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

Crutches & Brace - How long does it need to use after ACL surgery

ACL Surgery: how long do I need to use my crutches & brace?

Following ACL reconstruction, athletes are always curious when they can ditch the crutches and brace and start working towards their previous activities.  The graft type, the complexity of your surgery (i.e. if/what other tissues were repaired), and your overall healing capacity are factors that help determine your timeline.  The following should give you an idea of what to expect whether you had your ACL repaired or your ACL and meniscus repaired.

If you had only the ACL repaired with crutches:

Initially use crutches & brace:

– You can expect to initially walk with the crutches and your knee brace locked in extension. Your knee lacks stability and strength as your new graft is healing, so one of the main goals for the first phase following surgery is to protect the graft.


– A bone-patellar tendon-bone (BPTB) graft is considered more stable than other options, so your surgeon may clear you to walk without crutches as long as you don’t experience an increase in pain. For many, this milestone is met in 7-10 days post-op – using crutches after ACL surgery.

– For those with a hamstring graft or allograft (harvested from a cadaver), your surgeon may prefer you to keep walking with crutches and partial weight-bearing progressing to weight bearing as tolerated for 4-6 weeks after surgery. In order to ditch the crutches, you’ll need to demonstrate proper gait mechanics and quad control. According to NHS website, your physiotherapist will advise you about what exercises to do.


– Performing a straight leg raise without a knee lag (shown below) is usually a good indicator that you’re ready to unlock your brace (from 0-90° knee bend). That is, laying on your back and lifting your leg towards the ceiling while keeping the knee in full extension throughout the entire movement. When the quads are weak, you’ll see a compensatory bend in your knee as you lift (aka extensor lag) which may straighten out at the end of the movement.

– Individuals are often cleared to stop wearing their brace while walking around the house 6 weeks after surgery if they’ve achieved appropriate quad control.

– Regardless of graft type, your MD may clear you walk without the brace slightly earlier if you demonstrate good quad control and can walk without asymmetry and abnormalities (like limping).

But what if I had my ACL & meniscus repaired?

Menisci are cartilaginous crescent-shaped rings between your femur and tibia that absorb shock, distribute force, increase stability of the knee joint, and provide lubrication to promote long-term joint health. Naturally, concurrent injury to the ACL and meniscus means that your recovery is more conservative.

Initially use crutches & brace: 

– Similar to if you solely underwent an ACL repair, you will initially walk with crutches, partial weight bearing restrictions and your brace locked in extension.

Without crutches & brace:

– Protocols vary in their instruction based on surgeon preference and your progression through your recovery.

– It’s common to be restricted to walking with brace locked in extension, crutches and partial weight bearing for 6 weeks following surgery.

– Or you may get the okay from your surgeon between 2-4 weeks, to unlock the brace from 0-90° of knee bend (flexion) but maintain use of crutches.

– You may be instructed to begin weaning off crutches in 4 weeks. Again, this is usually dependent on appropriate quad control and gait mechanics.

**Please remember that your timeline can vary based on your recovery and the specifics of your surgery. Always consult your surgeon and physical therapist before discontinuing use of crutches or brace.


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home office set up mobile app - Prep Performance Center (3)

Set Up For Success: At Home Office Set Up, Exercises and Survival Tips

Home Office Set Up. Good morning everyone! Happy Tuesday… I hope you are ready and prepared to start working from home for the next few weeks. As a physical therapist and business owner, I am often caught in the middle of my workday going against all of the advice I give my patients. We all should practice what we preach, but when you have a few hours to work from home, who wouldn’t want to do it on the couch?

During this uncertainty, we want to help you make the most of your time and have a few tips as you start working from home … your body will thank me later. Not only should you make these changes now, but think about them when you return to the office. While you are still working a full workday, you should have an extra 15 min per day to dedicate to yourself and your health. Think about how you no longer have that long commute on the train or the sluggish drive-in on the highway. Try a few of our stretches and exercises (with home office set-up) and we will have you ready for your Spring activities without skipping a beat!

