Your anterior cruciate ligament or ACL in your knee helps stabilize the joint. Chronic ACL deficiency is an overstretched or torn ACL that has not been surgically repaired. Symptoms include loss of range of motion, muscle weakness and joint instability. According to a 2010 issue of the "North American Journal of Sports Physical Therapy," open-kinetic chain or nonweight-bearing exercises and closed-kinetic chain or weight-bearing exercises, when combined efficiently and effectively, improve your knee's range of motion, strength and stability. Consult your physical therapist before performing new exercises.
Range of Motion
Swelling and reduced activity levels cause knee stiffness and loss of range of motion. Your physical therapist may manually move your knee, called passive range of motion to increase flexibility. As range of motion improves and pain subsides, perform range-of-motion exercises like heel props and heel slides in a seated position. Heel props are performed with your leg straight and your heel on a rolled-up towel or pillow, which helps improve knee extension. Heel slides are when you slowly slide your heel towards you as you bend your knee. Perform exercises between three and seven days a week to regain normal range of motion.
Strength
Open-kinetic chain or nonweight-bearing strength exercises include straight-leg raises, bridges and cycling on a stationary bike. Straight-leg raises are performed seated with your legs straight. Slowly lift your leg off the table and hold for five to 10 seconds. Bridges are performed lying down with your knees bent and feet flat on the floor. Slowly lift your butt off the floor and hold for 10 seconds. As your strength improves, resistance can be added to the straight-leg raises using ankle weights and bridges can be modified to single-leg bridges. You may also increase your resistance, pace or duration on the stationary bike. Perform two to three days a week or as directed by your physical therapist.
Stability
Stability exercises are performed in a standing or weight-bearing position and include single-leg balance and step-downs. Initially, you may need to hold onto a table or the back of chair for support. For single-leg balance, stand on your injured leg and hold the position for up to 60 seconds. Single-leg balance progressions include closing your eyes, standing on a wobble board and ball tosses. Step-downs are performed standing on a step. Slowly bend your injured knee lowering the heel of your opposite leg to the floor. Perform two to three days a week or follow your physical therapist's instructions.
Functional
Functional exercises are dynamic and help prepare you for your normal activities and correct impaired gait mechanics. General functional exercises include squats, lunges, single-leg hops, stair climbing and sprints. Sport-specific exercises will vary, but may include agility drills like running around cones and kicking a soccer ball. Exercise progressions may be slow and should be monitored closely by your physical therapist.
References
- Brigham and Women's Hospital; Standard of Care: Non-Surgical Management of the ACL Deficient Knee; Mike Cowell; May 2004
- American Academy of Orthopaedic Surgeons; Anterior Cruciate Ligament Injuries; March 2009
- "North American Journal of Sports Physical Therapy;" The Effects of Open versus Closed Kinetic Chain Exercises on Patients with ACL Deficient or Reconstructed Knees: A Systematic Review; Rebekah Glass; June 2010
- Chester Knee Clinic & Cartilage Repair Center; Accelerated ACL Reconstruction Rehabilitation Program; Mark De Carlo, P.T.; February 2011
- "Clinical Biomechanics;" Gait Mechanics in Chronic ACL Deficiency and Subsequent Repair; Reed Ferber, et al.; 2002
