ACL rehab month 4

Posted on April 22, 2012

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Month 4 marked the first time I have run!!! Albeit backwards and side to side. (Forward running starts in month 5.) Ironically enough, at least to me, running has been the easiest thing for me. But, shit if the strength work hasn’t been hard.

It’s not that anything is painful really. Other than some occasional pain on my kneecap, which is more an annoyance, and really only happens when I have some fluid in the knee, pain has not been an issue during this process.

However, things like split squats, hamstring curls, glute bridges, etc. have been tough. I am lifting baby weight and sometimes I am REALLY working hard.

There is no doubt my hamstring has not regenerated completely yet, although it’s not supposed to have yet either. That is supposed to happen anywhere between 6-12 months. I have a ways to go before I’m in that range. Thus, I’m not too worried about my strength levels. Plus, they are going up. It’s just been surprisingly tough and slow.

Post-op Days 86-92 (Week 13)

Routine schedule:

Day 86: Massage, ROM, Proprioception, Strength,

Day 87: Massage, ROM, Conditioning (Running first), Proprioception

Day 88: Massage, ROM, Upper body,

Day 89: Massage, ROM, Proprioception, Strength,

Day 90: Massage, ROM, Conditioning (Running first), Proprioception

Day 91: Massage, ROM, Upper body,

Day 92: Massage, ROM

Massage Work

Foam Rolling / Tennis Ball: Adductors, Glutes, Quads, Calves, Peroneals, TFL,

 

Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)

-Passive knee extension with quad squeezes

-Flexion: Full flexion allowed as tolerated.

-Patellar mobilizations

-Tibial rotations. Palpate hamstrings and tibia to make sure these are moving and movement is not only occurring at the ankle.

-Clamshells

-Straight leg raise

-Plantar flexion / dorisflexion

-Hip flexion

-Hip adduction / abduction

-IT Band stretching

(I wrote about this stretch a ton. Found here: http://b-reddy.org/2012/03/04/the-best-damn-it-band-stretch-ever/ )

-Single leg glute bridges with alternating leg kicks

(Credit to Mike Reinold and Eric Cressey for this one. Found here: http://www.youtube.com/watch?v=31e6GckNmeY )

Strengthening (Barefoot)

Day 86:

A1) Squatting to 90 degrees 2 x6-8r

A2) Glute Bridges weighted 3 x6-8r

B1) RESS to 90 or as tolerated 2-3 x10-12r

B2) Hamstring curls 3 x10-12r

B3) Single leg calves 2 x10-12r

-> I wasn’t feeling too great this day. Some days my leg will just refuse to loosen up and or it’s just not feeling strong. So on this day I did some extra ROM work and some extra glute activation / strengthening.

Day 89:

A1) Squatting to 90 degrees 2 x6-8r (25lbs)

A2) Glute Bridges weighted 3 x6-8r (125lbs)

B1) Side to side to 90 or as tolerated 2-3 x10-12r (BW -> These are hard.)

B2) Hamstring curls 3 x10-12r (20lbs)

B3) Single leg calves 2 x10-12r

Running / Conditioning

-Running backwards and side to side with no stopping or cutting

-> AND HE RUNS!!! Backwards and side to side that is…

This felt really odd the first day. It’s really hard to describe, but it feels as if your surgically repaired leg isn’t yours. As if it’s not quite attached to your body. It’s not painful, it’s just weird. With that said, it felt more normal the second day and progressively more normal from there on out.

-Biking

-Elliptical –Forward and backwards

-> I’ve pretty much gone over to biking instead of the elliptical at this point. This is primarily because I had so many weeks on the elliptical before I could ride the bike, so it’s just a nice change of pace.

-Pool:

-Running all directions

-Backwards and side to side running w/stopping

Plyos both legs all directions

-Plyos single leg backwards and side to side

-> The pool is always a progression ahead of land running. Thus, as I’m beginning to run sideways and backwards on land (which I was doing last month in the pool), I begin to run in all directions in the pool (but no cutting), which I’ll be doing on land next month.

Proprioceptive training

Weight shifts on bosu ball eyes closed.

-Single leg standing straight and bent unsupported w/ball

-Single leg straight and bent on bosu ball w/ball

High knee stepping sideways over cones with ball. Forward and back with ball.

-Plyos with leg press machine

-> Plyos are done on the leg press as a progression to plyos on land. This enables you to adjust how much weight you’re lifting as opposed to your own bodyweight dictating you lift your own bodyweight.

Meds

-Ibuprofen (Ideally after exercise.)

Nutrition

-Calories = Bodyweight x 15 + 20% on strength days (heavy carb emphasis these days)

-> Something I forgot to mention: It’s a good idea to make more of the calories on lifting days from carbohydrate sources whereas on days off they are primarily from fat and protein sources.

-Calories = Bodyweight x 10 on other days.

