ACL Rehab: Top 11 ways to improve KNEE FLEXION after Surgery
We are here to help you make this part of your rehab as painless as possible. Range of motion is often the dreadful part of therapy. However, if you properly warm your knee up, these range of motion exercises for improving your knee flexion or helping you bend your knee better should be easy to complete.
Please note that all of these exercises should be approved by your orthopedic surgeon and Doctor of Physical Therapy. In order to protect your knee and the soft tissue that was repaired, you want to be approved to add these exercises.
Below you will find the secret to improving knee flexion with little to no pain. If you can follow these steps, I am confident you will meet your range of motion goals in no time and with limited to no pain along the way.
The key to improving your knee flexion after surgery is Early Mobilization.
I know it sounds crazy, but getting up to go to the bathroom and making your own lunch is part of therapy! It is imperative that you follow the BUM principle and Be Up and Moving. Obviously, you want to allow for time to rest and elevate your knee, but being up and moving helps manage swelling as well as assists with tissue healing and remodeling. We call this weight bearing as tolerated, WBAT. By progressively moving your knee during normal daily activities and adding more weight throughout the healing process, you will progress your range of motion in no time, experience less postoperative complications, and improved satisfaction with your recovery timeline.
At PREP Performance Center we believe that you need to complete your exercises early and often. It is key to be up and moving approximately once an hour and complete the exercises below 2-3 times throughout the day. Exercises are expected to be “painful but tolerable”. Usually if you follow the program as we have set forth, there is minimal pain reported by our patients.
Should you experience excessive pain, swelling or difficulty progressing your range of motion the following day, please discuss with your physical therapist and doctor. In order to progress timely, you also need to ensure you don’t over do it. Pushing yourself too fast or too hard can cause a setback which can often lead to frustration, excess swelling and possibly tissue damage.
Remember… If you stay within the “Painful but Tolerable” range, your knee flexion will continue to progress each and every day.
NOTE: Self awareness, breathing, and relaxation are key to a successful ACL Recovery.
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- Pain Management- Mobilization of the swelling will reduce the pain during ROM exercises
a. Elevate your legs for 20 minutes and take your pain medicine at least 20 minutes before - Cryotherapy/Ice- Said to reduce inflammation and edema
a. Ice one hour before your knee flexion program - Walk- Early mobilization and gentle mobility will help reduce swelling around the knee
a. Walk for 10 minutes prior to beginning your program and bend your knee when walking - Compression –
a. Wrap your knee with an ace wrap to minimize swelling after icing - Effleurage
a. Complete effleurage for 3-5 minutes to reduce swelling. Gently massage your leg and pull up towards your heart - Heel Slides
a. Complete supine heel slides on bed 3 x 10 repetitions, lie on your back and gently bring your heel toward your bum
b. Try to get one more inch with each and every rep
c. Take a deep breath and gently hold your knee in place and then straighten your leg on the exhale - Heel Slides with Assist
a. Complete heel slides with assist for 2 x 10 repetitions (5 second hold)
b. Lie on your back and use a strap to help you bend your knee
c. Try to get one more inch with each and every rep and pull your knee closer to your bum
d. Take a deep breath and gently hold your knee in place and then straighten your leg on the exhale - Hamstring Curls
a. Complete prone hamstring curls 2 x 10 repetitions
b. Lie on your belly and gently bend your knee
c. Inhale as you bring your heel towards your bum and exhale on the way out - Knee Flexion
a. Complete prone knee flexion 2 x 10 repetitions
b. Using a strap, lying on your belly bend your knee - Quad Mobility
a. Complete prone quad mobility 10 x 10 seconds each
b. Using a strap, lying on your belly, bend your knee as tolerable and hold for 10 seconds
c. Try to get one more inch with each and every rep and pull your knee closer to your bum
d. Take a deep breath and gently hold your knee in place and then straighten your leg on the exhale - Quad Stretch
a. For a deeper quad stretch (reducing knee pain), elevate your knee on a foam roller and complete the prone quad stretch
b. Complete prone quad mobility 5 x 30 seconds each
c. Using a strap, lying on your belly, put foam roller just above your knee cap, bend your knee as tolerable and hold for 30 seconds.
