Our blog titled What Is An ACL Injury outlines what an ACL injury looks like and how it’s sustained, in this blog we take a look at the different stages of ACL rehabilitation and what’s involved.
Following surgery for a damaged ACL, individuals are required to undergo a long and intensive rehabilitation protocol to ensure that adequate knee function is returned. This process can often take 12 months or longer due to the nature of tissue healing after such a surgery and heavy stress that the ACL is required to endure during movement. The primary goals of ACL rehabilitation include returning normal knee range of motion (ROM), increasing lower limb muscle strength, returning normal gait patterns including walking and running, neuromuscular/proprioceptive retraining and sports specific training.
Weeks 0-2
This stage involves initial postoperative management in addition to early knee ROM exercises. Individuals will often be required to gradually increase weight bearing in this stage through the use of crutches. It is also likely that individuals will begin early isometric strengthening of the quadriceps and hamstring muscle groups.
- Swelling and pain management
- Aiming to achieve 90 degrees of knee flexion and neutral knee extension ROM
- Education on gait and functional ADL’s
- Early strengthening exercises
Weeks 2-6
The primary goal during this stage is the return of normal ROM and restoring a normal gait pattern. Proprioception will also be a focus during this stage. Proprioception is the perception and awareness of body position and movement. This is an important function for balance and is often impacted by surgery following an ACL injury.
- Restoring normal ROM
- Full weight bearing and return of normal gait
- Continue progression of strengthening exercises for the knee, hip and ankle
- Proprioception exercises
Weeks 6-12
In this stage, the focus shifts to the progression of strengthening exercises, particularly for the quadriceps and hamstrings, along with the introduction of early sport specific retraining. Common exercises include squats, step-ups, lunging and gluteal strengthening along with their variations.
- Progression of closed chain strengthening exercises
- Lower limb flexibility exercises
- Continue challenging proprioception
- Hydrotherapy including pool running
- Exercise bike/treadmill (no jogging)
Weeks 12 and beyond
Beyond the 3 month mark ACL rehabilitation becomes more individual focused. Depending on the goals, rehabilitation will generally shift to focus on returning to work or sport. It is in this stage that sports specific exercises are generally considered and running also starts to be reintroduced.
- Begin progress running and cardiovascular fitness
- Commence sport/work specific functional retraining
- Maintain strength and ROM
If you’re currently undergoing ACL rehabilitation and would like to find out more about how our Physios can help you, visit this link.