All the exercises I have ever done throguhout ACLr

[feeny]

I thoguht I'd put a big list together. Some friends asked me for it. Some are basic - some are majorly advanced. Funnily enough - some I could never have done before my operation. Please get advice about any exercises if you are at all uncertain!!

Knee Exercises and ideas post ACL reconstruction[/u]

Basic Mobility:

Patella mobilisations:
Sit down with leg straight and extended, but relaxed. Gently move the patella around in small circles, going both sides. This helps prevent adhesions.

Quad Sets:
a) rolled up towel under the knee, bending toes back towards knee cap and push knee back into towel whist contracting quads to straighten leg as far as it will go - making sure that you are pushing knee back into towel the whole time - hold contraction for 10 seconds

b) rolled up towel under the heel, leg straight out with knee back and calf off the floor - contract quads trying to push the back of the knee into the floor whilst the leg is straight - hold contraction for 10 seconds

c) no towel for this one - leg straight out whilst sitting on the floor, as straight as it will go - push the back of the knee into the floor, contract quads and try raise the heel of your foot 1cm or so off the floor whilst your knee back is touching the floot - hold contraction for 10 seconds

d) lying on y our stomach - no towel required - stretch out both legs so you are flat on the floor, put the ball of your foot on the bad leg on the floor, and whilst keeping your hips on the floor contract the quad muscle which feels like your leg is almost "arching" straight up - hold contraction for 10 seconds.

Try to do 2-3 sets of about 10. All of these exercises must be done using the quad muscles in the legs. The objective is to teach and regain quad control evenly in both legs.

Basic quad and hamstring stretches. Always, and lots of them!

Mobility and water exercises:
Straight line striding / jogging / running in a pool - basically run in a straight line until the water is around shoulder height, turn around and run back. Remember -the deeper the water the more resistance and the lesser the impact on the knee.
Straight line hopping - as above - but hop up and down - be wary hopping in the shallower end as the water provides less bouyancy
Sideways running - as above, but facing sideways
Sideways hopping - as above, this time hopping
Kickboard - small in-line kicks only. This is a great all round exercise


Cardio Exercises:

a) Recumbent (sit down) bike: I find this excellent for both mobility and training the VMO (big quad muscle on the inside of your knee)
b) Orbital Strider / Free Runner / Cross Trainer: I find this excellent to help with fitness, strength and a non impact alternative to running
c) Step Machine: More strengthening and CV exercise
d) Treadmill: I basically run on the treadmill, but running is also a high impact CV exercise - CV benefits can be achieved on the machines above.
e) Skipping Rope - when you feel confident enough! Once you are skipping, start doing one legged skipping, focussing on the injured leg.

Cardio exercise regime is up to you. I have found it beneficial to increase resistance on the recumbent bike and orbital strider machines and in this way build endurance and regain muscle tone at the same time. Im not a huge fan of running great distances any more - I just cant see any good reason to put my knee under lots of impact in every day training.

Balance:
Drills on 1 leg, using a foam roller, a balance board, a wobble board, one legged, two legged etc. Balance is really important to train post acl. We must teach our knees to learn where they are in space and train our muscles to do all of the work - not rely on our ligaments! Proprioception is the body’s ability to know where al imb is in space - and our knees are deficient in this area. Balance training brings back this sense - it needs to be automatic = all the muscles around the knee need to react to protect it and balance exercises are the perfect way to train this sense. I personally own both a wobble board and a vew-do board and do all sorts of things from squats, lunges, medicine ball work and even some soccer juggling drills on these balance apparatus. I have found this has helped my chosen sports (snowboarding and soccer) tremendously. I cant speak highly enough os balance training.

The Squat

This is a very important exercise! I do all sorts of squats. When doing all types of squats - make sure you can still see your feet over your knees - your thighs should not stop you seeing your feet when you bend! Keep the back straight and stomach tucked in towards your spine. Feet about shoulder width apart. You should not go down further than 90 degrees. Use your heels to help push up!

a) Mini Squats: When beginning, back against the wall and start with 1/4 squats, go slow and focus on technique, build up to 1/2 squats and when confident go to unassisted full squats.
b) Standing squat: Basically stand with feet shoulder width apart and do a squat.
c) 1 leg squat: Stand on one leg, the other leg extended and raised a little, perform a squat going down as far as possible without falling over! Try not to keep your balance without any assistance.
d) Drop Squat: Like a standing squat but go down very very quickly and use your leg muscles to stop your "fall", then slowly return to start position (great for helping with patella tendonitis).
e) Jumping Squats: Slow squat down, engage the heels and explode up, jumping up as high as you can.
f) Sumo Squat: Feet out wide, pointing 45 degrees away from the body in opposite direction.
g) Decline squat: Stand on a bench which is on a decline, with your feet together and pointing downwards. Do a squat and hold the position with your knees bent. A decline angle of 15-20 degrees is perfect.

