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    Acl Accelerated Protocol

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    kapsicumad
    This document outlines an accelerated rehabilitation protocol for ACL reconstruction in 5 phases. The goals are to regain knee function, range of motion, strength and proprioception. Phase 1 focuses on range of motion and early strengthening. Phase 2 adds balance training and increased strength. Phase 3 progresses strength training and adds balance and proprioception work. Phase 4 adds cutting exercises and sport-specific drills. Phase 5 continues strengthening and functional training with the goal of returning to unrestricted sports.

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    Acl Accelerated Protocol

    Uploaded by

    kapsicumad
    212 views6 pages
    This document outlines an accelerated rehabilitation protocol for ACL reconstruction in 5 phases. The goals are to regain knee function, range of motion, strength and proprioception. Phase 1 focuses on range of motion and early strengthening. Phase 2 adds balance training and increased strength. Phase 3 progresses strength training and adds balance and proprioception work. Phase 4 adds cutting exercises and sport-specific drills. Phase 5 continues strengthening and functional training with the goal of returning to unrestricted sports.

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    ACL

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    This document outlines an accelerated rehabilitation protocol for ACL reconstruction in 5 phases. The goals are to regain knee function, range of motion, strength and proprioception. Phase 1 focuses on range of motion and early strengthening. Phase 2 adds balance training and increased strength. Phase 3 progresses strength training and adds balance and proprioception work. Phase 4 adds cutting exercises and sport-specific drills. Phase 5 continues strengthening and functional training with the goal of returning to unrestricted sports.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    212 views6 pages

    Acl Accelerated Protocol

    Uploaded by

    kapsicumad
    This document outlines an accelerated rehabilitation protocol for ACL reconstruction in 5 phases. The goals are to regain knee function, range of motion, strength and proprioception. Phase 1 focuses on range of motion and early strengthening. Phase 2 adds balance training and increased strength. Phase 3 progresses strength training and adds balance and proprioception work. Phase 4 adds cutting exercises and sport-specific drills. Phase 5 continues strengthening and functional training with the goal of returning to unrestricted sports.

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    At a glance
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    The rehabilitation protocol is designed to safely and efficiently return patients to a high level of activity following ACL reconstruction through regaining strength, range of motion, and neuromuscular control.

    The goals of rehabilitation are to control pain and swelling, regain normal knee function, regain lower extremity strength, and regain proprioception and balance.

    Phase 1 includes range of motion exercises, quad sets, straight leg raises, leg presses, mini squats, and balance exercises.

    Anterior Cruciate Ligament Reconstruction

    Accelerated Rehabilitation Protocol


    Dr. Mark Adickes

    Introduction:
    • This rehabilitation protocol is designed for patients with ACL
    injuries who anticipate returning early to a high level of activity
    following ligament reconstruction.

    Goals of rehabilitation are to:


    • Control joint pain, swelling, hemarthrosis
    • Regain normal knee range of motion
    • Regain a normal gait pattern
    • Regain normal lower extremity strength
    • Regain normal proprioception, balance, and coordination

    The physical therapy is to begin post-op day #1. It is extremely


    important for the supervised rehabilitation to be supplemented by a
    home fitness program.

    Important post-op signs to monitor:


    • Swelling of the knee or surrounding soft tissue
    • Abnormal pain response, hypersensitive
    • Abnormal gait pattern, with or without assistive device
    • Limited range of motion
    • Weakness in the lower extremity musculature

    Return to activity:
    • It requires both time and regular clinic evaluation to safely and
    efficiently return to functional activity.
    • Adequate strength, flexibility, and endurance are all necessary to
    return to high level function, all of which are addressed in this
    program.
    • Isokinetic testing and functional evaluation are required to
    assess a patient’s readiness to return to sport.
    Dr. Mark Adickes

    Phase 1: Week 1-2

    Range of Motion:
    • Passive ROM, No limits
    • Aggressive Patella mobility
    • Ankle pumps
    • Gastroc-soleus stretches
    • Wall slides
    • Heel slides with towel
    Strength:
    • Quad sets x 10 minutes
    • SLR (flex, abd, add)
    • Multi-hip machine (flex, abd, add)
    • Leg Press (90-20 °)-bilateral
    • Mini squats (0-45 °)
    • Multi-angle isometrics (90-60 °)
    • Calf Raises
    Balance Training:
    • Weight shifts (side/side, fwd/bkwd)
    • Single leg balance
    • Plyotoss
    Weight Bearing:
    • Wt bearing as tolerated with crutches
    • Crutches until quad control is gained, then discontinued
    Bicycle:
    • May begin when 110 ° flex is reached
    Modalities:
    • E-stim/biofeedback as needed
    • Ice 15-20 minutes with knee at 0 ° ext
    Brace:
    • Wear post-op brace at all times with the following exceptions:
    o Remove brace to perform ROM activities
    o Brace not required in bed
    • Will measure for functional brace post-op day #1
    Hygiene:
    • OK to shower post-op day #1
    • No pools, ponds or hot tubs until 2 weeks post-op (do not
    submerge incision)

