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ACL repair post surgery:
Maximum protection phase goals
- Timeframe - 1-4 weeks
- 1. Protect ligament - brace w/ WB, appropriate ex, avoid quad contractions
- 2. Regain motion - 0-90 by 1st wk, 0-125 by end of stage, use gravity positions to "stretch"
- 3. Strengthen hams - low level ex into knee flex
- 4. Quad control - co-contractions w/ hams, 4-way SLR in brace
- 5. Normalize gait & WB
- 6. Decrease pain & inflammation (may be #2 if pain/inflam limits exercises)
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ACL repair post surgery:
Early Max protect phase exercises
- Co-contractions - hams before quads
- CKC w/ brace (prob wk 2) - mini squats - SLS
- NO SAQ/LAQ
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ACL repair post surgery:
Late Max protect phase exercises
- Co-contractions - 4-way SLR out of brace - progress w/ weight above knee
- Mini squats
- SLS
- Active knee extension 90-60 no resistance
- Weight shifts & low step-ups in brace
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ACL repair post surgery:
Moderate protect phase goals
- Timeframe - 5-10 weeks
- 1. Protect graft (graft is especially fragile ~4-6 wks p.o. & pt is feeling better...not a good combination!)
- 2. Gain full ROM & flexibility - HS, quads, IT bad
- 3. Improve strength - 1) HS, 2) hip & ankle, 3) quads
- 4. Improve proprioception & balance - helps to normalize gait
- 5. Dynamic control of joint - thru CKC
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ACL repair post surgery:
Mod protect phase begins with...
- 1. ROM is 0-120
- 2. Full WB gait (brace may still be used)
- 3. Ability to control knee with quads and hamstrings
- 4. Controlled pain & swelling
- 5. Tests show no increased joint instability
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ACL repair post surgery:
Mod protect exercises
- Brace may be used up to 2-3 months for CKC, gait, etc
- OKC 4-way hip strengthening
- LAQ no resistance - progression to resistance on prox tib
- Continue w/ CKC, make more dynamic
- Strong HS strengthening - stool scoots
- SLS w/ no external support
- Stabilization exercises - walking against resistance of cables
- Proprioception/balance - BAPS board (late mod)
- Avoid CKC strengthening & PRE's
- Avoid resisted OKC ext 60-0 (TKE)
- Avoid CKC squats 60-90 (deep knee flexion)
- Knees no farther forward than toes during squats
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ACL repair post surgery:
Minimum protection phase begins with...
- 1. Full ROM & flexibility
- 2. Strength 75%-80% or normal
- 3. Normalized FWB gait
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ACL repair post surgery:
Min protect phase
- Increase strength, power, endurance, dynamic stability
- Continue LE stretching program
- Advance with CKC & pylometrics, proprioceptive training, jogging, running, jumping
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