Top 10 Ways to Improve Knee Extension
After ACL-R Surgery
Knee Extension – After ACL surgery, rehab can be a slow, painful process – but it doesn’t have to be!
A big part of ACL surgery rehab is improving your knee flexion (bending your knee) and knee extension (straightening your knee).
However, if you properly warm your knee up, these 10 simple steps for improving your knee extension or helping you strengthen your knee better should be easy to complete. See related article by Mayo Clinic.
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 extension, and being able to strengthen your knee 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.
Pain Management (Knee Extension)
- Elevate your legs for 20 mins and take your pain meds at least 20 min before
Cryotherapy/ICE
- Ice an hour and then Wrap your knee with an Ace Wrap to minimize swelling after icing
Walk
- Walk for 10min prior to beginning your program (bend your knee when walking)
Effleurage (Knee Extension)
- Complete Effleurage for 3-5 min to reduce swelling
- Gently massage your leg and pull up towards your heart
Hamstring Stretch
- Complete Hamstring Stretch on bed 3 x 45s
- Lie on back and use a strap to pull leg toward ceiling
Thomas Test Stretch
- Complete Modified Thomas Test Stretch 3 x 45s
- Lie on back and gently let surgical leg hang off edge of bed
Quad Set (Knee Extension)
- Complete Quad Set 2 x 10 5s hold (Use Towel Roll for Cues)
- Lie on your back, towel behind knee, squeeze quad and straighten leg
Straight leg Raise
- Complete Straight Leg Raise 3 x 10
- Lie on your back, Quad Set into towel, then raise leg (toes to nose)
Prone Quad Set
- Complete Prone Quad Set 2 x 10 (5s hold)
- Lie on your belly, toes pointing down, squeeze quad and straighten knee to ceiling
Prone Knee Hang (Knee Extension)
- Complete Prone Knee Hang 3 x 1min Adding a minute as tolerated
- Lie on your belly with your knee and calf hanging off the bed
Read More Article: 11 Steps To Improve Knee Flexion After ACL Surgery
6 Items to get before ACL Surgery
Preparing for ACL surgery can seem intimidating, if not overwhelming. Here are a few suggestions on items you should have to help your recovery go smoothly! Some of the following may be provided by the hospital, but it is a good idea to check with your medical team before ACL surgery to ensure you have access.
Ice
Ice and cold packs can help reduce inflammation and pain following surgery, so it’s a good idea to have some available wherever you will be recovering. Cold therapy machines are commonly rented for use after surgery. This unit functions by continuously running cold water through a cuff you secure around your knee and some options even provide intermittent compression to your knee to further reduce swelling and pain! Consider keeping 10-15 mini water bottles in your freezer to use with the cold therapy machine.
Loose Clothing
You may be surprised by how difficult it is to pull on a pair of pants or shorts without being able to bend your knee very much or stand on one leg. Make sure to have enough loose, comfortable clothing so that changing does not become a daily struggle.
Shower equipment
Getting into and out of the shower will require some maneuvering early in your recovery, and items like a shower stool and bath mat can help you bathe more safely. Take a look at the set-up of your shower beforehand to decide what you’ll need. Does the tub have a lip? Is it slippery or angled? You can also place a chair just outside of the tub so that you can get undressed while sitting and transfer from the chair into the tub. Other bathroom items to consider include a removable shower head, grab bars and a toilet seat riser.
Trash Bags
You will be instructed to keep your incisions dry during the early phase of recovery to promote healing. Make sure you have trash bags big enough to cover your knee while you bathe. You can purchase a more expensive leg cover from retailers, but many individuals prefer to use a standard trash bag.
Snacks
Stocking up on small snacks such as apple sauce or pudding are important so that you do not take your pain medication on an empty stomach. Consider choosing some food items that are high in natural fiber (i.e. pears, avocado, oat bran) to prevent constipation due to the medication. You should be getting around 25-30 g of fiber per day to help you have regular, quality bowel movements, but few individuals actually get enough.
Support
Although not an item, identifying your support team and their schedules is important before ACL surgery. You may need to rely on others to cook, help you change, and help you bathe. You should identify people you trust whose schedules allow them to help out. This could mean a few people, especially in the first few weeks, helping out at different times so that you do not attempt a task that is unsafe before you know your limits. You should also ensure that whoever is helping you bathe is physically fit enough to help transfer to the tub and back up without losing balance.
Another thing to consider before ACL surgery is how you want your recovery space to be set up. Consider removing carpets or objects that you could trip on and having a set place to keep your medication and a snack. If you live in a place with multiple bathrooms, you should think about which will be easiest to use with an assistive device (i.e. crutches or walker) and has the best shower and toilet set up. With the proper preparation, you will be able to focus on your recovery. See related article from NHS website on preparations before surgery.