d. There should be little to no knee pain, but a stretch should be felt in the quadriceps
- Pain Management- Mobilization of the swelling will reduce the pain during ROM exercises
Looking for more information and a customized program, download our app and follow along our ACL Rehab Phase 1 program. With grader progressions of exercises and various resources to learn from we have everything you need in one place: CLICK HERE
6 Best Exercises to Eliminate your Knee Pain
Knee pain is one of the most common issues people seek out medical treatment to ease the discomfort and improve their function. Whether you are a 15-year-old basketball player, a 50-year-old runner, or a 75-year-old grandma, knee pain can limit our ability to do the things we love to do.
Patients often report achy knees, stiffness in the knees, and knee pain with walking or going up and down stairs. If you’re a more active person, knee pain with running, jumping, and/or landing can also be affected. This can cause a major limitation in one’s daily life and often leaves patients stopping wellness and recreational activities, choosing to stay at home instead of enjoying the activities they love. When pain is ignored, the condition can often worsen and cause more functional limitations if left untreated.
General knee pain is often treated quickly with a thorough movement assessment and physical therapy program that will address strength and mobility deficits that are contributing to the pain. One may ask, “why do my knees hurt?”. That is a good question. More often than not, it is because some muscles are tight, others are weak and your body is not doing a good job of absorbing and dispersing the shock encountered throughout the day. When we walk, the approximate force exerted on our knees is approximately 3x our body weight. Therefore, those muscles can fatigue over time if not properly trained. It’s important to seek care sooner rather than later so you avoid joint damage or early degeneration.
Over time the joint and surrounding cartilage can also break down, muscles may be tight and other muscles may weaken. Now don’t get scared, not all pain is treated equally and this is not something you need to worry about. Arthritis, a normal progression of “wear and tear” on our joints and bones, plagues approximately 32 million people. That means that the majority of people over the age of 50 have arthritis.
While some of these numbers seem scary, it’s important to note that if you come in early and often, we can often reduce the time needed to get you back to doing the activities you love. When you see a Doctor of Physical Therapy they will complete a full body evaluation that will identify strengths and weaknesses, mobility and flexibility deficits throughout your body and more specifically your knee. Then together you and the Physical Therapist will develop a plan of care that will help you meet your goals and establish a timeline for expected return to your life without knee pain!!!
It’s important to note that in most states you can go see a physical therapist WITHOUT having to see a Medical Doctor or Specialist. Direct Access was established in Illinois in 2018 and has made getting rid of that knee pain more accessible, more affordable, and a faster solution to eliminating knee pain.
See some sample exercises that help most people with general knee pain:
Thomas Test Stretch
Seated Piriformis Stretch
Bridges (Knee Pain)
Sidelying ABD
Sit to stand (Knee Pain)
Sidestepping/Duck Walks
Most Physical Therapists work with your insurance carrier.
To learn more about osteoarthritis, check out this page from the CDC.
The Basics of Glute Strengthening
What are the glutes?
Glute strengthening – There are 3 muscles that comprise the gluteals. These consist of the gluteus maximus, medius, and minimus. All three of these muscles have unique functions and work as the primary stabilizers of the low back, hips, knees, and ankles. Didn’t know they did that much? Most people don’t and is why we are talking about them today. Having strong glutes that turn on properly and at the right time is crucial in preventing lower extremity injuries, especially an ACL injury. Often there are muscles that do not get mentioned but are also extremely important in preventing ACL injury or re-injury. These muscles are called the external rotators of the hip and are no bigger than one of your fingers. These muscles are small but mighty in helping to prevent your knee from turning inward towards the midline (a huge source of injury and knee pain).
There are 3 best glute strengthening exercises you should be doing every single day, and prevent re-injury of your ACL or even from developing something as simple as knee pain following your ACL surgery.
