McACL PHASE II MUSCLE RE-EDUCATION (Time spent : daily)
DAY 5/6 to end week 2
Walking : Should be PWB to FWB
-May be walking at home without crutches
if meniscal repair the surgeon may have suggested you be on for 3 weeks
-Use crutches for outdoors – tip : if you are hobbling / limping about you are doing your knee no favours and on crutches you can walk heel to toe [ and more likely to be offered a seat ]
-If FWB can you balance on that leg
-Should be bending (flexion) 90 degrees plus
-Should be fully straightening knee
-Wound should be clean and well closed
REHAB EXERCISES
(1) CO-CONTRACTION EXERCISES 3 x 10 reps
this is like someone saying ‘show me your muscles’ just tighten up your quad for a few secs then release; don’t worry if it looks like they not working initially this is normal as your knee and quads have been through a lot and will take a few days to a week to ‘come round’ !
(2) these are your key strengthening & mobilising exercises
[i] SLR [ Straight leg raise ] if very weak can use a scarf / bandage to assist initially.
[ii] SLR to flexion along bed – heel sliding
[iii] then with the heel off bed 1 inch : do 3 x 10 reps each exercise every few hours
(3) PLASTIC BOTTLE EXERCISE : SLR on bed over rolled up towel, plastic bottle or wedge to get end range extension, pull toes back push back of knee into bottle . DO 3 sets 20 reps
(4) Gentle push above/below knee to encourage extension if tight (check with physio if appropriate)
(5) Leg press with dynaband or Theraband [ can purchase an extra heavy Theraband from Amazon uk
PRONE (LYING ON FRONT)
(6) Flexion using good foot to assist or bandage / scarf to assist
starting out cross your ankle and use good leg to assist the band … don’t worry about lying on the knee – if sore use a small cushion or rolled up towel under the lower thigh ….
(7) 3 point kneeling – On all fours – keep the affected knee off the bed / mat and can do doggies / fire hydrant to kickbacks
(8) If appropriate : Prone lying to encourage knee extension – let the weight of your foot straighten out your knee.
can cross legs over to add more pressure * only if tight to straighten and if directed to do by your physio
SITTING
(9) Flexion assisted stretch then straighten to SLR. (10) Bending to pull foot under chair can use other to assist
Can also do Leg press with dynaband in sitting
STANDING – standing holding on to something for balance – like a railing or back of a chair
(11) Lift Knee bending to the front – return to neutral- then bring heel to bottom
(12) Weight-bearing try to straighten knee – weight through heel
WALL EXERCISES
(13) Push back of knee into wall / slide heel up / then slide down to stretch / use other leg to assist
WALKING
(14) Ensure walking pattern is natural – walk heel to toe …
– ensure no limp : if problem see physio ASAP
–POOL EXERCISES : ( from day 7)*
-may need waterproof dressing for wound.
-can use an AQUA JOGGING FLOATATION BELT – just imagine Usain Bolt is sprinting in slow motion but just raise knee into range – don’t force too high – you are just gently going through the motion at this stage not working out!
belts can be bought via Amazon uk 
EXERCISE IN POOL : at pool side do gentle squats / try one legged squats / high knee lifts / kick through water / lying on your back with float on chest can do gentle flutter kicks and some bicycle kicks …but
NO SWIMMING until weeks 4-6 (especially no breast stroke)
-CAN UNI LEG CYCLE 20mins x 3 for stamina
-CAN DO UPPERBODY WEIGHTS
-N.B.* NO LEG QUADS WEIGHTS OPEN CHAIN
NO EXTENSION MACHINES
NO QUADS BAR WITH WEIGHTS
NO OUTER RANGE UNTIL MONTH 5
NO INNER RANGE UNTIL MONTH 9
*N.B.* CHECK THAT YOUR PHYSIO IS UP TO DATE ON THIS DATA
* ALL RECENT EVIDENCE AND RESEARCH SUGGESTS THAT OPEN CHAIN QUADS EXERCISES CAN STRETCH THE GRAFT AND MAY BE RESPONSIBLE FOR THE LACK OF SUCCESS OF A SMALL PERCENT OF THE PROCEDURES IN THE USA.
CLOSED CHAIN QUADS ARE SAFE (see phase III)