With weights:
You can weight all squat exercises if you want. I usually weight drop squats and jumping squats - holding dumb-bells whilst I do them. I dont like doing squats with a big heavy bar bell across my shoulders - but lots of other people do. If you are doing unweighted squats - do as many as you can!!! If you are using weights - I try for somewhere between 10-15 and 3 sets. You can also do squats holding a medicine ball in varying positions. One of my favourites is sumo squats whilst holding a medicine ball over my head and leaning from side to side as I come up from the squat.

On Unstable surfaces:
I try and do some squat exercises on an unstable surface like a foam roller, wobble board or balance board. This is an advanced exercise but is absolutely brilliant. I set my self a target number of squats to do on a foam roller and if I fall off I start again.

Other Leg Exercises:
Lunge: With both feet together, take a big step forward and bend your back knee slowly until it touches the floor. Try to make sure you can see your toes over your knee, keep your upper body straight with your stomach tucked in towards your spine. Step backwards when done, returning your feet together. This can also be done as a walk - taking steps forward. I also do this holding a medicine ball either directly in front of me with arms straight or directly above my head with arms straight.

Calf raises: Stand on a step with your heels hanging off the step. Push yourself up onto your toes and then lower your heels again. Variations: Do this one legged, and even more advanced, try to use as little balance assistance as you can. Try doing these one legged without holding on to anything. When it all gets too easy, hold a medicine ball over your head!

Hamstring with swiss ball: Get a swiss ball and put both your legs up on it, heels together, legs straight and raise your hips off the floor. You will be bearing your weight on your shoulders. Slowly roll the ball with your heels bending your knees and bringing the ball in towards your bum as far as it goes. Slowly roll it back to full extension. More advanced: Do this with one leg on the swiss ball and one leg in the air (hard!)

Some weight exercises:
Leg press machine: Slow leg press exercises, I do 2-legged and 1-legged to build my injured leg. Make sure that your foot is firmly planted on the plate, in line with your knee and hip.

Hamstring curl machine (lying on stomach): Again, 1-leg and 2-legged. Focus on technique and full flexion.

Dead lifts: With a barbell in front of you, feet in a squat position, take a wide grip on the bar and lift it through your legs, straightening your legs and keeping your back straight. you end in a position where you are standing straight with your arms straight hanging down holding the barbell. Return to starting position without arching your back and repeat.

Plyometrics:
These are exercises designed to develop power. The basic theory is that we jump higher if we crouch and then jump suddenly. This is because our muscles perform better when we contract them and then quickly expand them. This is the essence of plyometric exercises. The idea of plyometrics is all speed - each exercise should be done as quickly as possible but without neglecting technique! These are all fairly advanced - I generally dont do plyometric exercises during the same session as I do weight bearing exercises. 10-15 reps, 2-3 sets is plenty for plyometrics.

Skipping Rope: By its nature all skipping is plyometric! Great all around exercises and there are plenty of rope jumping drills for training different things.

Burpees: This is one of the hardest exercises I do. It all sounds easy, but few things tire me out as much as the burpee. Start standing tall, feet together. Quickly drop to the floor, bending your knees and landing on your hands, with your knees flexed close to your chest. Kick your legs out behind you, into a pushup positition. (Optional: Do a pushup). Spring off your toes bringing your knees back to your chest, with your palms still on your floor. Then power up through your heels into a jump as high as you can, raising your hands over your head and trying to touch the sky. The whole burpee should be done in 1-2 seconds. Repeat.

DIamond jumps: Use a square or an imaginary square and with feet together jump from corner to corner around the square as fast as possible. Combinations include diamond, front-back and lateral-side to side.

Front-Back step jumps: Using a box or step - and start on the lowest height. Basically, as quickly as possible, stand behind the step, facing it. Jump up onto the step and forwards off it, then without stopping or taking a step, jump straight backwards onto the step and backwards again off it. The objective is speed. When this becomes easy, raise the step height, or alternatively jump straight over the step and back again.