1. Sidelying Abduction
– Lie on side with hips rolled forward slightly
– Place top leg behind bottom leg with toes pointing towards the ground
– Squeeze the glute muscles and raise top leg, maintain toes towards ground through full range of motion
– Repeat for 2 sets of 10
2. Clamshell for glute strengthening
– Lie on side with hips, knees and ankles stacked
– Keep ankles in line with hips
– Without hips rolling back, open top knee
– Repeat for 2 sets of 10
3. Bridge for glute strengthening
– Lie on back on flat surface, place feet flat on ground and bend knees to 90 degree angle
– Place weight through heels and squeeze glute muscles as you lift hips off the ground
– Maintain belly button to spine to protect back
– Repeat for 2 sets of 10
5 ways to increase your sprinting speed with combined strength training
Sprinting Speed. Have you ever heard that weight lifting as a sprinter is going to make you “too bulky to run fast”? Well, there is an abundance of evidence proving this is not true and actually beneficial in increasing an athletes speed when combined with plyometrics and your regular sprint training!
Each muscle in your lower body contributes to the production of overall sprinting speed in a unique way. Running is a high-velocity activity which requires a lot of force generation from your muscles. Therefore, you must implement high-velocity strength training into your program that mimic the actions of the muscle during the specific phase of running in which they are primarily active. The exercises below are designed to replicate the strength and power you need throughout the gait cycle, and will allow you to produce a greater force.
A website trackspikes.co.uk talks about the average speed for many athletes is 24kmh (15mph).
An efficient warmup that increases your heart rate and keeps muscles loose is your first step to success. Also, remember proper mechanics and completing your reps and sets safely is the most important thing in strength training for sprinting speed 🙂
TAKE HOME MESSAGE for sprinting speed: as a sprinter, you want to have a greater focus on your ability to apply the force rapidly (high-velocity/explosive strength), rather than the maximum amount of force you can apply (maximum strength).
Exercise #1: Jump Squats with Kettle Bell
PARAMETERS →
4 sets x 8 reps
Intensity – 5% of your body weight
2 minute rest between each set
HOW TO →
– Start in standing with feet shoulder width apart and dumbbells or weight in hand.
– Bend your knees and hips to lower all the way down
– Quickly explode in the opposite direction, passing through standing and pushing through your ankles to follow through with a vertical jump.
– Absorb your body weight as you return to the floor (don’t land with straight knees)
chest upright, and core activated.
Exercise #2: Med Ball Toss
PARAMETERS →
4 sets x 6 reps
Variable weight as tolerated (suggest to start ~15-20lb ball)
2 minutes rest between each set
HOW TO →
– Start in a slightly squatted position with medicine ball near the hip opposite to the wall
– Squat down further at the same time as you rotate your trunk away from the wall.
– Rapidly and controlled explode through your legs and rotate your run toward the wall as you throw the ball at the wall.
– Catch the bal off the wall before it hits the ground as you absorb the weight and squat again
Exercise #3: Standing Long Jumps/Broad Jumps
PARAMETERS →
4 sets x 8 jumps (forward and back)
Intensity – Body Weight
2 minutes rest between each set
HOW TO →
– Begin in a standing athletic position.
– Squat down and bring your arms back to prepare to jump.
– Explode up and out and you jump off the ground.
– In mid air, extend your back and straighten out your body with arms above head (banana).
– Bring your feet in front of you to prepare for landing
– Absorb the force through bending your hips and knees. Repeat another jump from the quarter portion you land from the former jump.
Exercise #4: Jerk with Barbell
PARAMETERS →
4 sets x 5 reps
Intensity – 70% 1RM
2 minutes rest between each set
HOW TO →
– Start standing with the barbell on the front of your shoulders and elbows bent.
– Slight squat to prepare for upward motion
– Lift the barbell off your chest to above head in one rapid continuous motion.