    Goals for Phase 1:


    • ROM 0-110 °
    • Adequate quad contraction
    • Control pain, inflammation, and effusion

    Dr. Mark Adickes

    Phase 2: Week 2-4

    Range of Motion:
    • Passive ROM, unlimited
    • Aggressive Patella mobility
    • Ankle pumps
    • Gastroc-soleus stretch
    • Light hamstring stretch at wk 4
    • Wall, heel slides to reach goal
    Strength:
    • Quad sets with biofeedback
    • SLR in 4 planes (add ext at wk 4)
    • Heel raise/Toe raise
    • Leg Press
    • Mini squat (0-45 °)
    • Front and Side Lunges
    • Multi-hip machine in 4 directions
    • Bicycle/EFX
    • Wall squats
    Balance Training:
    • Balance board/2 legged
    • Cup walking/hesitation walk
    • Single leg balance
    • Plyotoss
    Weight Bearing:
    • As tolerated with quad control
    Modalities:
    • E-stim/biofeedback as needed
    • Ice 15-20 minutes
    Brace:
    • We will switch to a functional brace at the start of Phase 2
    • Wear functional brace at all times with the following exceptions:
    o Remove brace to perform ROM activities
    o Brace not required in bed

    Goals for Phase 2:


    • Maintain full passive knee extension
    • Increase knee flexion to 125 °
    • Diminish pain, inflammation, and effusion
    • Increase muscle strength and endurance
    • Restore proprioception
    • Maintain Patellar mobility

    Dr. Mark Adickes

    Phase 3: Week 4-12

    Range of Motion:
    • Passive ROM, unlimited
    • Gastroc/soleus stretching
    • Hamstring stretching
    Strength:
    • Progress isometric program
    • SLR with ankle weight/tubing
    • Leg Press-single leg eccentric
    • Initiate isolated hamstring curls
    • Multi-hip in 4 planes
    • Lateral/Forward step-ups/downs
    • Lateral Lunges
    • Wall Squats
    • Vertical Squats
    • Heel raise/Toe raise
    • Bicycle/EFX
    • Retro Treadmill
    • Mini-squats/Wall squats
    • Straight-leg dead lifts
    • Stool crawl
    • Isokinetic work (90-40 °)(120-240 °/sec)
    Balance Training:
    • Steam boats in 4 planes
    • Single leg stance with plyotoss
    • Wobble board balance work-single leg
    • ½ Foam roller work
    Modalities:
    • Ice 15-20 minutes following activity
    Brace:
    • Functional brace as needed
    Goals for Phase 3:
    • Full ROM
    • Increase muscle strength and endurance.
    • Progress slowly into jogging program at week #8 as ROM
    normalizes, pain and swelling are minimal. Begin on mini-tramp,
    progress to treadmill as tolerated then move to a hard surface
    when tolerated.
    • Enhance proprioception, balance, and neuromuscular control.
    • Restore functional capability and confidence
    • At week 12: Isokinetic test at 180 and 300 degrees/sec

    Dr. Mark Adickes

    Phase 4: Week 12-16

    Range of Motion:
    • Passive ROM, unlimited
    • Continue all stretching activities
    Strength:
    • Continue all exercises from previous phases
    • Progress plyometric drills
    • Increase jogging/running program
    • Swimming (kicking)
    • Backward running
    Functional Program:
    • Sport specific drills
    Cutting Program:
    • Lateral movement
    • Carioca
    • Figure 8’s; decreasing the size of the course as tolerated
    Modalities:
    • Ice 15-20 minutes as needed

    Goals for Phase 4:


    • Maintain muscular strength and endurance
    • Enhance neuromuscular control
    • Progress skill training
    • Perform selected sport-specific activity
    Dr. Mark Adickes

    Phase 5: Weeks 16-36

    Strength:
    • Continue advanced strengthening
    Functional Program:
    • Progress running/swimming program
    • Progress plyometric program
    • Progress sport training program
    • Progress neuromuscular program
    Modalities:
    • Ice 15-20 minutes as needed

    Goals for Phase 5:


    • Return to unrestricted sporting activity as determined by
    Isokinetic and functional evaluation
    • Achieve maximal strength and endurance
    • Progress independent skill training
    • Normalize neuromuscular control drills
    • At six and twelve months, a follow-up Isokinetic test is
    suggested to guarantee maintenance of strength and endurance.

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