ACL and meniscus surgery physical therapy- Week 5

(Last Updated On: January 5, 2018)

Post-op Day 29-35 (Week 5)

Routine schedule:

Day 29: ROM, Proprioception, Strength

Day 30: ROM, Conditioning, Proprioception

Day 31: ROM, Proprioception, Strength

Day 32: ROM, Conditioning, Proprioception

Day 33 ROM, Proprioception, Strength

Day 34: ROM, Conditioning, Proprioception

Day 35: ROM

 

Crutches

-Eliminated

 

Bracing

-Only while sleeping to insure I don’t bend my leg excessively

-I still wear an ACE bandage to 1) Help remind me I did just have surgery. I’m starting to feel good enough that sometimes I actually forget to be careful. This is a good thing, it helps let me know I’m getting better. But, it can be a bad thing if I accidentally push too far. And 2) It helps let other people know I have an injury.

 

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

-Extension: To 0 degrees or 5-7 degrees of hyperextension.

-Passive knee extension with quad squeezes

> Same old crap here. I’m doing this every day, multiple times per day. And trust me, it’s necessary. While I am beginning to get less stiffness, I still need to check I have full extension quite often.

 

-Flexion: Active flexion allowed only to 90 degrees. BUT, no RESISTED flexion allowed. Full passive flexion allowed as tolerated.

> I haven’t achieved full flexion yet, but I’m being a bit conservative here. Right now it doesn’t feel great to attempt full flexion. But, once I’m committed to getting flexion it comes right back. So, I’m really not too concerned with acquiring it. It will come back.

-Patellar mobilizations

-Sitting hamstring stretch

-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

-Sitting knee extension 90-0 degrees

 

Strengthening (Barefoot)

Day 29:

A1) Squat to 60 degrees 4 x6-8r (15 lbs)

> Squat depth is increased every couple of weeks.

A2) RDL 4 x6-8r (30 lbs)

B1) Single leg leg press to 45 degrees (35lbs)

B2) Glute Bridges

C1) Single leg calves (35lbs)

C2) Isometric heel slides @ 30, 60, 90

 

 

–> Perhaps the biggest difference from week 4 to week 5 is the introduction of knee flexion strengthening. Due to having a hamstring graft, you don’t want to introduce this too soon or it continually feels like you are moving a strained hamstring = not good.

Because active knee flexion strengthening isn’t allowed until after week 8, isometrics are introduced a few weeks prior to prepare for active strengthening. It’s all about the progressions!

Day 31:

A1) Squat to 60 degrees 4 x6-8r (20lbs)

A2) RDL 4 x6-8r (35lbs)

B1) Single leg leg press to 45 degrees (35lbs)

B2) Glute Bridges

C1) Single leg calves (35lbs)

 

Day 33:

A1) Squat to 60 degrees (25 lbs)

A2) RDL (40lbs)

B1) Single leg leg press to 45 degrees (42lbs)

B2) Glute Bridges

C1) Single leg calves (42lbs)

C2) Isometric heel slides @ 30, 60, 90

 

Conditioning

-Elliptical (25 mins, 30 mins, 30 mins each respective day)

-Pool- Walking all directions.

 

Proprioception training (Barefoot)

–Weight shifts eyes closed and open.

-Weight shifting on bosu ball; eyes open and closed.

-Single leg standing straight and bent; unsupported.

Meds

Ibuprofen as needed (after exercises).

 

Nutrition

-Calories = Bodyweight x 15 * 1.10 on strength days.

-Calories = Bodyweight x 10 on other days.

-Protein always high.

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Week five represents the second month of therapy, but the first month is the most important.

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