions.  When these maximums are reached, you may progress to single-limb hops on the trampoline and you may jump rope alternating your feet.
  • Speed and Agility Training: The intensity of the following drills are progressed from walking → running ½ speed→ running ¾ speed→ running full speed.
    • Circle Run: Run in a circle 20 feet or greater in diameter. Perform 3 repetitions to the right and three repetitions to the left.
    • Figure “8” Run: Run along a figure of “8” pattern that is 20 feet or longer in length. Perform 3 repetitions to the right and three repetitions to the left.
    • Carioca: While moving to the left, cross your right leg in front of the left, then behind the left, and continue alternating for a distance of 50 yards. Then, repeat this pattern moving to the right, this time crossing your right leg in front of your left and then behind your left as you move. Perform this exercise 5 times to the left and 5 times to the right.
  • Return to Running Program: Before starting this program you should be able to walk one mile at a brisk pace without a limp and without any pain or swelling afterward.  Your return to running will begin by alternating walking with jogging.  This program should be performed no more than every other day and should be initiated on flat terrain such as a treadmill or soft track.

You can expedite your recovery if you perform all exercises, in all phases, pain-free and as directed by your physical therapist. Even though progression through the rehabilitation phase is an individual process, expect to return to your sport no earlier than 6 months after your ACL reconstruction.

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: Danielle Dalessandro

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.

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:

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.