There are five (5) Phases to ACL Surgery Rehabilitation to help patients make better progress in recovery after ACL surgery. These are also exercises that you can easily do at home.

Phase 1: Week 1-2 After Surgery

The objective for this phase is to be able to bend and straighten your knee as far as the uninjured leg. You should focus on regaining as much strength as possible in your quadriceps muscle which straightens your knee and your hamstring muscles which bend your knee.(insert image)

1. Knee extensions

Place the heel of your injured leg on an object that is few cm thick (like a phone book). Gradually relax and let your leg straighten. This first part of exercise helps you to maintain a normal range of movement. You should repeat this exercixe at least 3 times a day for 10 minutes.

2. Static quads

With your leg in the same position and without lifting your heel up in the air, tighten your quadriceps (front of the thigh) muscle as hard as you can by pushing down with the back of your knee for 10 seconds. Then, relax for 10 seconds before tightening your muscle again. Repeat this exercise for 10 times, This helps to maintain quadriceps strength.

3. Heel slides

Start with your injured leg stretched out. Gradually bend your knee by sliding your heel toward your buttock. Bend your knee until it becomes slightly uncomfortable and you can feel some pressure inside it. Hold this position for 10 seconds. Then straighten your knee out again and relax for 10 seconds. Repeat this exercise for 10 times. It helps to maintain the range of movement.

4. Prone knee bend

Lying on your front, hook the unaffected foot under the foot of the operated leg. Keeping your hip and knee in contact with the bed / floor, with the assistance of the unaffected leg to bend your operated knee towards your bottom within your limits of comfort. Hold this position for 10 seconds and then slowly lower your leg to straighten it. Repeat this exercise for 10 times.

Phase 2: Week 2-6 After Surgery

Before you start the following exercise, you should:

– be OFF crutches

– have gained full range of movement

At this stage everyone progresses at different rates. Progress through the following exercises. They tend to get harder as you work through them, to ensure that you are satisfied with the level you are at before moving on. Your physiotherapist should be able to advise you further at this stage.

A. Quads strengthening

1. Double leg squats

Standing squats with a ball squeezed between your knees. This may be easier if you slide your back down a wall. Hold at 45 degrees for 5 seconds.

Repeat this exercise for 10 times.

2. Step Ups

Lead up with your operated leg and then step down again.

Repeat this exercise for 20 times.

Other suggested activities: Cycling is also the best method of strengthening the knee at this stage. To start with a static bike at the gym, starting with 5 minutes on a low resistance and progressing sensibly.

B. Hamstring Strengthening

1. Hamstring catches (In standing)

Bend and straighten your knee between 0-30 degrees stopping abruptly at the end of each range. Repeat this exercise for 20 times. Repeat the above exercise between 30-90 degrees and 90-140 degrees.

You can progress these exercises with hamstring curls, adding weights at the gym at 6-12 weeks.

2. Hamstring stretches

Place your operated leg straight out in front of you with your heel on the floor. Lean forwards bending from the hips and rest your hands on your bent non-operated leg. To ensure that you maintain your back straight.

Hold each stretch for 20-30 seconds for maximum outcome.

C. Calf Strengthening

1. Calf Raises

In standing, rise up onto your toes, lifting your heels. Return to standing.

Repeat this exercise for 20 times.

2. Calf Stretches

To ensure that your feet are facing forwards. Take your operated leg out behind you with your knee straight and your heel down. Lean in towards the wall so that you can feel the stretch in the back of your calf.

Hold each stretch for 20-30 seconds for desired outcome.

D. Proprioception

It helps you to regain awareness of your joint position by re-educating the leg with balance exercises.

1. Single-leg Stance

Stand on your operated leg. Maintain your balance for 1 minute. Keep your upper body, hips and arms still and in alignment.

Progress to: Do the above exercise with your eyes closed

Phase 3: Week 6-12 After Surgery

Before you start the following exercise, you required to have:

– full knee range of movement

– minimal to no swelling of your affected knee

– be able to balance on the affected leg for greater than 20 seconds

1. Single knee extensions in sitting

Hold a straight leg for 5 seconds. Return to position. Repeat this exercise for 15 times.

2. Single leg squats

(insert image)

3. Knee Extensions

Place the heel of your injured leg on an object that is few cm thick (like a phone book). Gradually relax and let your leg straighten. This first part of exercise helps you to maintain a normal range of movement. You should repeat this exercise at least 3 times a day for 10 minutes.

4. Static Quads

With your leg in the same position and without lifting your heel up in the air, tighten your quadriceps (front of the thigh) muscle as hard as you can by pushing down with the back of your knee for 10 seconds. Then, relax for 10 seconds before tightening your muscle again. Repeat this exercise for 10 times, This helps to maintain quadriceps strength.

(insert image)

5. Other activities

Swimming

– front crawl straight leg kick

– no breast stroke until 4 months plus

Cycling

– build up resistance on static bike

– progress to outdoor cycling as advised

Jogging

– start by running in a straight line at 40% pace and progress as advised by your Physiotherapist

Thing to take note: It is essential to seek the advice from your physiotherapist before starting for the above activities

Phase 4: Preparation for return to sport at 3-6 months

The objective of this phase is to prepare you for a safe return to your chosen sports at more than 6 months. This part of your rehabilitation will be concentrated on sports specific drills An individual exercise program will be set for you at this stage of your rehabilitation.

Phase 5: Return to sport at 6-9 months

To resume back to non contract sport (example: racket sports) at 6 months you required to have:

full pain free range of movement
no joint swelling

And be able to:

run in a straight line at full pace
run sideways and backwards
run in a figure of eight
jump and hop in all directions

Conclusion

If you are unsure of the steps on rehabilitation from your recent surgery, please do not hesitate to contact us at Spire Orthopaedics.

ACL Surgery Rehabilitation Exercise in Singapore