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Date issued:  April 2020

For review: April 2022

Ref: A-433/AJ/Physiotherapy/Anterior Cruciate Ligament Reconstruction Phase 5

PDF:  Anterior cruciate ligament reconstruction phase 5 [pdf] 299KB

Phase 5 Rehabilitation (6 months onwards)

If the aim of your surgery was to restore directional stability during activities of daily living, there is little point in taking rehab a lot further. If however all is well at this stage and the aim is to return to high level activity then sports specific training should begin at six months and continue for three months aiming to return to sport between nine months and one year post operatively.

Criteria to progress on to phase 5;

• Normal function during normal daily activities
• Be able to sit comfortably back on heels
• No problems with low risk activities (i.e. running, low impact aerobics)

 

Goals to be achieved before moving to next phase of rehab

• Single leg hop 95% compared with non-operative leg (Reid A et al 2007)
• 95% muscle power and endurance compared with non-operative leg
• No pain or swelling (Jakobsen et al 2010)
• Return to sport

 

Guidelines

• Return to sports specific training as agreed

 

Precautions

• Avoid returning to full sport before ready

 

 

Box jumps (forward, back, sideways, increase speed and progress to one leg)

 

Stand in front of a box, platform or step.

Jump onto the box and immediately back down to same position.

Repeat immediately getting progressively faster keeping landing time as short as able. 10-15 reps 2-3 sets

Variations:

Stand sideways next to the box or platform.

Jump sideways up onto the box then jump off the other side, then jump back up onto the box.  Jump back down to the starting position and repeat as fast as you can maintain good control and alignment.

Jump completely over the box, back and forth as quickly as possible.

Progressions

Build up to 30 reps and 2 sets

Increase speed.

Use single leg

 

Bounding

Stand in front of a short box or platform.

Place one foot on the edge of the box.

Jump up high and land with the opposite foot on the edge of the box and other foot on the floor.

Immediately repeat.

10-15 reps 2-3 sets

Variations:

Increase the platform height

Repeat without a step (skipping on the spot

Depth jumps

(Increase height as control allows and progress to one leg)

10-15 reps 2-3 sets

Progressing to 2 sets of 30

Stand on top of a high box, close to the front edge facing a second box.

Jump from the platform, landing on both feet between the platform and the box.

Jump off the ground as fast as possible onto the box.

Progression:

Increase height of platform

Use single leg

 

Hurdles

(Increase height, length and progress to one leg) 10-15 reps 2-3 sets

Stand facing hurdles (30-90cm height).  Squat down and jump over hurdle with feet together using a double arm swing.  Upon landing immediately jump over the next hurdle keeping the landings short.

Progression:

Increase hurdle height

Increase space between hurdles

Use single leg

 

Proprioceptive/balance and coordination Programme

Using cones mark out circuits and perform agility drills

• Straight line (8 x 20m) 10 reps      
• Oval (8 x 20m) 10 reps
• Circle (8 x 10m) 10 reps
• Soft zig-zag (8 x 20m) 10 reps      
• Figure of eights (8 x 10m) 10 reps
• 90 degree turns (10 x 20m)
• 45 degree turns (10 x 20m)
• Cutting (20 x 10m)

Shuttle runs

Once your have been running successfully then introduce as desired and required stop start running, shuttle runs, cutting and turning and downhill running.

Modified T-Test (running agility and directional change rehab)             (Pauole et al 1996, Hickey et al 2009, Myer et al 2006)

General Mobility and cardiovascular programme (Herrington et al 2013).

Progress as below

1. sports specific rehab- kicking and ball work
2. normal training
3. easy low grade match
4. return to full competition