Many athletes successfully return to sports after suffering anterior cruciate ligament (ACL) tears. But the comeback trail is difficult. Immediately after the surgical reconstruction, the patient must begin a rigorous, medically supervised rehabilitation program to restore the knee's full range of motion and prevent muscle atrophy. The patient must build additional muscular strength around the joint to provide stability. "Once we know it's an ACL tear, we can be fairly confident that in 4 to 6 months you'll be doing what you want," Purdue trainer Jeff Stein told Rivals website in 2007. "In two years, you'll be doing it just as good, if not better than before. This is not a career-ending injury. It's just a bump in the road."
After Surgery
Step 1
Begin flexing the leg immediately after surgery. Follow the exercise protocol prescribed by your physician.
Step 2
Perform high-volume quad sets, three to five times per day, beginning the day after surgery. Sit against a wall with your injured leg out straight to perform the quad set,Tighten your front thigh muscles and press the back of your knee down toward the floor. Hold for six seconds and release.
Step 3
Exercise with hourly ankle pumps and regular hamstring stretches and curls. Strive for full passive extension outside of the immobilizer and 90 degrees of flexion. Your surgeon may want you to put some weight on the repaired leg, if it is tolerable, with the help of crutches.
On Leaving Hospital
Step 1
Step up the exercise regimen after leaving the hospital, standing hamstring curls, standing or sitting hip flexion, quadriceps stretches to full passive extension, leg raises, hourly hamstring stretches and quad sets. With assistance, gain knee flexion greater than 90 degrees while sitting. Your surgeon may ask you to continue putting some weight on the repaired leg with the help of crutches.
Step 2
Introduce resistance training to your rehabilitative routine as prescribed. Focus on building quadriceps strength. After the first two weeks of recovery, the exercise regimen may include assisted knee flexion up to 130 degrees, light resistance pedaling on an exercise bike, light weight training with 5 lbs. or less and hip flexion, extension and abduction exercises.
Step 3
Become more aggressive with your training after six weeks. Some regimens may call for four daily sets of 10 repetitions on straight leg raises, calf raises, quad sets, hamstring curls with light weights and hip flexors, abductors and extensors. Your surgeon may approve light flutter kicking, and flat-surface cycling and walking.
Step 4
Aim for full knee extension after 12 weeks, if approved by the surgeon. Step up your effort in the weight room. Try to press your body weight in the leg press and half your body weight in half squats. Bike or swim daily, avoiding whip kicks. Jog backward. Alternate light jogging and walking on a flat surface, building toward one-mile light jogs.
Step 5
Resume some light sports activity after four months, like shooting baskets or playing nine holes of golf. Increase jogging to 15 minutes at 8- to 10-minute mile pace. Increase biking to 20 minutes per day. Add step-ups to your workout routine, building toward 100 per day. If approved by your surgeon, begin agility work with shuttle runs and zig-zag runs.
Step 6
Work toward full recovery after six months. Your thigh circumference on the repaired leg should be within 1 cm of the other leg. Full speed running, heavier resistance work on the exercise bike and running up stairs will move you closer to your competitive return.
Tips and Warnings
- Always follow the rehabilitation script devised by your surgeon. If any specific exercises causes excessive pain or swelling, discontinue them and consult with your surgeon.
- Avoid downhill running until late in your rehabilitation program. Don't return to competition until cleared by their surgeon.
Things You'll Need
- Knee brace
- Resistance training equipment
References
- Sports Medicine Institute, University of Minnesota; Postperative Rehabilitation Protocol for Anterior Cruciate Ligament Reconstruction; Robert F. LaPrade M.D.
- Krames Online; ACL Rehabilitation: Quad Sets
- Rivals.com; Dreaded ACL Tears No Longer Career Ending; Andrew Skwara; August 2007
- Boston.com; Recovery From ACL Takes 6-9 Months; Kay Lazar; September 2008
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