Yes for sure you will be thinking a lot before ACL surgery, such as these: What to buy before ACL surgery? What to eat before ACL surgery? Nervous before ACL surgery? Should I wear a brace before ACL surgery? How to prepare the house for ACL surgery? Questions to ask before ACL surgery? How to sleep with ACL injury before surgery? Can I ride a bike before ACL surgery? All these you have in mind, you can be relieved by consulting to our physical therapist and book an appointment. Tap the button below.
Why Does My Knee Crack During My ACL Surgery Recovery?
Knee Crack | If you’re recovering from ACL surgery and worried whether the noises from your knee are a warning sign that your surgery hasn’t gone well, or that you’ve done too much, too soon, you aren’t alone!
Hearing your knee crack, click or pop after your ACL surgery is a very common experience among those who have gone through an ACL reconstruction.
And we understand that it’s a very scary thing.
The last thing you want is for something to go wrong, and end up battling an injury you’d hoped would be in the past.
We know you want to get back to sports, workouts, and running, and we are here to help get you there!
1. Why Are My Knees Clicking During My ACL Surgery Recovery?
There are a few reasons your knees may be clicking that are completely normal.
A. Scar Tissue
Following ACL surgery, there is typically some scar tissue that develops within the knee 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!
B. Swelling
Oftentimes after surgery, the knee joint and 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!
B.1. Range of Motion and Stretching Exercises For ACL Surgery Recovery
C. Weak Quadricep Muscles
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 after ACL 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!
C.1. Quadriceps Strengthening Exercise:
2. What If I’m Still Worried About My Knee Clicking?
While hearing a crack or pop is completely normal following surgery, it can be reassuring to speak to an expert physical therapist – like our team at our Chicago clinic.
Our advice would be to get help from knee pain specialists who work with athletes and active people recover from knee injuries on a daily basis.
At PREP Performance Center, you can get drug-free knee pain relief, whilst helping speed up recovery and improve your performance when running and playing sports.
To find out how we can help you recover from ACL surgery, or any other knee injuries you are struggling with, arrange a Free Discovery Visit.
Right now, the demand at our clinic is very high, so arrange your Free Discovery Visit or call us on (773) 609-1847 now.
Dealing with knee cracking during ACL surgery recovery? Our guide to ACL reconstruction can help – download it today.
Download Your Guide to ACL Reconstruction
3. Other Free Resources To Prevent and Treat Sports Injuries
Read Our Blog – How To Prevent Knee Pain When Running
Read Our Blog – 11 Steps To Improve Knee Flexion After ACL Surgery
Read Our Blog – 6 Best Exercises To Eliminate Your Knee Pain
Follow Us On Social Media – Prep Performance Center Facebook, Prep Performance Center Twitter and Prep Performance Center YouTube
When can I return to soccer after my ACL surgery?
Planning to return to soccer? 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.
Get the green light to play again with our Return to Play Questionnaire. Download it now and ensure a safe return to sports after injury.
Download Return to Play Questionnaire
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!
Regaining Function: Post-Surgical Rehabilitation for ACL Injuries
In our last blog, we discussed anterior cruciate ligament (ACL) injuries and how to prevent them. However, the unfortunate truth is that they are not always entirely avoidable. For athletes in high-impact sports, or those that require sudden stops or changes in direction, ACL injuries are all too common. In fact, many of these injuries may even require surgery, resulting in a lengthier recovery period. So, you undergo your surgical procedure, you’re on the mend… what now? At PREP Performance Center, we understand how frustrating sitting out of the game can be. Our post-surgical rehabilitation services can help you achieve the quickest recovery possible for such a complex injury. Contact our Chicago, IL clinic today for more information on how we can help you regain your function.
What to expect on post-surgical:
Post-surgical rehabilitation is a lengthy process following a surgical ACL correction. It typically requires 6-9 months of extensive physical therapy and hard work. We understand that this can be physically, mentally, and emotionally challenging on a young athlete. There are a lot of ups and downs to the rehab process – you go from being a star athlete to sitting on the sidelines for as long as a year. However, PREP Performance Center works hard to make your rehabilitation process as smooth as possible, so you can get back to playing the sport you love. In order to achieve this, some important aspects of your treatment plan will include:
– Strength training
– Balance
– Body awareness
– Leg symmetry
– Jumping and landing techniques
This is all done to make sure that you are performing optimally and not compensating. Our mission is to provide the proper techniques and resources to you so you can get back to the game with regained function and a significantly decreased risk of sustaining another injury. Doctor of Physical Therapy Mary Kate Casey says, “Rehabbing an athlete after an ACL injury is multifactorial. As a former athlete who sustained the injury as well, I understand the mental, emotional and physical challenges that come along with this injury. It is imperative to address all of these concerns in therapy to ensure the athlete is prepared and ready to play at elite levels. This involves a lot of reps, sets, and helping the athlete regain confidence in their body”
Statistics for ACL injuries:
There are some intimidating statistics regarding ACL injuries – according to the National Institutes of Health, it is estimated that approximately 350,000 ACL reconstructions are performed annually across the nation. Despite surgical repair, those who sustained an ACL injury in need of correction are 79% more likely to develop knee osteoarthritis in the future and 20% more likely to suffer a re-injury within 2 years of their procedure. In addition, athletes may not be able to return to their sport with the same level of play, and they may struggle with confidence issues or fear of re-injury when they return.
