Anterior Cruciate Ligament Reconstruction Phase 2 Rehabilitation (weeks 3-6)
Date issued: April 2020
For review: April 2022
Ref: A-430/AJ/Physiotherapy/Anterior Cruciate Ligament Reconstruction phase 2
PDF: Anterior Cruciate Ligament Reconstruction phase 2 [pdf] 435KB
Phase 2 Rehabilitation (weeks 3-6)
Criteria to progress onto phase 2
- Able to walk without elbow crutches
- Able to walk upstairs unaided
- Full knee extension
Goals to be achieved before moving to next phase of rehabilitation.
- Flexion to 90 degrees
- Full Extension
Precautions
- Continue as before
Remember exercises must not be progressed onto the next phase unless pain levels are stable or improvin
Range of Motion and stretching programmes
Continue as before
Strengthening Programme
- Calf raise on a step
- Mini squats
- Forwards and sideways step ups
- Bridging
Calf raise on a step
Stand with your feet shoulder width apart on edge of step. Raise up on to your toes, then lower and let heels sink over edge of step, raise up again and repeat. 10-15 reps, 2-3 times a day
Mini squats
Stand with feet hip width apart. Slowly bend knees to about 20 degrees, keeping knees lined up over feet and then straighten up to standing position, and repeat. 10 reps, 3-4 times a day
Bridging
Lie on back with both knees bent. Tighten your quads and hamstrings, squeeze your buttocks together and lift your bottom off the floor. Progress exercise by lifting both hands in the air. 10-15 reps, 2-3 times a day
Forwards and sideways step ups
Lead with the operated leg. 15-20 reps, 2-3 times a day
Proprioceptive/Balance and coordination Programme
- Wobble board (two legs)
- Single leg balance
Wobble board (two legs)
Stand on the wobble board. Practice balancing and do not let the sides of the board touch the floor.3-5 minutes, 1-2 times a day
Single leg balance
Standing on the operated leg, lift the other leg off the floor and try to balance. Close 1 or 2 eyes 3 minutes practicing, 2-3 times a day
Variations-
- Hold wall with one hand
- Fold arms across chest
General Mobility
Static Bike no resistance and high saddle position. 5-10 minutes, 1-2 times a day
The reference list below was used to develop this protocol. If you are interested in learning more these resources may be a good place to begin.
References & Bibliography
Butler, DL, Kappa Delta Award paper. (1989) Anterior Cruciate Ligament: its normal response and replacement ;7:910-921
Beynnon, BD., Fleming, BB., (1998) Anterior cruciate ligament strain in-vivo: a review of previous work. Journal of Biomechanics. 31(6), 519-25.
Crossley, K., Zhang, W., Schache, A., Bryant, A., & Cowan, S. (2011), Performance on the single leg squat task indicates hip abductor muscle function. The American Journal of Sports Medicine, 39, 866-873
Fitzgerald, GK, Lephart, SM, Hwang, JH, Wainer, MR., (2001) Hop tests as predictors of dynamic knee stability. Journal of Orthopaedic Sports Physical Therapy. 31:588-597
Heijne, A., & Werner, S., (2007) Early versus late start open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study. Knee Surg Sports Traumatol Arthrosc. 15:402-414.
Hickey, KC., Quatman, CE., Myer, GD., Ford, KR., et al., (2009) Methodological report; Dynamic field tests used in an NFL combine setting to Identify lower extremity functional asymetries. Journal of strength and conditioning research. 23(9) 2500.
Herrington, L., Myer, G., & Horsley, I. (2013) Task Based rehabilitation protocol for elite athletes following Anterior Cruciate ligament reconstruction: a clinical commentary. Physical Therapy in Sport. 14, 188-198.
Hiemstra, LA., Webber, S., MacDonald, PB., Kriellaars, DJ., (2000) Knee strength deficits after Hamstring and patella tendon ACL reconstruction. Medicine and Science in Sports and Exercise. 32(8):1472-1479
Myer, G., Paterno, MV., Ford, KR., Quatman, CE., & Hewett TE., (2006) Rehabilitation after anterior cruciate ligament reconstruction: Criteria-based Progression through return-to-sport phase. Journal of Orthopaedic & Sports Physical Therapy, 36(6), 385 – 402.
Myer, G., Ford, K., & Hewett, T., (2008) Tuck jump assessment for reducing anterior cruciate ligament injury risk. Athletic Therapy Today. 13, 39-44
Myer, G., Chu, DA., Brent, J., & Hewett, T., (2008) Trunk and hip control neuromuscular training for the prevention of knee joint injury. Clinical Sports Medicin. 27, 425-448
Myer, G., Paterno, MV., Ford, K., & Hewett, T., (2008) Neuromuscular training techniques to target deficits before return to sport after anterior cruciate ligament reconstruction. Journal of Strength and Conditioning Research. 22, 987-1014.
Noyes, FR., Braber, SD., & Mangine, RE., (1991) Abnormal lower limb symmetry determined by functional tests after anterior cruciate ligament rupture, American Journal of sports medicine, 19 513-518.
Padua, DA., Marshall, SW., Boling, MC., Thigpen, CA., Garrett, WE Jr., Beutler, AI., (2009) The Landing Error Scoring System (LESS) is valid and reliable clinical assessment tool of jump landing biomechanics: The JUMP-ACL study. American Journal of Sports Medicine. 37, 1996-2002.
Perry, MC., Morrissey, MC., King, JB., Morrissey, D., & Earnshaw, P., (2005) Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 13(5), 357-69.
Pauole KK, (1996) The physical performance T-Test as a measure of speed, Power, and agility in females. Long Beach, CA: California State University; 1996
Shiraissha M, Mizuta H, Kubota K, Otsuka Y, Nagamoto N., (1996) Stabilomatric assessment in the ACL-reconstructed knee. Clinical Journal of Sport and Medicine. 6(1):32-39
Tyler TF, McHugh MP, Gleim GW, Nicholas SJ., (1998) The effect of immediate weight bearing after ACL reconstruction. Clinical Orthopaedics and Related Research. Dec (357): 141-148
Whatman C, Hing W, Hume P. (2012) Physiotherapist agreement when visually rating movement quality during lower extremity functional screening tests. Physical Therapy in Sport. May;13(2):87-96.
