Rehabilitation of ACL Reconstruction

29 Pages·2014·1.78 MB·English

Rehabilitation after ACL
Reconstruction
John Nyland, DPT, EdD
Artur Proniewicz, MD
Paul Mazzone, BS

Athletic Training Program
Kosair Charities College of Health and Natural Sciences
Spalding University, Louisville, KY 40203, USA
1
Introduction
• The objective of this teaching module is to
present an ACL rehabilitation progression based
on restoration of normal active knee and hip
range of motion, non-impaired locomotion form,
lower extremity strength, and power with
consideration for sport specific agility demands,
tissue healing biology, biomechanics and
psychobehaviors.
2
Tenets
• Create a healing environment

• Do no harm

• Educate the patient

• Develop self-efficacy and resilience

• Emphasize exercise movement quality over quantity (total
sets/repetition volume and resistance)

• When in doubt leave it out

• Consider biological, biomechanical and behavioral healing timetables

3
Monthly General Emphasis Guidelines
1 2 3 4 5 6 7 8 9 10 11 12
ROM

Movement
Form-Balance
Strength

Neuromuscular
Control
Power

Agility

Sport-Specific
Training
Return to Sport
Decision-Making
4
Progressive Knee and Hip ROM
• Re-establish non-impaired active knee
extension

• Perform knee flexion stretch in prone with
hip slightly extended

• Progress knee flexion more slowly
following posterior meniscus horn repair

• Non-impaired high knee flexion range of
motion is key to prevent patellofemoral
region irritation and dysfunction

• Focus knee flexion range early and revisit
during power and sport-specific training

5
a
Examples
• Prone knee flexion with
hip extension (a)

b
• Flexed knee to chest
(piriformis stretch)(b)

• Functional frontal plane
c
mobility (c)

6
Locomotion Form
• Slow, controlled, high-quality
movements

• Low impact

• Safe

• Create a frontal plane knee wobble
and learn how to control it

• Teachable movements

• Welcome mistakes. Then discuss
and correct potentially
pathomechanical relationships
7
Examples
• Form run
Simulation (a)

• Back step
butt kick (b)

c

• Single leg
a
lateral step
stabilize (c) b

• Lateral step-
weight shift-
rotate x 3 (d)
d
8
Basic Strength Training
• Restore quadriceps function (BPTB, quadriceps tendon graft)

• Restore high knee flexion function (hamstring graft, BPTB,
quadriceps tendon graft)

• Improve strength of hip and entire lower extremity

• Increase dynamic mid-range knee stability

• Progressive resistance exercises (with ≥ 8 repetition
maximum
9
Examples
• Multi-directional
straight leg raises (a)
a b

• Single leg press (b)

• Single leg squat (c)

• Lateral step-ups (d)

c d e
• Single-leg flexed knee
deadlifts (e)

• Lateral plank with scissors (f)
g
f
• Supine heel walking (g)

• Swiss Ball Series (h)
10
h