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:
LEARN TO OPTIMIZE REHAB & RTS DECISION MAKING AFTER ACL RECONSTRUCTION
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