ACL Reconstruction Rehab Program Essentials. ACL Reconstruction Surgery. ACL Tear. Tim Keeley B.Phty, Cred.MDT, APA Principal Physiotherapist

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1 ACL Reconstruction Rehab Program Essentials Tim Keeley B.Phty, Cred.MDT, APA Principal Physiotherapist physiofitness.com.au ACL Reconstruction Surgery Injury Mechanism Hamstring Graft Patella Tendon LARS Ligament Augmentation & Reconstruction System What will we cover?... Stages 1-6, Components Your job is... Goals, pre-injury, 100% ACL Tear

2 ACL Reconstruction Surgery My ACL Story... Demo Which type of surgery? Brace Injury, Surgery and Pain issues Antero-medial rotatory stability Pain inhibition Post-surgical pain and stiffness VMO and hip stabiliser de-activation Swelling and trauma Semi tendinosis / gracilis harvest Patella tendon harvest Rehab Program Essentials Range of Movement Swelling and pain reduction Muscle activation, Core Stability Postural, Motor and Proprioceptive control Strength and Muscle Bulk Impact and Stability Endurance Program Timeframes Return to Sport Bridge the Gap 100% not 80%!

3 1 Stage 1: Weeks 1-2 Goals: 0 Extension / 90 Flexion, pain and swelling reduction, VMO and glute activation Physio: within 1 st week, local treatment, acupuncture, KT taping, compression, REST Stretches: 2-3 x a day, Ext / Flex heel slides, prone extension, calf, hamstring* ICE! ( is your friend ) Stage 1: Essential Exercises Strength/Rehab: 2-3 x day, VMO squeezes, SLR *(quads lag), prone holds, prone glutes, clams, heel pushes, calf raises Proprioception: one-leg balance, walking re-education Cardio: Bike circles Do s and DONT S Ice and Rest! 2 weeks off work Extension is the most important Repeat exercises, multiple times Don t push too hard Limit walking and standing Use a crutch if needed to stop limping

4 2 Stage 2: Weeks 2-6 (2-4 if LARS) Goals: 0 Extension / 130 Flexion, FWB, VMO and glute activation, FMP s Physio: As per week 1, Rehab program instruction, soft and scar tissue massage, patella mob s Stretches: 1-2 x a day, add in quads, glutes and lower back, foam roller Stitches out 10 days, Surgeon review Stage 2: Essential Exercises Strength/Rehab: VMO Quad squeezes, glute bridges, wall holds, isometric hamstrings, BW squats, BOSU Squats, leg press*, deadlifts*, patter kicks* Proprioception: 1 leg BOSU, hammy drops Cardio: Bike, rower, pool Do s and DONT S Push for extension in exercise MOTIVATE! boredom / crucial stage Get VMO firing Watch even weight-bearing Careful of PFJ Pain Don t favour the easy stuff! Must do pool

5 3 Stage 3: Weeks 6-12 (4-6 if LARS) Goals: Full flexion maintenance, rehab program development, strength and stability Physio: Rehab program instruction, *hamstring massage, soft tissue release Stretches: 1 x a day, add in child s pose protect knee - hamstring/patella graft weakest at 9 weeks Stage 3: Essential Exercises Strength/Rehab: Physio Lunges, 1 leg step downs, Front squats, *eccentric hamstring curls, swiss ball curls, single leg deadlifts Proprioception: BOSU 1 leg step down, bands BOSU side step, lateral step ups Cardio: Bike, rower, swim (no breast-stroke), short walk NO JOGGING! 4 Stage 4: Weeks (6-10 if LARS) Goals: Increase walking distance, building muscle size and hamstrings, intro impact and jog Physio: Program instruction Stretches: as needed

6 Stage 4: Essential Exercises Strength/Rehab: Increase weights, 1 leg step ups, stand to sit squats, *eccentric leg extension machine Proprioception: hamstring jog kicks, BOSU lateral hops, single leg deadlifts 1 leg step-up jumps, side steps, grapevines Cardio: Walking, Light jogging 5 Stage 5: Weeks (10-14 if LARS) Goals: Increase running distance Physio: Review deficits, maintain timeframe Strength/Rehab: Increase weights Proprioception: jogging side steps, change direction drills, single leg hops, 4 corners Cardio: running, *soft sand, shuttles 6 Stage 6: Weeks month mark Goals: Return to sport* (longer for rotary & heavy impact sports) Strength/Rehab: Increase weights Proprioception: Sport specific drills and training Cardio: Sprints (14-20 if LARS)

7 It can be done! Last but not least... Hamstring vs Patella vs LARS? PT s need to work with the Physio... Physio need s to work with the PT! Continuation of the VMO rehab exercises Long term outcomes Physio Reviews Bridge the GAP 100% not 80%! Thank you! physiofitness.com.au facebook.com/physiofitness

8 Thank you! physiofitness.com.au facebook.com/physiofitness Appointments E:

Today s session. Common Problems in Rehab. www.physiofitness.com.au/filex.htm LOWER BODY REHAB ESSENTIALS TIM KEELEY FILEX 2012

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