ACL Rehab Phase 1 | Anterior Cruciate Ligament Post-Op Exercises
The goal in the first stage of rehabilitation is regaining normal joint function and you should be focussing on decreasing swelling, reaching full extension, reaching normal patellar-femoral joint motion, selective quadriceps control, and normal walking gait. (In een table naast Kirsten)
You can start with mobility exercises like heel slides and knee extensions with a towel underneath the backside of the knee. If needed you can mobilize knee extension or patellar-femoral joint manually. Patients need to use crutches until they can walk symmetrically. Cycling on an ergometer is allowed. The primary function of cycling in this stage is warm-up and/or mobilization. (show pendulum on the bike)
Isometric, concentric and eccentric exercises are allowed in this early stage in a closed chain. Be careful with open-chain exercises. After four weeks they are allowed in a small range of motion from 90-45 degrees. Every week 10 degrees of extension can be added, so after 5 weeks you can do leg extensions from 90 to 35 degrees and a week later to 25 degrees etcetera. When the reconstruction was done with a patellar-bone-patella graft external resistance is allowed after four weeks. In a hamstring graft reconstruction, however, resistance is only allowed after 12 weeks. These limitations are described due to the fact that in the early stage you don’t want to strain the new graft too much. In normal daily life, the graft will experience harmless strain already, during sitting and standing up from a chair and stair walking. In your training in the first 3-4 weeks, it’s safest to train in a range of 0-60 degrees of flexion in your squat and/or leg press exercises. Open chain exercises like active leg raises and side-lying abductions don’t strain the ACL and can be performed from the first week on.
The ACL does not only have a mechanical function. 2,5% of the ligament is made up of mechanoreceptors, thus it has a neuromuscular function in the knee joint as well. These receptors are responsible for the detection of positional changes in the joint, like in end-range positions where they facilitate protective reflexes. After an ACL injury, there is no new ingrowth of mechanoreceptors. Therefore, it is important to start with neuromuscular training like balance exercises in an early stage.
Now we’re going to demonstrate a couple exercises that can be used in the first stage of the rehabilitation:
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Meuffels DE, Poldervaart MT, Diercks RL, Fievez AW, Patt TW, Hart CP, Hammacher ER, Meer FV, Goedhart EA, Lenssen AF, Muller-Ploeger SB. Guideline on anterior cruciate ligament injury: a multidisciplinary review by the Dutch orthopaedic association. Acta orthopaedica. 2012 Aug 1;83(4):379-86.
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van Melick, N., van Cingel, R.E., Brooijmans, F., Neeter, C., van Tienen, T., Hullegie, W. and Nijhuis-van der Sanden, M.W., 2016. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British journal of sports medicine, 50(24), pp.1506-1515.
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Samuelsson, K., Andersson, D. and Karlsson, J., 2009. Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 25(10), pp.1139-1174.
Wright RW, Preston E, Fleming BC, Amendola A, Andrish JT, Bergfeld JA, Dunn WR, Kaeding C, Kuhn JE, Marx RG, McCarty EC. A systematic review of anterior cruciate ligament reconstruction rehabilitation–part I: continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation. The journal of knee surgery. 2008;21(03):217-24.
- Alan Righetti03/09/23ACL Injuries: From Theory to Practice Great Course. A lot of informations and injury management based on criteria to progress from one stage to the other to optimize return to sport and to give the athlete high quality rehabilitation.Els de Wael24/04/23ACL Injuries: From Theory to Practice SUPER INTERESSANTE CURSUS
Heel uitgebreide cursus over de ACL met duidelijke fasering en een groot aanbod van oefeningen en testen.
Super veel uit geleerd, echt een meerwaarde!Ben Moes08/01/23ACL Injuries: From Theory to Practice GREAT ACL COURSE
Can only recommend this course for any student or even working physiotherapist as it brings great evidence-based insight into the ACL-Rehabilitations
- Michal Wajdeczko02/12/22ACL Injuries: From Theory to Practice GREAT OPPORTUNITY TO BE A PROFESSIONAL.
