HOCKEYROOS ASHLEIGH NELSON CONTINUES HER SERIES OF BLOGS ON THE JOURNEY OF REHABILITATION FOLLOWING SURGERY ON THE ANTERIOR CRUCIATE LIGAMENT (ACL) OF HER RIGHT KNEE WHICH TOOK HER OUT OF CONTENTION FOR THE RIO OLYMPIC GAMES
ACL Rehab Program – Weeks 1 – 5
The most common question when another person learns of your ACL tear is: “What does the rehabilitation process involve?” In order to appease many of those interested or individuals going through the same rehabilitation process, here is a brief description of what I have gone through and exercises involved from weeks 1-5.
- This is a basic description of what I am doing but hopefully gives you a reasonable idea of how I have progressed.
- This program has been compiled and overseen by medical professionals specific to my ACL repair.
- Only use this as a reference point and obtain professional services for your own ACL rehabilitation.
- All ACL recoveries are different so it is essential to listen to your body.
- If your body is not ready to engage in the below exercises then do NOT do it.
- Injury: April 27, 2016
- Surgery: April 29, 2016 (overnight stay). Hamstring graft right knee.
Week 1: (May 2, 2016)
Aim: Maintain activation in quadriceps and VMO (inner quad/thigh) through isometric contractions. Reduce swelling after surgery. Attempt to get leg slowly into full extension (note: flexion comes with time, extension is a priority).
Mobility: Partial weight bearing with crutches and brace (can take on and off – however, majority of time in brace). Out of bed, mobile and partial weight bearing on the morning following surgery.
Medication: Regular use of pain medication – slow and rapid release.
Exercises: VMO and quad co-contraction
- Pain especially on transfers (in and out of car, off couch and toilet, in and out of bed).
- During the first few weeks consider hiring a “game ready” machine to assist with swelling reduction.
- Difficulty getting dressed due to an inability to stretch hamstring.
- Limited sleep – unable to get comfortable while sleeping on my back. Would often move onto the couch midway through the night.
- Quite emotionally volatile – still dealing with knee injury, feeling tired and in pain isn’t a good mixture.
- Feeling unwell and tired on pain medication.
- Lost of appetite.
Week 2: (May 9)
Aims: Continue to reduce swelling compression, elevation and ice. Continue activation exercises. Continue leg extension. Post stitches being removed start with scar management (massage scar with bio oil)
Mobility: Time in and out of brace (use as required). Partial weight bearing with crutches.
Medication: Reduced use of rapid release medication. Still using slow release to manage pain.
Rehab exercises (non weight bearing): Rehab – co-contractions, straight leg raise, hami curls
Fitness exercise: Upper body conditioning 5 x per week. 1 leg (unaffected leg) airdyne can be used for conditioning purposes.
Example session: UB – 10 punches (seated) , 10 pushups , 10x 1 leg squats (unaffected) , 10 DB row, 10 situps. 20 punches, 9 PU, 9 SL squats, 9DB row, 9 situps. Continue to 100 punches and 1 pushup etc.
May 13 – 1st physiotherapy appointment
May 12 – reviewed by surgeon and stitches removed
Approved for swimming with pool buoy as wound has healed
Leg close to full extension
Some lag on straight leg raise – continue trying to get full leg extension and quad/VMO activation.
Week 3 (May 16, 2016)
Aim: Partial weight bearing – taking some steps without crutches. Continue with gaining and maintaining fell leg extension. Scar and swelling management – gentle massage over scars. Start flexion no more than 45 degrees – due to meniscus repair. Double leg airdyne introduction
Pain: Some pain with flexion behind the back of the knee. Pinching at lateral meniscus site. Poor sensation around scar sites.
Mobility: Partial weight bearing graduating into full weight bearing without crutches. Reduced use of brace – sometimes used if knee was sore and required extra support.
Driving: Resumed driving automatic car over small distances.
Medication: No medication used.
(Everyday, unweighted) Rehab – co-contractions, straight leg raise, hamstring curls, seated co-contractions, prone reverse extensions
Introduction and trial of lower body exercises completed 1 x per week:
3 x 1min wall sit 3 x 6 squats to 45 3 x 6/leg lunge to 45 3 x 10sec straddle hold 3 x 6/leg running man
Fitness exercises: 5 x per week
DL airdyne introduced: Note seat height placed at an elevated level to reduce flexion of knee.
Upper body -16 mins. Tabata (20 secs on, 10 secs off – 4mins total). Airdyne x2 & ball slams. Airdyne x 2 russian twists
UB conditioning – 2min airdyne. 30 SL rope, 10 v-sit, 30 sec hang (25mins total)
Week 4: (May 23, 2016)
Aim: Stop loss of muscle loss in right leg (atrophy). Scar & swelling management. Commence gait re-education. Continue with gentle flexion exercises and maintaining full extension. Introduction of stationary bike riding (with high bike seat)
Mobility: Limited use of crutches, unless going for distance. No longer using brace at all.
Pain: Primary pain comes with flexion due to meniscus damage behind the back of the knee. Some pain negotiating stairs.
Daily rehab exercises as per week 3.
Low body rehab exercises x 6 times per week
3 x 1min SL wall sit 3 x 6 squats to 45 (no weight until week 5) (See video) 3 x 6/leg lunge to 45 (See video) 3 x 10sec straddle hold
SL catch and throw – balancing activities (See video)
Calf bounces 10min bike with a high seat
1 x swim session – 1.5km -2 km with pool buoy (no kicking)
4 x fitness workouts per week see two examples below
2min AD 12 push ups, bentover row, press, slasher 2min AD 10 push ups, bentover row, press, slasher cont to 2 push ups, bentover row, press, slasher
Continue to 1 rep of each exercise
1min of each exercise AD, rope, DB thruster (unaffected leg to chair, Russian twist, ball slam, rest)
5 rounds total
Week 5: (May 30, 2016)
Aim: Stop loss of muscle loss in right leg (atrophy). Scar & swelling management
Continue gait re-education. Continue with gentle flexion exercises and maintaining full extension. Introduction of SL rehab exercises. Introduction of cross trainer
Mobility: No use of crutches, slight limp with walking. Difficulty getting full extension with stride.
Pain: Pain behind back of the knee has reduced. Some awareness during initial stages of bike riding and airdyne.
Daily rehab exercises as per week 4.
Low body rehab exercises x 6 times per week: (Single leg intro)
3 x 1min SL wall sit 3 x 6 squats to 45 + weight 3 x 6/leg lunge to 45+ weight 3 x 10sec straddle hold 3 x6/leg Box step downs SL catch and throw Calf bounces
1 x swim session – with pool buoy (no kicking)
4 x fitness workouts per week see examples below
10min crosstrainer 21-18-15-12-9-6-3 2 min airdyne between sets Slasher to halo Bentover row Ball slams V-sits Punches
15min cross trainer Partner 1 Straddle stretch x 10 Straddle holds -fwd,bkw,up/down, hold Wall angles Walk-ups
Partner 2 (See video) Tabata something (bike or airdyne for length of time partner one takes to complete above set)
In my next blog I will update my progression from week 6 – 12. If you have any questions or would like a rehab exercise recorded and explained please leave a comment below.