Knee Flexion Ways to Improve After Surgery - Prep Performance Center

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.

    1. 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
    2. Cryotherapy/Ice- Said to reduce inflammation and edema
      a. Ice one hour before your knee flexion program
    3. 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
    4. Compression –
      a. Wrap your knee with an ace wrap to minimize swelling after icing
    5. Effleurage
      a. Complete effleurage for 3-5 minutes to reduce swelling. Gently massage your leg and pull up towards your heart
    6. 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
    7. 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
    8. 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
    9. Knee Flexion
      a. Complete prone knee flexion 2 x 10 repetitions
      b. Using a strap, lying on your belly bend your knee
    10. 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
    11. 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

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

wrist pain in the gymnast - consult Prep Performance Center in Chicago

Wrist Pain in the Gymnast

Gymnastics is an extremely intense sport both emotionally and physically. The physical demands of this sport unfortunately leave gymnasts susceptible to almost any injury under the sun. Wrist pain is very commonly experienced by gymnasts, males, and females alike. Distal Radial Epiphysitis, also called “Gymnast Wrist”,  specifically, is a common diagnosis that may explain this wrist pain amongst gymnasts due to the sport’s repetitive nature. 

Upper body injuries are more common in male and female gymnasts compared to other sports. The upper extremities are weight-bearing joints and absorb direct forces in all events of both men’s and women’s gymnastics. Acute injuries, such as a wrist fracture, often occur from a fall on an outstretched arm. However, injuries related to overuse and overtraining, such as Distal Radial Epiphysitis, are more common in gymnasts. 

The Diagnosis and How This Occurs:

– Distal Radial Epiphysitis, also known as “Gymnast Wrist”, is a growth plate injury to an adolescent gymnast with immature, growing bone structures
– The growth plate is prone to injury because the ligaments and joint capsule of the wrist are stronger than the cartilaginous growth plate 
– Repeated loading and wrist hyperextension cause the body’s forces to be directed to the radius bone which has not yet fused. This causes inflammation and widening of the growth plate. This often occurs with dorsal wrist impingement. 

Common Symptoms:

– Several weeks of unilateral or bilateral wrist pain 
– Usually occurs gradually, without history of acute trauma 
– Worsened pain with load bearing activities and when the wrist is extended 
– Pain relieved with rest 
– Range of motion normal or slightly limited due to pain
– Possible decrease in grip strength 
– Tender to palpation along the distal radius 
– Swelling may be present 

Differential Diagnoses:

– Dorsal Wrist Impingement 
– Scaphoid Stress Fracture 
– Carpal Ligament Sprains (Scapholunate and Lunotriquetral Ligament Injuries) 
– Triangular Fibrocartilage Complex Injuries 
– Ulnar Impaction
– De Quervain’s Tenosynovitis 
– Distal ulnar or radial stress fracture 

Pertinent Tests/Diagnostic Imaging:

– X-ray findings will typically appear normal
– In severe cases, a widening of the growth plate or ulnar variance may be visible
     – X-rays may be recommended 6-12 weeks post diagnosis or when symptoms subside to verify proper healing, but are usually not necessary if the initial X- rays appeared normal 
     – Routine X-rays may be recommended for about 6 months to one year post injury if the initial X-ray showed a lot of damage to the growth plate
– MRI is not usually necessary 

Risk Factors:

– Repetitive stress predisposes the wrist to acute injury, overuse injuries, and degenerative damage 
– Adolescent athlete with premature growth plates 
     – Adolescent gymnasts ages 10-14 are more likely to have wrist pain
– Recent growth spurt causing transient weakness at the growth plate

When to Seek Medical Attention: 

– Persistent pain that does not improve with rest over time 
– If this condition progresses it could lead to a fracture of the growth plate or ulnar variance 
– Ulnar Variance: if Gymnast Wrist becomes chronic and goes untreated, the growth plate may close prematurely resulting in cessation of radial growth too early, while the ulna continues to grow
     – Positive Ulnar Variance (the ulna appears longer): may result in altered wrist biomechanics, decreased wrist range of motion, and altered loading in weight bearing positions of the wrist 
     – Progressive damage to the ulnar side of the wrist may increase risk for chronic wrist pain and dysfunction