The ” ACL injury From theory to practice” course is definitely one of the best I’ve ever had. Lots of useful practical and theoretical notes. All information were collected in a chronological whole, based on scientific medical evidence. Clear videos en practical advise makes this course more attractive. I really enjoyed the course and I advise it to everyone.Damie van Gijzen31/10/22ACL Injuries: From Theory to Practice VERY INFORMATIVE COURSE
If you want to learn a ACL course with different ways to treat the patient, from the begin to the end, than this is an very good course to learn.Verena Fric12/03/22ACL Injuries: From Theory to Practice Lots of relevant informationen around ACL, many ideas how to manage in practice and especially in late phase after ACL Surgery. I defintively recommand this course to everyone who wants to be update and increase his/her knowledge about ACL Rehab.
- Omar12/03/22ACL Injuries: From Theory to Practice VERY INFORMATIVE COURSE!
Can’t be more satisfied with this course content that cover all aspects in the ACL managementMostafa12/01/22ACL Injuries: From Theory to Practice THE BEST OF THE BEST!
I am a physiotherapist from Egypt and I have been working in the sports field for two years and dealt with many cases of ACL, but I always stood at certain points and i couldnt understand what was happening and I had many questions that I did not know the answer to, and after I took this course Many points became clear to me, and I had much more confidence in dealing with ACL cases.
I recommend this course to everyone who deals with acl cases , because it is really as it is in the title, from theory to practice.
I would like to thank Dr. Bart and Physiotutors for their wonderful effort.Nicolas14/08/21ACL Injuries: From Theory to Practice Very complete course covering all the problems that can be encountered in clinical practice. From understanding the mechanisms of injury to injury prevention and return to performance. Lots of information, all based on recent scientific literature and the instructor’s experience. Thanks Bart & Physiotutors !
- JOSÉ GUALÃO27/05/21ACL Injuries: From Theory to Practice VERY GOOD
Extremely happy with the contentDavid05/04/21ACL Injuries: From Theory to Practice TOP!
Cursus die van A tot Z weergeeft wat een ACL letsel is en hoe de aanpak moet zijn! Het volgen van deze cursus is echt nodig om ACL optimal rehab te kunnen aanbieden.SEPPE13/12/20ACL Injuries: From Theory to Practice EVERYTHING YOU NEED TO KNOW ABOUT ACL INJURIES!
This is the most complete course ever. It contains everything you need to know about ACL injuries. I strongly recommend it to everyone!
- PAVEL SASMSONOV28/10/20ACL Injuries: From Theory to Practice OUTSTANDING COURSE!
This course is more than just webinar. It gives you deep understanding of different aspects and principles of rehabilitation ACL injured and reconstructed patients. Thank you, Bart and all Physiotutors team for uptodated information on different topics regarding this definetly tough topic. Despite that fact that I had some experience working with different ACL-patients I got structured whole information and gained a lot of new ideas to implement into my clinical practise!
Thank you so much!ANDRÉ23/10/20ACL Injuries: From Theory to Practice JUST DO IT!
This course have been nothing but great. So much good information and you can expect to learn a whole lot about all factors affecting the rehabilitation. It was worth every penny and I really recommend anyone treating patients with ACL-injuries to enroll in this course.HELEN04/10/20EVERYTHING YOU NEED TO KNOW ABOUT ACL INJURIES
This really is a fabulous course. Everything you need to know about ACL injuries and rehabilitation is discussed and supported by research. I would highly recommend this course – thank you Bart!
- PEDRO J.01/08/20ACL Injuries: From Theory to Practice GREAT COURSE!
I think it’s the most comprehensive course on ACL right now. It perfectly addresses the latest updates on the subject. My congratulations to the whole team for the course and to Bart Dingenen for sharing all his work. Greetings!Ben Saldivar27/05/20ACL Injuries: From Theory to Practice If you want to provide the best possible care to your ACL patients this course is a must.
Extremely detailed over all areas. Nothing else I’ve seen like it. Great job guys.Damie van Gijzen01/01/70ACL Injuries: From Theory to Practice VERY INFORMATIVE COURSE
If you want to learn a ACL course with different ways to treat the patient, from the begin to the end, than this is an very good course to learn.