– Slight flight phase as you pull the barbell over head
– Land in a split squat stand with knee and hip flexion
– Lower the barbell back down you your chest as you bring your feet together
– Repeat with the other leg in front
** maintain an active core throughout and absorb the force through your knees with a soft landing.
Exercise #5: Plyometrics – Scissor Jumps
PARAMETERS →
4 sets x 10 reps (each leg)
Intensity – body weight
Rest 2 minutes between each set
HOW TO →
– Start with feet together in standing
– Jump up and split your leg forward and back
– Land in a split squat position with both knees bending to 90 degrees
– Explode through that lowered squat position
– Switch your legs in the flight on the jump and land in a squat with the other leg in front in the same 90/90 position. Repeat until you’ve done 20 total (10 on each leg)
**ensure you keep your front knee behind your toes during the squat
Contact us today!
Are you ready to run at your sprinting speed peak level of performance? Contact Doctor of Physical Therapy, Mary Kate Casey at our Chicago, IL clinic today! Through our video running analysis, we can assess all the running mechanics listed above at once and figure out how your running efficiency can be increased to improve your speed performance and reduce your risk of injury. Give PREP Performance Center a call at 773-609-1847 for more information on our video running analysis program!
When can I return to soccer after my ACL surgery?
Planning to return to soccer sport? Returning to sport occurs in multiple and progressive phases that start 3-5 months following surgery. At approximately 6 months, it is possible to safely progress to full participation in sport. This timeline can fluctuate depending on the individual and is completely normal for someone to progress faster or slower than someone else. Each ACL journey is unique!
The first step is to assess readiness for initiating early return to sport interventions in the clinic. There are several criteria physical therapists assess to ensure safety for this next step.
There is also an observation done by the National Center for Biotechnology Information of 50 soccer players after ACL.
Criteria to progress to Early Return to Sport (based on Prep Performance Center Specialized ACL Rehab Program)
– Normal gait
– ROM equal to contralateral side
– Symmetric weight acceptance for squats to 60°
– No reactive swelling after exercise or activity that lasts for more than 12 hours
– No episodes of instability
– Maintain quad strength
– 10 repetitions single leg squat proper form through at least 60° knee flexion
– Drop vertical jump with good control
– Functional Assessment
– Quadriceps index >80%; HHD mean preferred (isokinetic testing if available)
– Hamstring, glut med, glut max index ≥80%; HHD mean preferred (isokinetic testing for HS if available)
– Single leg hop test ≥75% compared to contralateral side (earliest 12 weeks).
When cleared to progress to this next phase, the physical therapist will begin to introduce sport specific interventions. Goals for this early phase of return to soccer sport are to progress strength training, initiate a return to running program, progress plyometrics and agility training, and promote proper movement patterns during sport specific activities. It is important during this phase to avoid any post exercise pain or swelling or activities that produce pain at the graft donor site. If, at any point, you experience these symptoms, tell your physical therapist so he or she can adjust the program as necessary to protect your knee!
The next step in returning to full participation in sport (6+ months post surgery) is to assess readiness to begin non-contact practice. There are several criteria physical therapists assess to ensure safety for this next step.
Criteria to progress to Full Return to Sport (based on Prep Performance Center Specialized ACL Rehab Program and MGH Rehab Protocol for ACL Reconstruction)
– Normal jogging gait
– Good single leg balance
– Less than 25% deficit on Biodex strength test
– No reactive swelling after exercise or activity
– Clearance from surgeon
– Completion of run program without pain or swelling
– Quad, hamstring, glute index > 90%
– Hamstring/Quad ratio > 70%
– Hop testing > 90% compared to non-operative leg
– Psych Readiness to Return to Soccer Sport
When cleared to progress to this next phase, the physical therapist will continue to work with you in the clinic focusing on strength, proprioception, symmetrical performance during sport specific drills, plyometrics and agility, cutting and pivoting. Outside the clinic, starting at 6+ months, you will begin to participate in non-contact practice which will eventually progress to full practice and full play as dictated by how your body responds at each level. During this late stage of your rehab, it is extremely important to continue doing the exercises your physical therapist recommends for home in order to optimize function and safety.