Ulnar variance - consult Prep Performance Center

Principles and Goals of Wrist Pain Treatment:

– Decrease the stress that is causing the pain
     – Stop weight bearing exercises for about 6 weeks or until symptoms subside 
– Wrist rehab to achieve symmetrical wrist range of motion and strength 
– Improve shoulder flexibility and thoracic spine mobility 
– Alternative training and conditioning aimed at improving upper body and core strength to decrease the stress on the wrist joint when returning to gymnastics 
– Stage 1: correct impairments in joint mobility, muscle length, and neuromuscular control in the spine, shoulder, and upper extremity joints
– Stage 2: continue manual techniques to correct impairments, progress exercises in neuromuscular control, introduce sport specific activities in limited weight bearing positions
– Stage 3: address impairments with manual techniques as needed, advance exercises in neuromuscular control, progress sport specific activities to full weight bearing positions  

Return to Sport:

wrist braces - consult Prep Performance Center in Chicago

– Once there is a decrease in pain, and range of motion and strength have been restored, the gymnast can begin a gradual increase in training load
– It is important that there is careful attention to sport biomechanics and proper form/ technique to limit further damage or re-injury 
– Wrist braces may also be worn to limit excessive wrist hyperextension 

Exercises to try if you may have Wrist Pain in Gymnast:

Wrist specific exercises 
     – Hand arch and splay 

Hand arch and splay - Prep Performance Center in Chicago
     – 4-way wrist strengthening (flexion, extension, ulnar and radial deviation) 

Upper body exercises 
     – It is important to have stabilization in proximal joints such as the shoulders and spine in order to improve stability and decrease stress in the elbow, wrist, and hand 
     – Scapular retraction and Shoulder ER at 90-90 
     – Planks and Side Planks 

Exercises to treat wrist pain in the gymnast - Prep Performance Center in Cebu
Training modifications 
     – Supported handstands on a wall, block, or table to decrease weight through the wrists and hands 

PT Role in Preventing Wrist Pain:

Overuse injury prevention
     – Limit excessive loading of the wrist
     – Maintain wrist joint flexibility
     – Incorporate wrist strengthening into training
     – Emphasize proper technique to reduce unnecessary stress 
     – Strengthen core and upper extremity joints to reduce stress on the wrist joints 
     – Wrist braces may be used in skeletally immature gymnasts to decrease the load on the wrist joints and help prevent early closing of the growth plates 


Benjamin HJ, Engel SC, Chudzik D. Wrist Pain in Gymnasts: A Review of Common Overuse Wrist Pathology in the Gymnastics Athlete. Current sports medicine reports. 2017;16(5):322-329.
Boucher B, Smith-Young B. Examination and physical therapy management of a young gymnast with bilateral wrist pain: A case report. Physical Therapy in Sport. 2017; 27:38-49.
DiFiori JP, Puffer JC, Aish B, Dorey F. Wrist Pain in Young Gymnasts: Frequency and Effects Upon Training Over 1 Year. Clinical Journal of Sport Medicine. 2002;12(6).
Hart E, Meehan WP, 3rd, Bae DS, d’Hemecourt P, Stracciolini A. The Young Injured Gymnast: A Literature Review and Discussion. Current sports medicine reports. 2018;17(11):366 375.
Poletto ED, Pollock AN. Radial Epiphysitis (aka Gymnast Wrist). 2012;28(5):484-485.
Trevithick B, Mellifont R, Sayers M. Wrist pain in gymnasts: Efficacy of a wrist brace to decrease wrist pain while performing gymnastics. Journal of Hand Therapy. 2019.
Written for PREP Performance Center by Gianna Scala, SPT

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EXERCISE TIPS How to get higher clicks in Irish Dance - Prep Performance Center in Chicago, Illinois, USA.

How to get higher clicks in Irish Dance?

