…..Wow what a 2 weeks. I feel there are plenty of places to get updates, facts, opinions on the Coronavirus pandemic and it’s bewildering impacts near and far. However, my remit for the next few hundred words is documenting this right ACL (anterior cruciate ligament) journey as promised….
So…staying at home has its benefits. I now have the company of my wonderful family & all that entails. I’m keeping myself occupied without face to face patients, by homeschooling which includes joining the kids for a very modified* Joe Wicks workout last week! I’m now 6 weeks post op and still should not carry out plyometric (jumping) type exercises as the graft still needs protecting. But I can modify, do some of my own rehab exercises and get moving with the kids. They loved me joining in where I could.
Below is 1 of 2 videos showing a mix of rehab exercises I’m doing. Not all at the same time & this doesn’t represent reps/sets. Some will look familiar from just prior to surgery.
Progress has definitely been made in the last 2 weeks. Activity around the house, whilst modified where necessary is more normal. Sadly that means all cleaning is back on! I’m also able to spend longer on my feet. Work on gait (walking pattern) continues, but I’m up-to a mile to our local field. The thing that limits my walking distance is not wanting to reinforce a poor pattern once the technique has gone.
Cycling on the turbo-trainer now involves sweat! I have my own avatar on Zwift and am up-to 30 mins every other day. Zwift is essentially an online virtual game. You rig your bike up & can ride with others whilst viewing all your stats. Going forwards the stats available will be really useful to monitor progress whilst gradually increasing time/resistance. Currently the bike is beneficial for getting a stiff joint moving and is a safe activity which doesn’t compromise the graft.
Stiffness of the knee is still my primary complaint- still. It is a common post op issue. It’s also a seesaw…. you work on heel hangs for 10 mins , prone (on tummy) heel hangs over edge of a bed, then you stiffen up into flexion. You work on that & vice versa. It’s a balance! Currently I have 0-120 degrees knee flexion.
Given that I haven’t achieved full range of movement yet and I still have intermittent pain in the medial joint line (inner part of knee joint) and patella-femoral (knee cap) joint I’m not rushing on to progress. If a gym were available at present I’d be using the leg press with light weights at this point, focusing on using the anti-gravity treadmill, hydrotherapy pool, and being in the swimming pool! It isn’t so rehab will adjust to factor that in. But here’s some of the exercises I’ve been doing.
I’m breaking up exercises & not doing then all in a block. Some mobility, gait and basic activation exercises I may do 2-3x /day. A bit of progress last week was catching up with Tom Goom “the running physio” whose runs one of the conferences I was due to attend in the coming months. Sometimes as a physio it’s tricky to be objective about your own care! He suggested I also focusing on breaking up strengthening and cardio-vascular (CV) days just as I would when training. This has definitely helped settle some anterior knee pain (pain at front of knee).
Another important feature historically in ACL rehabilitation has been that open chain kinetic exercises not used post surgery for 6months +, due to belief they would overstress the graft leading to laxity or failure. However, more recently this has been disputed. What is important is that these exercises are controlled and implemented at the correct time for individual patients and within a restricted range. This isn’t easily achieved within the home environment.
Open kinetic chain knee exercises allow the foot to move without contact with the floor and can isolate muscle group and increase strength assuming load is appropriate.eg leg extension machine (quadriceps) or leg curl machine (hamstrings). Straight leg raise can be thought of as open chain at both the hip and knee. Closed kinetic chain exercises include exercises such as squats and lunges which involve the foot being in contact with the floor.
Whilst as physiotherapists and as patients we are keen to progress and for new exercises each patient needs to be ready! Underlying weaknesses can lead to compensation, poor quality, potentially injury or graft damage. I catch up with my physio on the phone tomorrow as face time face contacts are not currently an option.
*Be sure to do exercises appropriately for your stage of rehab and relevant to your surgeons protocol as instructed by your physiotherapist*
Outline criteria for progressions weeks 4-12 post hamstring graft ACL reconstruction
-Quality quadriceps set and straight leg raise (SLR) with no lag
-Flexion to 90 degrees
-Minimal swelling /inflammation
-Normal gait on level surfaces
Goals for rehab 4-12 weeks
-Restore normal gait on stairs
-Maintain full extension
-Regain full flexion ideally by week 6
-Protect graft & fixation
-Increase hip, quadricep, calf and hamstring strength (respect soft tissue healing times of grafted hamstring site).