Timing 7-12 weeks after surgery
This phase follows on from the previous but begins to work the knee in a single leg fashion. The aim is to further increase resilience and tolerance in the knee in more difficult environments. This will be done through progressively more difficult strength and control exercises. As with previous phases none of this should cause the knee to become more stiff, swollen or sore. Please ensure you have approximately 30 seconds rest between sets and 2 minutes rest between exercises. Exercises should be performed 4 times a week.
Bridge progression single leg bridge
Lying on the floor/bed
3 x 10 reps each leg
2 x a day
Lie on your back with your knees bent and your feet flat on the floor. Tighten your buttock muscles and pushing through one heel only, lift your hips up, keeping the pelvis level and aiming for a straight line from shoulders to knees. Lower slowly down.
Bridge swiss ball leg curl
Floor with swiss ball
3 x 10 reps
1 x a day
Lying on your back, place your feet on your swiss ball. Keep a slight bend in the knees. With your arms on the floor to support you, push through your heels into the ball to raise your hips off the ground until your shoulders, hips and knees are in a straight line. Pull the ball towards you with your heels as far as is comfortable, then return to the start position.
Side plank Isometric
Floor
3 x 20 seconds each side
1 x a day
Lying on your side, place one foot in front of the other. With your forearm also on the ground and your elbow directly under the shoulder, push through your shoulder and feet to lift your body off the ground. Keep your shoulder, hip, knee and foot in a straight line and hold for 40 seconds. Don't forget to breathe!
Squat Progression Goblet Squat
Floor with dumb bell/kettle bell
3 x 10-15 reps
2-3 x a day
Standing with your feet shoulder-width apart sit back into a squat, bending your knees to ninety degrees as if you were sitting down onto a chair. A weight can be held between both hands, held against the chest in a prayer position.
Split squat
Chair or couch
3 x 8 reps each leg
1 x a day
Stand in front of a chair or couch, with the feet together. Step one foot back behind you and up onto it. With your weight on the front heel and keeping your torso upright, lower your body until your front knee is at a 90-degree angle. Pause and drive through the front foot to return to the start position.
Single leg calf raises off step
Step
3 x 8-12 reps each side
1 x a day
Leading with your good leg, stand on a box or step with your heels off the edge. Now lift the good leg slightly so that all your weight is on the injured leg. Lift up onto your toes as high as you can. Pause, then lower back down until your heel is slightly lower than the step.
Hip Hinges gradually to load
Floor and weights
3 x 10-15 reps
1 x a day
Stand with your feet shoulder-width apart and your arms by your side. Slightly soften the knees and engage the stomach muscles. Keeping the back straight, and letting the arms hang naturally, push your hips back and lean forward until you feel a pull in the hamstrings. Pause, then push your hips forward, bringing yourself back to your start position. As you progress, you can add hand weights.
Reverse Lunge – start bodyweight to fully loaded
Floor and weights
3 x 8 reps each leg
1 x a day
Standing with your feet together, step one foot back into a lunge stance. With your weight in the front foot and keeping your torso upright, lower your body until both knees are at a 90-degree angle. Pause and drive through the front foot to return to the start position. As you progress you can add hand weights.
Lateral step up – body weight
Step
3 x 10 reps each side
1 x a day
Stand side on to a step or box, with your injured leg closest to it - use a stick or handrail for support if you need to. Place one foot on the step, parallel to the step, then press through the foot and straighten the leg. Pause, then slowly lower until your outside foot is back on the ground.
Advanced Single leg balance
Pillow/foam mat/mattress
3 x 45 seconds each side
1 x a day
Stand on one leg on a pillow, cushion or mattress - anything that will make you a bit unstable - and try to keep your balance while lifting your arms above your head and back down again. You can progress by throwing a ball from one hand to the other as you balance. Do this for around 40 seconds - if you lose balance, just reset and start again until the time is up.
Goals at 12 weeks
Single leg calf raises – Perform maximal repetition on both legs, injured leg should be within 10% of non-injured leg
Single leg bridges – Perform maximal repetition on both legs, injured leg should be within 10% of non-injured leg
Side Plank – Hold for over 30 seconds
Plank – Hold for over 45 seconds
Single leg balance – Hold for over 45 seconds
Eyes closed single leg balance – Hold for over 10 seconds
Maintain a good single leg squat to 90 degrees
If you can achieve the goals above then you can move onto the next stage. If not then repeat this stage.
Notes
At this stage of the rehabilitation process, there are 2 different pathways to follow depending on your age and activity level.
Group 1 – Active sporting lifestyle (20-40 yrs old). If you pursued an active lifestyle prior to the ACL injury and want to recover back to the same levels of fitness or participate in a sport as before then you will need to follow Stages 4 & 5 of the rehab programme so that your rehab will continue until 6 months post operation
Group 2 – Walking and casual lifestyle (50+ yrs old). In order to strengthen the leg further during the next 6 weeks, repeat Stage 3 Post-Op (7-12 weeks) but increase the repetition of the exercises as the leg gets stronger (start by increasing by 5 reps) and also increase the resistance up to 5kg.