How to get higher clicks in Irish Dance? How to jump higher during my leaps? How can I increase my toe height? 

These are many questions you and many of your friends are asking yourselves during and after dance practice.  Your teacher is constantly saying click higher, jump higher, and stay on your toes.  But no matter how many times you run your steps, and you try to focus on toe height or getting those clicks higher, your body just won’t let it happen without other things like your posture falling apart.  You become a woodpecker and while your click height improves, your posture takes the hit.  

Irish dancers are athletes and they need to train like athletes. Some of the greatest athletes of all time, the GOAT as some refer to it, spend more time training out of their sport than training in their sport.  Think Michael Jordan, Simone Biles, and Tom Brady. That is because you have to have a solid foundation and fundamentals of movement before you can move on to more advanced skills like leaping, clicking, and spinning in the air. 

That’s where Performance Therapy comes in. It’s a blend of performance training and injury prevention techniques that together will yield an improvement in overall performance, quality of movement, and reduced risk of injury. Performance Therapy takes a medical approach to performance just like the Apple watch takes a medical approach to health and wellness by measuring your heart rate, blood pressure, and steps for example. 

There are 29 muscles that attach to the hip and pelvis along with ligaments that stabilize our joints. While stretching the wrong muscles or creating ligament laxity may lead to higher clicks in the short term, it can also lead to injury overtime. The risk may not be worth the reward in my opinion. 

That is why we take this approach. It isn’t always fun and flashy, but it yields the results you want. 

You can’t improve what you don’t measure. 

This means we can’t improve your click height, if we don’t know what is limiting you.

The reason why we take this approach is to give you the most effective program to help you reach your goals to get higher clicks. There are many reasons why you don’t have the click height you desire, however one size does not fit all and that is where our Performance Therapy Movement Assessment comes in. Through our ARSI Movement Assessment, we identify strengths and weaknesses, mobility and flexibility deficits, as well as balance and coordination difficulties. We analyze the results and, from there, we can determine the most effective and research driven way to help you achieve your goals. 

We believe this approach is optimal for each dancer as it provides a medical approach to improving your performance without sacrificing joint stability, joint integrity and muscle strength that can often lead to overuse or traumatic injuries. 

Download our Click Height Assessment below to help you identify some of these limitations yourself. Give this a try, score yourself and read our blogs for a more specific program that will help you improve your clicks height based on your results. 

In order to achieve the optimal click height, there are MANY things to consider.  We have developed these exercise programs to help you follow a more systematic approach to improving  your click height, posture and overall dance performance.

– Chan EWM, Hamid MSA, Nadzalan AM, Hafiz E. Abdominal muscle activation: An EMG study of the Sahrmann five-level core stability test. Hong Kong Physiother J. 2020;40(2):89-97. doi:10.1142/S1013702520500080
– Davis, D. S., Ashby, P. E., McCale, K. L., Mcquain, J. A., & Wine, J. M. (2005). The Effectiveness of 3Stretching Techniques on Hamstring Flexibility Using Consistent Stretching Parameters. The Journal of Strength & Conditioning Research, 19(1), 27-­32
– Davis, D. S., Quinn, R. O., Whiteman, C. T., Williams, J. D., & Young, C. R. (2008). Concurrent validity of four clinical tests used to measure hamstring flexibility. The Journal of Strength & Conditioning Research, 22(2), 583-588.
– Wu SY, Tsai YH, Wang YT, Chang WD, Lee CL, Kuo CA, Chang NJ. Acute Effects of Tissue Flossing Coupled with Functional Movements on Knee Range of Motion, Static Balance, in Single-Leg Hop Distance, and Landing Stabilization Performance in Female College Students. Int J Environ Res Public Health. 2022 Jan 27;19(3):1427. doi: 10.3390/ijerph19031427. PMID: 35162447; PMCID: PMC8835546.
– Kaneda H, Takahira N, Tsuda K, Tozaki K, Kudo S, Takahashi Y, Sasaki S, Kenmoku T. Effects of Tissue Flossing and Dynamic Stretching on Hamstring Muscles Function. J Sports Sci Med. 2020 Nov 19;19(4):681-689. PMID: 33239941; PMCID: PMC7675630.
– Castellote-Caballero Y, Valenza MC, Puentedura EJ, Fernández-de-Las-Peñas C, Alburquerque-Sendín F. Immediate Effects of Neurodynamic Sliding versus Muscle Stretching on Hamstring Flexibility in Subjects with Short Hamstring Syndrome. J Sports Med (Hindawi Publ Corp). 2014;2014:127471. doi:10.1155/2014/127471
– McHugh MP, Johnson CD, Morrison RH. The role of neural tension in hamstring flexibility. Scand J Med Sci Sports. 2012 Apr;22(2):164-9. doi: 10.1111/j.1600-0838.2010.01180.x. Epub 2010 Aug 24. PMID: 20738821.
– Krause DA, Youdas JW, Hollman JH, Smith J. Abdominal muscle performance as measured by the double leg-lowering test. Arch Phys Med Rehabil 2005;86(7):1345–8. [PubMed] [Google Scholar]
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6 Best Exercises to Eliminate your Knee Pain_Prep Performance Center in Chicago