Post-surgical rehabilitation can help decrease these statistics. If you are in need of surgical correction for your ACL injury, contact our Chicago, IL physical therapy center today. We will get you set up on a treatment plan following your surgery so you can begin your recovery process as soon as possible. Don’t let your injury hinder your life or take you out of the game for good – regain your function and get back to the sport you love with physical therapy.
Contact PREP Performance Center for more information.
Treating ACL Injuries in Young Lacrosse Players
Treating ACL – Are you passionate about lacrosse? Do you have a child who is passionate about lacrosse? This sport is a great way to get exercise, but the fast nature of it also poses a risk for sustaining an ACL injury.
The anterior cruciate ligament (ACL) is located in the knee and can be injured or torn when it is harshly twisted in the wrong way. ACL tears are especially common for lacrosse players, as the sport requires sudden stops and changes in direction. This increases the risk of twisting the knee the wrong way and sustaining an ACL injury.
An ACL injury is painful, debilitating, and a long road to recovery. Treating ACL those who undergo ACL reconstruction require 6-9 months of physical therapy prior to returning to the sport. Fortunately, Doctor of Physical Therapy Mary Kate Casey is well versed in rehabbing this injury, not only as a physical therapist but twice herself as an athlete and now a Four-Time National Champion Lacrosse player.
Doctors of Physical Therapy are the leading health care providers offering programs that can help reduce ACL injuries and can even prevent them from occurring in the first place. For more information on how physical therapy can help you or your athlete recover and prevent injuries, contact PREP Performance Center today.
Treating ACL Injury and Stats:
According to GetPT1st, “research shows that 26% of non-contact ACL injuries could be prevented by specific exercise programs.” At PREP Performance Center, we are dedicated not only to helping you recover from your ACL reconstruction, but we are also able to help you prevent further injuries from occurring in the future.
During our movement assessment, in treating ACL our physical therapists determine your strengths and weaknesses and can often identify areas that increase your risk of an ACL injury. We utilize balance, jumping, and landing tests such as the Y balance, Broad Jump, Triple Hop, and Landing Error Scoring System (LESS). The battery of tests assesses strength, power, balance, body awareness, leg symmetry, and jumping and landing mechanics to determine whether or not you are at high risk for a non-contact ACL injury. After diagnostic tests and physical examinations are complete, our physical therapists will design a specialized program based on your specific needs.
ACL Injury Prevention:
In a study examining the effect of ACL injury prevention programs, female athletes demonstrated a reduced ACL injury risk of 52% after incorporating the program into their fitness regimens. Even better, male athletes demonstrated a reduced ACL injury risk of 85% after incorporating the program into their fitness regimens. With such overwhelmingly positive odds, it is no secret why athletes take advantage of these programs.
For the past two decades, ACL injury prevention programs have been a strong focus in the field of sports medicine. Various programs have been created as a way to encourage and promote proper techniques for athletes who may be at high risk of sustaining an ACL injury. For lacrosse players, treating ACL for such prevention programs include targeted exercises for the sport that address muscle strengthening, muscle recruitment patterns, proprioception and plyometrics.
Most ACL injury prevention program sessions last approximately 20-30 minutes, making it very easy to incorporate into a practice setting. It is important that lacrosse athletes strongly consider participating in an ACL injury prevention program, due to the increasingly positive statistical evidence supporting their effectiveness.
ACL prevention programs have been proven to work, helping hundreds of lacrosse players everywhere, not only while they are on the field, but also while they are training. Our practice is dedicated to helping athletes recover from ACL injuries, in addition to preventing further injury in the future. If you’re a youth athlete, parent or coach and are interested in our ACL injury prevention program, contact the best physical therapy in Chicago today and find out how our services can benefit you. We can help you reach your optimum physical function and keep you on the field playing the sport you love!
Contact PREP Performance Center for more information.
