This was originally supposed to be days 11-14, however, I wasn’t able to see my surgeon until day 12. Thus, this turned into days 12-15.
Day 12 brought about some big changes in the rehab. Most noticeably the ability to BEND MY DAMN LEG!
I had some x-rays taken to examine the reconstruction and make sure all my new hardware is where it should be. It is. Whew.
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Post-op Day 12-15 (Week 2)
Order of exercises:
- ROM
- Proprioception
- Strength
- Conditioning
- Proprioception again
–> As you can see, the rehab is getting fancier. The order of the exercises comes into play. The reasoning is you want to perform proprioception exercises when you’re fresh to make sure they are of high quality. But, you also want to perform them when tired to condition the muscles to perform under fatigue. Hence the order above.
Compression
-Ace bandage
–> I got rid of the sock at this point. I was sick of the thing.
Crutches
-50-75% weight bearing as tolerated. Don’t try to put more than 50-75% of your weight on your injured leg. Don’t be afraid to use less than this as well.
–Begin backward and sideways walking. Use crutches if needed. (I needed them.)
-Should be done every couple of hours
–> The amount of weight bearing allowed is progress during these days. Also, backward and sideways walking begins. You’ll see a big theme with the rehab process is to do ambulation sideways and backwards before going forwards. Forward movements present the most stress on the ACL out of the three. It’s all about the progressions.
Bracing
-Brace is locked at 0 degrees during walking. It is unlocked to 90 degrees while sitting. THANK GOD.
–> This is the biggest difference from the preceding days. As expected, my leg was stiff as all hell when beding it for the first time in 12 days. However, within a day I was able to bend it to 90. Flexion range of motion comes back pretty quickly. Yet another reason to not rush the process.
Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)
(Remember videos can be found on the day 1 and day 2 posts.)
-Extension: Maintain 5-7 degrees of hyperextension.
-Passive knee extension with quad squeezes
-Flexion: Active flexion only to 90 degrees. BUT, no RESISTED flexion allowed. Passive between 0 and 90 degrees.
–> Be careful how you perform active flexion. I would perform mine standing but with my leg out in front of me as opposed to behind me. With the leg out in front of you you aren’t fighting gravity as much, so it’s easier. Plus, my hamstring isn’t strong enough yet (from the graft harvest) to perform flexion against gravity.
-Patellar mobilizations
-Sitting hamstring stretch
-Plantar flexion / dorsiflexion
-Sitting abduction / adduction
–> Pretty simple. Move the knees in and out. When using a hamstring graft in ACL reconstruction some surgeons will also harvest the gracilis. The gracilis flexes the hip, flexes the knee, and adducts the leg. Day 12 is where we start to work some of muscles that were harvested. Albeit in a very light manner. Thus, we have the introduction of knee flexion exercises, hip flexion exercises, and leg adduction exercises.
-Standing hip flexion
-Tibial rotations
–> Palpate hamstrings and tibia to make sure these are moving and movement is not only occurring at the ankle. The other muscle harvested when using a hamstring graft is the semitendinosis. This muscle flexes the knee, extends the hip, AND internally rotates the tibia. This exercise is used to wake up the semitendinosis in regards to tibial rotation. A weakness commonly found in hamstring patients yet barely ever addressed:
Strengthening (4 x10r)
-Clamshells
-Glute Bridges
-Straight leg raise
–Standing calf strengthening
–Sitting knee extension 90-0 degrees
-Quarter squat supported. No more than 45 degrees knee flexion!
–> No weight yet. With the ability to bend my knee comes the introduction of mini-squats.
-Standing hip extension (RDLs)
–> Done without weight:
Proprioception
-Weight shifts
-Both legs unsupported, forward/backward, diagonal, and side to side
Conditioning
-Biking- As your range of motion will allow
–> This was funny to me. Nearly every rehab protocol I’ve looked at lists “biking” as part of the early rehab process. Yet, nearly every protocol I’ve looked at says no active knee flexion past 90 degrees til about 8 weeks. I found out pretty quickly that in order to ride a bike you need about 110 degrees of knee flexion. So this was a no-go. Instead I tried the elliptical…
-Elliptical backwards
–> I really wasn’t able to do this much until day 14. Even then I could only get on for about 3 minutes before my knee had enough. Either way though it felt good to do something other than crutch around. Again, notice backwards before forwards.
Meds
-Aspirin / Tylenol (ideally after exercises)
–> I haven’t bothered with this. No need.
Nutrition
-Calories = Bodyweight x 15 x 1.10
-Protein always high
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For a comprehensive look at ACL rehab, check out The most important phase of ACL rehab
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Posted on January 13, 2012