Remember that not all ACL journeys are the same. This process will be unique to YOU and your body. Your physical therapist and orthopedic surgeon will be the best resources to help you understand where you are at in your individual journey and what to expect along the way.
For more details regarding Prep Performance Center’s goals and interventions at each phase of the specialized ACL rehab program, click here!
Off Season Training Tips for Young Gymnasts (Levels 5 and under)
Unlike most other sports there is no real off-season in gymnastics. But it’s important to let your mind and your body take a break from the sport each year to prevent overtraining or burnout, especially as a young gymnast. So what should you do in your off time to make sure you are fresh and ready to go once you’re back in season? … PLAY! While it is important to maintain your fitness in order to be able to pick back up without missing a beat, fitness can be maintained in large part through play.
Moderate to Vigorous Aerobic Activity during Off Season
This is a fancy term for activity that makes your heart race and makes you breathe hard. There are a lot of different ways to accomplish this: Running around playing tag or capture the flag with your friends, jumping on a trampoline or jumping rope, swimming, dancing, doing as many back walkovers as you can in a row… you name it! The important part, according to scientists at the CDC is that you spend at least 60 minutes being active!
Strengthening on Off Season
Rather than doing any particular exercises during off season it is best to use your muscles while playing. See if you can outlast your friends in a pull up competition on the monkey bars or see who can jump the farthest on the ground.
Stretching
You know the drill – hamstrings, quads, wrists, shoulders, splits – you do a LOT of stretching at practice. Anytime you spend flexing should help you to at least maintain all the flexibility you gained last season. But scientists have found that if you spend 10 minutes a day in each stretch you actually increase the flexibility of your tissues. So maybe challenge yourself to make this break the break when you get your center splits!
Specific stretches:
1. Back of the Wrists
– Description: Sit on the ground with the back of your hands flat against the ground in front of you. Make sure the back of your hands stay flat on the ground as you lean back until you feel a stretch on the outside of your arm below the elbow.
– Compensations: Make sure you are not allowing the back of your hands to lift off from the floor at all. Also make sure your fingertips are pointing straight towards your body and not inward or outward.
– Purpose: In gymnastics, unlike in life, you weight bear through your hands often whether in a back walkover or back hip circle. Weight bearing through your hands requires a lot of mobility in the wrists. When taking some time off from the sport it is important to keep your wrists limber in order to avoid injury upon return.
2. Bridges (Back and Shoulders)
– Description: Perform a bridge push out through your feet such that your feel a stretch under your armpits.
– Compensations: Make sure your fingertips are pointed straight back towards your feet and not rotating inward or outwards.
– Purpose: To maintain flexibility of your back and shoulders
3. Splits
– Description: Sit in your left, right, and middle splits for at least 30 seconds at a time.
Compensations: Keep your pelvis neutral – check to make sure those bones on the front of your hips are pointed straight in front of you and not downwards toward the ground. Make sure your knee cap on your back leg is flat on the floor and the kneecap on your front leg is pointing straight up toward the ceiling and that neither are rotated out to the side. One leg is always “better than the other” but it is important to stretch equally to prevent structural imbalances that can predispose injury.
– Purpose: To maintain flexibility of your legs.
Okay I know earlier I said that you could maintain your fitness through play and that’s definitely true for your aerobic fitness and strength, but stretching does need to be a bit more structured. But that doesn’t mean it can’t be fun. Maybe see if you can convince your parents to let you watch an episode of TV if you are stretching the whole time or have a slumber party with your friends from gymnastics and stretch together!
Contact us today!
Are you ready to perform at your optimal level? Contact Doctor of Physical Therapy, Mary Kate Casey at our Chicago, IL clinic today! Through our movement analysis, we can assess jumping and landing mechanics and help you improve performance and reduce your risk of injury. Give PREP Performance Center a call at 773-609-1847 for more information on our movement analysis program!