-Protein always high.

-Glucosamine and chondroitin, fish oil and vitamin D for supplements

 

Post-op Day 93-99 (Week 14)

Routine schedule:

Day 93: Massage, ROM, Proprioception, Strength,

Day 94: Massage, ROM, Conditioning (Running first), Proprioception

Day 95: Massage, ROM, Upper body,

Day 96: Massage, ROM, Proprioception, Strength,

Day 97: Massage, ROM, Conditioning (Running first), Proprioception

Day 98: Massage, ROM, Upper body,

Day 99: Massage, ROM

Massage Work

Foam Rolling / Tennis Ball: Adductors, Glutes, Quads, Calves, Peroneals, TFL,

 

Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)

-Passive knee extension with quad squeezes

-Flexion: Full flexion allowed as tolerated.

-Patellar mobilizations

-Tibial rotations. Palpate hamstrings and tibia to make sure these are moving and movement is not only occurring at the ankle.

-Clamshells

-Straight leg raise

-Plantar flexion / dorisflexion

-Hip flexion

-Hip adduction / abduction

-IT Band Stretching

-Single leg glute bridge with alternating leg kicks

Strengthening (Barefoot)

Day 93:

A1) Squatting to 90 degrees 2 x6-8r (20lbs)

-> I’m really not pushing this exercise at this point. Between the split squats, glute bridges, running, plyos, proprioception work, etc. I am getting a lot of leg work. At this juncture a lot of other things take precedent over my ability to squat. One of the primary reasons being it is a double leg exercise and I need a lot of work with single leg things e.g. split squats.

A2) Glute Bridges weighted 3 x6-8r (135lbs)

B1) RESS to 90 or as tolerated 2-3 x10-12r (BW x only 8r)

B2) Hamstring curls 3 x10-12r (Seated variation = 45lbs)

-> I have access to various hamstring machines so I’ve been rotating through them. The amount of weight I can use on each varies so I mark which one I use on which day. Either way, I am always doing a weight that is challenging for 10-12 reps.

B3) Single leg calves 2 x10-12r

 

Day 96:

A1) Squatting to 90 degrees 2 x6-8r (20lbs)

A2) Glute Bridges weighted 3 x6-8r (155lbs x8r, 6r)

B1) Side to side to 90 or as tolerated 2-3 x10-12r (BW)

B2) Hamstring curls 3 x10-12r (Seated = 45lbs)

B3) Single leg calves 2 x10-12r

Running / Conditioning

-Running backwards and side to side with no stopping or cutting

-Biking

-Elliptical –Forward and backwards

-Pool:

-Running all directions

-Backwards and side to side running w/stopping

Plyos both legs all directions

Plyos single leg backwards and side to side

 

Proprioceptive training

Weight shifts on bosu ball eyes closed.

-Single leg standing straight and bent unsupported w/ball

-Single leg straight and bent on bosu ball w/ball

High knee stepping sideways over cones with ball. Forward and back with ball.

-Plyos with both legs; side to side and backwards

> This marks the first time I have performed any jumping on land (the pool was prior to this). The jumping went fairly well. My leg was a little wobbly but overall it really wasn’t bad.

Meds

-Ibuprofen (Ideally after exercise.)

Nutrition

-Calories = Bodyweight x 15 + 20% on strength days (heavy carb emphasis these days)

-Calories = Bodyweight x 10 on other days.

-Protein always high.

-Glucosamine and chondroitin, fish oil and vitamin D for supplements

Post-op Day 100-106 (Week 15)

Routine schedule:

Day 100: Massage, ROM, Proprioception, Strength,

Day 101: Massage, ROM, Conditioning (Running first), Proprioception

Day 102: Massage, ROM, Upper body,

-> These days didn’t happen this week. I don’t remember exactly why, but I’m pretty sure it had to do with me drinking for nearly 48 hours straight and being way too hungover to do anything.

Day 103: Massage, ROM, Proprioception, Strength,

Day 104: Massage, ROM, Conditioning (Running first), Proprioception

Day 105: Massage, ROM, Upper body,

Day 106: Massage, ROM

Massage Work

Foam Rolling / Tennis Ball: Adductors, Glutes, Quads, Calves, Peroneals, TFL,

Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)

-Passive knee extension with quad squeezes

-Flexion: Full flexion allowed as tolerated.

-Patellar mobilizations

-Tibial rotations. Palpate hamstrings and tibia to make sure these are moving and movement is not only occurring at the ankle.

