Progressional Rehabilitation, Inc.

P.O. Box 1170, 403 West Central Avenue, Jamestown, TN 38556 Phone: (931) 879 4301 Fax: (931) 879-4302 Rey Cabarlo, RPT Mary Faye Cabarlo, RPT
PHYSICAL THERAPY OUTPATIENT CLINIC

ACL Protocol Lesson 1 Post-Operative Days 1-14 Exercises are to be performed a minimum of 3 times a day. You should perform range of motion exercises frequently during the day, going to extreme ranges 5 times a day. You should ice and elevate the knee for 20 minutes 3 times a day. Immobilizer is used for sleeping, walking, and weight-bearing. Initially begin putting 25% of your weight on the leg during walking/standing activities and progress to 75% gradually as tolerated. Goals to be attained: 1. 2. 3. 4. 5. Decrease swelling Decrease pain Increase range of motion: completely straight to sitting with knee bent to 95 degrees. Visible quadriceps contraction Increase weight-bearing to 75% of your body weight.

Exercises: 1. Patellar (knee-cap) mobilization Perform in up/down and side/side direction for 3 to 5 minutes. 2. Extension stretching on stomach Lie on your stomach with your leg extended off of the bed. Place a towel roll under your thigh for extra support if needed. 5 repetitions x 1 minute each; 30 sec rests between stretches. 3. Hamstring stretching Sit with injured leg straight on edge of mat/counter/bed. Half-sit with uninjured leg on the floor. Keep back straight, straighten leg. Once you can achieve full extension, lean forward at the hips. 5 repetitions holding 30 seconds each. 4. Multi-angled quad setting Lie on flat surface with legs out straight. Tighten the knee, pressing the back of the knee down in the surface. Hold 3 seconds. Repeat 25 times. Repeat using towel roll and rolled pillow.

5. Flexion stretches a. Initially, sit on edge of bed carrying injured leg down with uninjured leg. Do not rotate hip to achieve full bend. Hold for 10 seconds. Work on this for a 5 to 10 minute session. b. Progress to uninjured leg pushing for the injured leg backwards while witting on a high surface, i.e. vanity, workbench, kitchen counter. Hold in flexed position for 10 seconds. Work on this for a 5 to 10 minute session. c. Progress to wall slides Lie on your back with heel of injured leg on wall and uninjured under the leg as a safety net. Gradually slide foot down wall until stretch is felt and hold for one minute. Lift back up with uninjured between stretches. Repeat for 5 repetitions. d. Heelside stretch with towel Lie on your back with towel, belt, sheet looped around injured foot and held in each hand. Slide foot up in the bed while gradually pulling with the hands until stretch is felt. Hold for 30 seconds. Repeat 15 repetitions. Take knee into full available extension between stretches. Flexion stretches should be performed 5 times a day. 6. Heelslides Lie on your back, slide heel toward buttocks; 10 repetitions in a small range, 10 reps in medium range and 10 reps in full available range. Emphasize full extension between repetitions. 7. Straight Leg Raises Begin post-operative day 2 in the immobilizer: a. Flexion Lie on your back with injured leg straight and uninjured knee bent. Lift straightened leg 12 inches off of surface. Hold for count of three. Lower slowly. b. Adduction Lie on side of injured leg. Cross top leg over bottom leg bringing it in front. Tighten knee and raise injured leg off of surface toward ceiling. Hold for 3 sec and lower slowly. c. Abduction Lie on side on uninjured leg. Lift injured leg toward ceiling, making sure your hip facing the ceiling is straight. Hold for count of 3. Lower slowly. d. Extension Lie on your stomach. Lift injured leg off of surface toward ceiling. Hold for count of 3 and lower slowly. *Begin with 3 sets of 5 and progress to 3 sets of 10. 8. Calf strengthening Place theraband around ball of your foot, holding the other end of theraband in hand. Point foot/toes while pulling on theraband at hand feeling good resistance against foot. Return to neutral position and repeat for 3 sets of 50 repetitions. ** Perform ankle pumps and quad sets frequently throughout the day.