Also sharing herewith an article from as they are giving us insights about 30 exercises that we should try.

***We are going to use household items that most people have at home and we hope you will think about making these changes as you work from home and once you get back in the office. 

Set a schedule and try to stick to it

While this would be a great time to catch up on some Zzzs, it is also important that you stick to a schedule and keep yourself motivated. With so much uncertainty, we all need to do our part to complete everyday work tasks and show our employers that this work from home situation that we all hope for is possible. Sticking to a schedule will also help us stay on task and mentally prepared to get back into the office. 

Give yourself the breaks you deserve (At home or in the office)

Your employers may be shaking their heads at this, but as a Doctor of Physical Therapy and business owner, I believe it is very important to give yourself breaks throughout the day to reset your body and mind. Exercise has been shown to increase employee productivity! Throughout your workday at home, grab a cup of coffee, check-in on a friend, or check out some of our 15 min workouts to give yourself the break your mind and body deserve. 

Get a workout in a home office set-up

Research shows that if you exercise before, after or during your workday, employees often show increased productivity and job satisfaction. It might seem like a dream come true to be able to work from home, but without having outlets like the gym, a kickball league, or a child’s little league game, we could go stir crazy. Try our at-home workouts to give yourself the best chance of making it through the next few weeks. If anything, do it for the people around you: your roommate, boyfriend, wife, or children. They will thank you later!  Purchase our 4-week At Home Prevention & Performance Plan and gain access to our Custom Online App. 


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Work early and start your home-cooked meal early 

This is the time to take care of yourself and eat properly. Think twice before reaching for that frozen pizza. Despite what everyone may think, the grocery stores are still open and while they may have limited availability, there are opportunities to buy fresh ingredients to make delicious home-cooked meals. As your exercise regimen is most likely curbed at this time, try to make the right choice in food selection. Think about making 2-3 more servings than usual and save for your lunch the following day. 

Give yourself some stretch time

The third time’s a charm … we have said it before: give yourself some time to stretch during your workday. Tight muscles lead to muscle inhibition and overtime that can lead to general wear and tear on your body and poor posture. These stationary positions often lead to neck and back pain in the working professional and can often be prevented by 10-15 min per day of stretching. We like to think of this as UNDO to what you DO. If you are sitting in a chair with your head and shoulders forward, you need to UNDO that posture by stretching out the front of your body and giving your body a reset!

Don’t sit on the couch during your workday

Third time’s a charm … AGAIN. DON’T SIT ON THE COUCH. Enough Said.

I know you have been sitting at a desk every day for the last +3 years … and your desk set up works. That doesn’t mean it is correct. Most people have a desk chair and a computer in their home. But do you sit in that chair correctly? Is your keyboard at the right height? Is your neck in a good resting position? Again, as a business owner, I often find myself (as does my husband) with my neck crooked down at my phone and my laptop in my lap while sitting on the couch. For the next 3 weeks, try to stay away from working on your couch or your bed. This will only land you in my office, and while I love helping people, I enjoy educating people to prevent injury and implement the right things from the start. So check out our video to help you set up the correct at home desk. 

Proper At Home (Office) Desk Set Up

Try a few of these tips to keep you from back or neck pain while you work from home (office set-up):

– Put the laptop on a hard surface 

– Tilt the screen back so it is angled up towards your face

– Push your buttocks to the back of the chair 

– Feet flat and on the ground 

– Sit on your “sit” bones 

– Maintain the natural curve of your spine 

– Shoulder blades gently back and relaxed 

– Chin gently tucked and looking down at approx 10-15 degrees of neck flexion at your laptop

– Use a lumbar roll to maintain neutral spine alignment 

– Be safe and don’t forget to #PREPare!


Dr. Mary Kate Casey, PT, DPT 

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