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. 


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The Basics of Glute Strengthening - Prep Performance Center in Chicago

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


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Why does my knee crack after my ACL surgery - Prep Performance Center

Why does my knee crack after my ACL surgery?

First and foremost, you are not alone! Hearing a crack or pop in the knee after your surgery is a very common experience among those who have gone through an ACL reconstruction. There are a few reasons this may be happening that are completely normal. Following surgery, there is typically some scar tissue that develops within the joint and surrounding structures. When you first start moving the knee around, this scar tissue will start to break up causing an audible crack or pop – this is okay!

Oftentimes after surgery, the affected structures will experience swelling. This is a normal part of the healing process. When there is swelling in the knee joint, this can cause the knee cap to track differently along the thigh bone when bending and straightening the knee. When the knee cap gets off its normal track, this can cause an audible crack or pop. Again, this is not something to be overly concerned about as once the swelling is resolved, this motion should return to normal. In addition to ice and elevation, safe and gentle range of motion at the knee can help to decrease post operative swelling. An example of a simple range of motion exercise to increase knee flexion is heel slides along the floor while sitting with legs stretched out in front of you. Other examples include low intensity stretching for the hamstrings and calf muscles. All range of motion and stretching should follow the prescribed guidelines of immediate post operative care set by the surgeon in order to protect the healing ACL graft. Specific instructions on these exercises are linked below!

Similar to joint swelling, a weak quadriceps muscle can cause the knee cap to track differently and may result in a crack or pop. Following an ACL reconstruction, it is normal to experience quadriceps weakness. Regaining quadriceps strength is something your physical therapist will begin working on with you early in your rehab.  Much like swelling, once quadriceps strength returns the knee cap will track normally again. A safe quadriceps strengthening exercise to do following surgery is isometric quadriceps setting. This exercise will help to wake up the quadriceps muscle that has likely lost some strength since surgery. Again, all exercises should follow the guidelines set by the surgeon in order to protect the healing ACL graft. Specific instructions on these exercises are linked below!

While hearing a crack or pop is completely normal following surgery, make sure to tell your physical therapist and orthopedic surgeon at your next appointment. For more information about the goals of early post operative care, you can explore the Prep Performance Center specialized online ACL rehab program here!

Range of Motion and Stretching Exercises:

Heel Slides 

Hamstring Stretch 

Calf Stretch 

Quadriceps Strengthening Exercise:

Isometric Quad Setting 


On the other hand, contact your physical therapist or book an appointment today if you feel any of these symptoms.

– Why does my knee crack after my ACL surgery?

– Knee cracking years after ACL surgery.

– Knee popping 1 year after 1 ACL surgery.

– Will my knee ever be the same after ACL surgery?

– Knee popping 2 months after ACL surgery.

– Pain knee popping after ACL surgery.

– Knee popping 5 months after ACL surgery.

– Knee popping after ACL and meniscus surgery.

– Why is my knee popping with every step?


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