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
(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
(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
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
(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)