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ACL Rehabilitation Program
Pre-Operative Recovery Phase
The injured knee must be rested the day before surgery. For this, fixing orthopedic products (brace, splint) are used. Continuous use of immobilization brace should be limited to avoid atrophy of the quadriceps femoris.
It is also extremely important to achieve a decrease in swelling of the injured knee joint, and, if possible, to restore the range of motion in the joint. By the time of the operation, the patient needs to develop the correct gait.
Shifting body weight to the injured leg is allowed, as long as it does not cause pain. It is recommended to take non-steroidal anti-inflammatory drugs (Nurofen, Ibuprofen, Nais). Duration of application: 7 - 10 days after injury.
It is necessary to achieve full extension in the knee joint by performing the following exercises:
1) Passive extension in the knee joint.
- Sitting on a chair, place your foot on the edge of a stool or chair. Relax your thigh muscles. Allow the knee joint to extend under its own weight.
2) Heel support:
- Place a folded towel on the foot.
- Allow the leg to relax in the extension position.
- 3-4 times a day for 10-15 minutes. See picture 1
Figure 1. Heel support using rolled towel.
3) Passive leg extension.
- Lie face down with your feet at the edge of the table. Allow your legs to fully extend.
Figure 2. Passive leg extension. The knee should be outside the edge of the table.
Knee flexion:
1) Passive knee flexion:
- Sit on the edge of a table and allow the knee joint to bend under the influence of gravity.
2) Use wall sliding to increase the degree of bending.
- Lie on your back, place the injured leg on the wall and let the leg crawl down the wall while bending the knee.
Use the other leg to apply downward pressure.
Figure 3. Wall slide
3) Heel slide on the table; used to obtain final flexion at the knee joint.
- Pull the heel towards the buttocks by bending the knee. Hold it in this position for 5 seconds. Straighten your leg by moving your heel down. Hold it in an extended position for 5 seconds.
Figure 4 Heel slide on the table
- Grab your leg with both hands, pulling your heel towards your buttocks.
Figure 5. Sliding the heel on the table with the help of hands .
- Use the exercise bike twice a day for 10 to 20 minutes. See figure 6
Figure 6. The exercise bike helps restore muscle strength.
2) Swimming is also a very valuable procedure that can be useful in this phase of treatment to restore muscle strength and to maintain range of motion in the joint.
3) Low impact machines can also be used for preoperative preparation
This preoperative rehabilitation program should continue until you have achieved full range of motion in the joint and regained muscle strength in the lower extremities (you must walk without a limp).
Mentally prepare
- Need to decide what you expect from the operation
- Discuss postoperative rehabilitation methods with your doctor in advance
- Arrange with family and/or friends for help during postoperative care
- Read and work through all the steps of postoperative rehabilitation
After Surgery:
In the operating room, you will be immobilized with a brace or plaster splint to rest your knee joint in the knee extension position.
In the ward, an ice pack is applied to the knee joint, which will subsequently reduce pain and swelling in the postoperative period.
Postoperative immobilization of the knee joint is very important as it helps to control pain and swelling in the joint area.
Discharge:
Produced within 4 to 12 days after the operation. Arrange transportation to your home in advance. Driving is not allowed at this stage.
Postoperative Rehabilitation (Day 1 – 14)
1) Watch for swelling. Place the limb in an elevated position. It is possible to apply cold to the knee joint. It is allowed to get up, walk, but the rest of the time bed rest must be observed.
2) Do not sit for a long time with your leg lowered as this will cause significant swelling of the knee joint and the entire limb. If you have to sit for a long time, you need an elevated position of the operated limb (put it in front of you on a chair)
3) It is necessary to take anti-inflammatory and analgesic drugs to relieve pain.
4) As soon as the pain and swelling subside, you can move around with crutches.
It is not recommended to transfer body weight to the injured leg. This may cause swelling.
The brace must be worn up to 6 weeks after surgery.
Angle of flexion in the orthosis for this period: 0-10°
Early development of movements and extension in the joint
1) Passive knee extension using rolled up towel. The towel should be large enough to lift the shin and thigh off the table. See picture 1.
- Remove knee brace every 2 to 3 hours for exercise
- Allow the knee to passively extend to full extension for 10 to 15 minutes. In this case, it is necessary to completely relax the muscles of the thigh and lower leg.
This exercise can also be done while sitting on a chair. Holding the heel with a healthy leg, you must try to fully straighten the knee joint.
2) Active extension can be done with the healthy leg. Excessive hyperextension in the joint should be avoided. See Figure 7:
Figure 7. Use your good leg to extend the knee
Exercises that target the quadriceps femoris
3 times a day.
This exercise helps to prevent atrophy and contracture of the quadriceps muscle, reduce swelling and fluid in the knee joint.
2) Start straight leg raises in the brace (10 exercises 3 times a day). Do these exercises lying down.
- This exercise is performed sequentially by first contracting the quadriceps femoris with full knee extension. The contraction of the quadriceps "closes" the knee joint and prevents excessive stress on the installed graft.
- The leg remains in an extended position and is raised at an angle of approximately 45-60 degrees and held for about 6 seconds.
- The leg is then slowly lowered back onto the bed. Muscles relax.
REMEMBER TO RELAX THE MUSCLES EVERY TIME THE LEG IS LOWER
This exercise can be performed without a brace when the patient is able to raise the operated leg. Once you feel confident, this exercise can be done in a sitting position. See Figure 9
Figure 9 Straight leg raise (left prone), seated (right)
hip groups during the first 6 weeks after surgery.
- The hamstring muscles take approximately 6 weeks to recover; their excessive tension during this period can lead to persistent pain in this area in the long term.