-Clamshells

-Straight leg raise

-Plantar flexion / dorisflexion

-Hip flexion

-Hip adduction / abduction

-IT Band Stretching

-Single leg glute bridge with alternating leg kicks

Strengthening (Barefoot)

Day 100:

A1) Squatting to 90 degrees 2 x6-8r

A2) Glute Bridges weighted 3 x6-8r (155lbs x8r, 8r)

B1) RESS to 90 or as tolerated 2-3 x10-12r (BW x8r, 8r)

B2) Hamstring curls 3 x10-12r (My hamstring was cramping a bit at this point, so I canned this for the day)

B3) Single leg calves 2 x10-12r

Day 103:

A1) Squatting to 90 degrees 2 x6-8r

A2) Glute Bridges weighted 3 x6-8r

B1) Side to side to 90 or as tolerated 2-3 x10-12r

B2) Hamstring curls 3 x10-12r (Seated = 40lbs)

B3) Single leg calves 2 x10-12r

-> My leg was feeling extra stiff this week for some unbeknownst reason. I took this strength day really light on the majority of things. The only thing I hit hard was the hamstring curls as my leg felt fine with that.

Running / Conditioning

-Running backwards and side to side with no stopping or cutting

-Biking

-Elliptical –Forward and backwards

-Pool:

-Running all directions

-Backwards and side to side running w/stopping

Plyos both legs all directions

Plyos single leg all directions

-> Despite my knee not feeling great during the strength stuff, the running went really well this week. The awkwardness that was readily apparent when I first started had pretty much fully dissipated by this point.

Proprioceptive training

Weight shifts on bosu ball eyes closed.

-Single leg standing straight and bent unsupported w/ball

-Single leg straight and bent on bosu ball w/ball

High knee stepping sideways over cones with ball. Forward and back with ball.

Plyos with both legs; side to side and backwards

Meds

-Ibuprofen (Ideally after exercise.)

Nutrition

-Calories = Bodyweight x 15 + 20% on strength days (heavy carb emphasis these days)

-Calories = Bodyweight x 10 on other days.

-Protein always high.

-Glucosamine and chondroitin, fish oil and vitamin D for supplements

Post-op Day 107-113 (Week 16)

Routine schedule:

Day 100: Massage, ROM, Proprioception, Strength,

Day 101: Massage, ROM, Conditioning (Running first), Proprioception

Day 102: Massage, ROM, Upper body,

Day 103: Massage, ROM, Proprioception, Strength,

Day 104: Massage, ROM, Conditioning (Running first), Proprioception

Day 105: Massage, ROM, Upper body,

Day 106: Massage, ROM

Massage Work

Foam Rolling / Tennis Ball: Adductors, Glutes, Quads, Calves, Peroneals, TFL,

Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)

-Passive knee extension with quad squeezes

-Flexion: Full flexion allowed as tolerated.

-Patellar mobilizations

-Tibial rotations. Palpate hamstrings and tibia to make sure these are moving and movement is not only occurring at the ankle.

-Clamshells

-Straight leg raise

-Plantar flexion / dorisflexion

-Hip flexion

-Hip adduction / abduction

-IT Band Stretching

-Single leg glute bridge with alternating leg kicks

Strengthening (Barefoot)

Day 107:

A1) Squatting to 90 degrees 2 x6-8r (30lbs)

A2) Glute Bridges weighted 3 x6-8r (165lbs x8r, 8r)

B1) RESS to 90 or as tolerated 2-3 x10-12r (BW x10r, 10lbs x8r)

B2) Hamstring curls 3 x10-12r (Decline bench = 15lbs)

B3) Single leg calves 2 x10-12r

Day 113:

A1) Squatting to 90 degrees 2 x6-8r (30lbs)

A2) Glute Bridges weighted 3 x6-8r (155lb x8r, 8r)

B1) Side to side to 90 or as tolerated 2-3 x10-12r (BW -> These are still really hard)

B2) Hamstring curls 3 x10-12r (Decline bench = 20lbs)

B3) Single leg calves 2 x10-12r

Running / Conditioning

-Running –Flat ground backwards and side to side with no stopping or cutting

-Biking

-Elliptical –Forward and backwards

-Pool:

-Running all directions

-Backwards and side to side running w/stopping

Plyos both legs all directions

Plyos single leg all directions

-> On the second running / conditioning day this week I pretty much took off of all running. Every now and then my back will flare up, it primarily happens when I am working a lot as I lean over quite a bit during the day. Thus, the second day I went harder than normal in the pool to still get some running work. This worked well.

Proprioceptive training

Weight shifts on bosu ball eyes closed.

-Single leg standing straight and bent unsupported w/ball

-Single leg straight and bent on bosu ball w/ball

High knee stepping sideways over cones with ball. Forward and back with ball.

Plyos with both legs; side to side and backwards

-Plyos; single leg; backwards and side to side

Meds

-Ibuprofen (Ideally after exercise.)

Nutrition

-Calories = Bodyweight x 15 + 20% on strength days (heavy carb emphasis these days)

-Calories = Bodyweight x 10 on other days.

-Protein always high.

-Glucosamine and chondroitin, fish oil and vitamin D for supplements

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