Early Phase ACL Rehab

1. ROM (Range of Motion) is most important in the first several weeks and knee extension is typically the hardest one to gain back. Knee extension should be ATLEAST the same as the non-surgical leg or more and recommended to be in “hyperextension.” This is extremely important for the later phases that involve strengthening, COD (change of direction), plyometrics and more. This reduces stress on the ACL graft.

2. Quadricep Activation– Quad Sets- It’s boring initially but being able to activate the quadricep muscle without an “extensor lag” during SLR is key and usually want to achieve this by 4-6 weeks. Reducing swelling is key for good quadricep activation and repetition.

3. Gait Pattern-Gait mechanics should be restored early on before progressing to other exercises. Is the knee flexing enough? Do they lack knee extension at terminal stance? Are they compensating at the hip or nonsurgical leg?

4. Patellar Mobilizations– Mobilizing the patella is extremely important to assist with knee ROM. (superior, inferior and medial/lateral glides)

5. Home Exercise Program– Don’t neglect your HEP. Going to see a physical therapist 2-3 times a week isn’t going to be enough at this phase. HEP should be performed 3-4 times per a day depending on the exercises given.

6. Pre Testing– If possible, getting baseline testing done on the noninvolved LE prior to surgery is helpful in getting accurate results for RTS (return to sport) testing later on ACL rehab. After surgery, you’re not as active due to post op restrictions and will lose strength in general in both LE’s. Important to measure strength in nonsurgical knee early to have as a true point of reference.

7. Force Plate Testing– Finding a physical therapist with experience and knowledge of force plate testing is extremely important. Gold Standard for true outcome assessments that rule out guessing and improve confidence with decision making. Force Plates are able to assess asymmetry percentage differences with squatting, balance, jumping, hopping and more that the naked eye can’t see. Finding a PT with experience that can simplify the results to you and specifically target what you need to work on is key. Utilizing force plates can save weeks and potentially months of rehab due to quicker results with specific training.***

8. Insurance-Dealing with insurance can be difficult and finding out the specifics can be challenging when it comes to how many visits you might get per calendar year, co pay, co-insurance, high deductible and more. One of the reasons I stick with cash pay that is affordable and not limited by insurance.