- Unintentional overstretching of the muscles usually occurs when bending forward excessively and when putting on socks or shoes, picking up objects from the floor.
Postoperative rehabilitation (3-4 weeks)
Full joint extension
1) Continue with full, passive joint extension. Active flexion, active extension, isometric quadriceps exercises, and straight leg raises are also required.
2) Flexion at the knee up to 60 degrees
Recovery of muscle strength:
1) Partial squatting.
- Feet shoulder width apart with feet slightly turned outwards
- Use a table for support, slowly squat and stand up slowly.
- Hold in extreme positions for 6 seconds.
- Do the exercise 3 times a day for 10 squats.
Figure 10. Partial squats using a table for support.
2) Lifting on the toes.
- Using the table for support, slowly lift your heel off the floor.
- Hold for 6 seconds, then slowly lower yourself onto your heels.
- Do the exercise 3 times a day for 10 lifts.
Figure 11. Finger raise
3) Continue to use the orthosis while walking, even if you have developed sufficient muscle strength. This will protect your transplant.
4) Walk with crutches, with full body weight on the leg. It is necessary to work out a normal gait with a roll of the foot.
5) You can continue to use the exercise bike, which is an excellent tool for restoring quadriceps strength. See picture 6
- The distance to the pedal should be such that the knee joint is in a slightly flexed position.
- There should be no resistance. Maintain good posture throughout the session.
- Once your pedaling ability improves, you can start increasing the resistance (approximately 5-6 weeks).
- Your goal is to slowly increase the time spent on the machine (starting at 5 minutes, gradually increasing the time up to 20 minutes)
- The resistance should be increased in such a way that by the time you finish the exercise, you feel fatigue in the muscles.
THE BICYCLE IS ONE OF THE SAFEEST EXERCISES YOU CAN USE TO REHABILITATE YOUR KNEE. THERE ARE NO RESTRICTIONS ON ITS USE.
Postoperative rehabilitation (weeks 5-6)
1) Passive flexion (flexion) of the knee joint up to 90 degrees. (See Figure 8 below)
- Sit on the edge of a bed or table and let the knee joint passively flex, the opposite leg being used to measure the amount of flexion in the joint.
- This exercise should be done 4 to 6 times a day for 10 minutes. It is very important to achieve at least 90 degrees of passive flexion 35 to 40 days after surgery.
Figure 8 Passive Gravity Flexion Allows Knee Flexion to 90 Degrees
range of motion in the joint.
3) Continue isometric quadriceps and straight leg raises (see Figure 9).
4) Squats, toe raises (see Figure 10 and Figure 11).
5) If you are attached to a fitness center or gym, you can start working on the following machines:
- Exercise bike. Classes up to 15-20 minutes a day.
- Elliptical stepper. Class time 15 - 20 minutes a day.
- LegPress Strength Trainer. Flexion range 90 – 0. (See Figure 12)
Figure 12 LegPress Power Trainer. Flexion range 90 – 0
- Rear thigh trainer. Possible use at 8-10 weeks if the ACL has been restored from the tendons of the posterior thigh.
- Upper shoulder trainers.
- Swimming: walking in the pool, water bike, water health jogging. Speed diving and swimming are not allowed.
Postoperative Recovery (Weeks 7-8)
1) The expected range of motion should be from full extension to 125 degrees.
Start bending with a load.
2) Continue with all the previously described exercises.
3) Exercises to maintain body balance (helps restore the spatial sensitivity of the knee joint)
Postoperative rehabilitation (9-12)
By 9-12 weeks, the range of motion in the knee joint should be complete.
1) Continue with all the previously described exercises.
2) Training on the simulator for the muscles of the back of the thigh. Relate stress to pain. If you experience pain, reduce the load.
3) Continue with body balance exercises.
4) Continue with the swimming pool.
5) Start exercising on the treadmill.
NO MOUNTAIN BIKING OR CLIMBING!
Postoperative rehabilitation (12-20 weeks)
1) From the 12th week increase the intensity of exercise.
2) Start running, gradually increase the duration and distance
3) It is recommended to wear a soft knee pad while running.
Postoperative rehabilitation (6 months)
This is the earliest time you can return to full sports activities.
To resume sports activities, you need:
- Restore quadriceps strength to at least 80% of healthy leg
- Restore posterior thigh muscle strength to at least 80% of healthy leg
- Restore full range of motion in the joint
- No edema
- Satisfactory joint stability
- Complete the rehabilitation program
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US CDC: Urine, not chlorine, is to blame for redness of the eyes after the pool
Reddening and tearing of the eyes in the pool is not caused by chlorine, which is usually used to disinfect water, but by urine, US researchers found. Chlorine has a bad reputation as it is believed to irritate the eyes when bathing. However, this is not quite true.
Chlorine destroys the waste products of the body that enter the pool water. And coughing and eye irritation are caused by offal, which are formed as a result of a chemical reaction with the feces of bathers.
Chlorine binds to excretions from the human body, forming the same chemical irritants. It is they who are to blame for the redness of your eyes, - Michael J Beach from the US Centers for Disease Control and Prevention told Women's Health.
Experts note that chemicals formed by mixing sweat, urine and other dirt release a specific odor into the air. Inhalation of these fumes can cause coughing, wheezing, and even severe asthma.
Showering and going to the bathroom before swimming will help reduce the amount of urine in the pool and, as a result, the formation of irritants, the organization's website says.
Beach says there has been an increase in illness among public pools in the United States in recent years. He explains this by the fact that adults and children suffering from diarrhea freely visit the pool.