Lateral side-side step jumps: Using a box or step - and start on the lowest height. Basically, as quickly as possible, stand to the side of the step, facing forwards. Jump sideways onto the step whilst facing forwards then without stopping or taking a step, jump to the same side again off the step landing on the other side. Without stopping or take a step, jump sideways again onto the step and off in the same manner.. The objective is speed. When this becomes easy, raise the step height, or alternatively jump across over the whole step and back again.

Agility
I have done some sprint and agility drills such as sprinting between two cones forwards, backwards, sideways and zig zagging. However, I have found the best agility drill to be to ask someone to stand in front of you and shout directions to you (forward, backward, left, right) and then explode without pause in that direction, whilst facing the person the whole time. They should shout instructions rapidly, and just dont stop! For added effect have them shout in some exercises like star jumps, pushup, burpees, sprinting on the spot, run-to-me etc. This is all the agility work I need and is an absolutely exhausting workout!!!

My Current Workout Regime(s)
I decided to add this section here and list whatever my current workout routine is. I am at about 17 months post-op now - I work out every second day still, and I play one game of indoor soccer / week.

Common to both workouts - CV work at start
Miscellaneous CV work - I aim to burn 500-600 calories in a 30 minute intense CV period. Usually, by the end of this I am truly buggered. I have the choice of either increasing the time or the intensity - I opt for intensity because I dont really want to spend more time in the gym! I prefer lower impact CV work - so I will opt for freerunner / stepper / rower / bike over running.
I list all weights as a % of my bodyweight - not sure how relevant this is, but I guess if you weigh 200kg you will be lifting different things than if you weigh 50kg!

Workout 1 - Strength
(all 1-legged exercises to be done both sides!)

Leg Press - (180% body weight) 2 legged - 1-2 sets x 10-12
Leg Press - (125% body weight) - 1 legged 1-2 sets x 10-12 (1 leg I do 70% of the weight I do 2-leg)

Hamstring Curl - Max weight 2 legged 1-2 sets x 10-12
Hamstring Curl - Max weight* 70% 1 legged 1-2 sets x 10-12

1 legged squats - leg forward - 1 set 10-12
1 legged squats - leg back - 1 set 10-12

Calf raise 1-legged leg straight 1 set of 20 (use minimal balance aid!)
Calf raise 1-legged leg slightly bent 1 set of 20 (use minimal balance aid!)

Dead Lifts (66% of body weight) 2-3 sets x 10-12

---upper body---
---abs---
---stretches---

Workout 2 - Plyometric / Agility

(no breaks in the sequence below until the end)
Roller Squats (squats on a foam roller) - 1 set of 40
Jumping squats (barbells, 25% of body weight total) - 1 set of 12-15
Medicine ball sumo squats - 1 set of 12-15
Lateral Heaves (hips up, using hamstring) - 1 set of 20 - 30
- 1-2 minute break and repeat sequence 1-2 more times -

Plyometric lateral box jumps - 2x15 each side
Plometric front-back box jumps 2x15 each side
Plyometric 1 leg box hops / tuck jump 2x15 each side
Burpees 2 sets 10-15

OR (every second plyo workout I vary between box jumps and rope jumps)

Skipping rope 5-7 sets of 100 jumps, my drill is something like:
100 both legs
100 alternate legs
100 3-4 jumps on injured leg only for every 1 jump on uninjured leg
100 high speed, alternate legs
100 with double jumps, triple jumps and cross overs

---upper body---
---abs---
---stretches---

[jainemac]

pretty exhaustive and exhausting! list there..think you have covered everything!
 

[jb-knee-geek]

feenster - what a writeup, I'm exausted just reading it!

How about a feenster ACLr's rehab video, if anyone should cut one it should be you.

excellent, it's a keeper, thanks.

[rugby nut]

Thanks for that comprehensive list. I'll read through it when I have time, got to go out shortly. I'll print it off & see I what I can use for my own rehab.

[sharshar]

Wow, thanks feeny! I'm going to print it out and use it to plan my workouts in the future! As you mentioned, post-ACLR knee rehab never really ends, so this list will definitely come in handy for a very long time! =) Thanks!

[feeny]

added water exercises I did in the early days 

[Guuma]

Wow, great list!

[ermintham]

wat are the exercises to avoid if i had a ACLr hamstring autograft?

[Kai]

Feeny.. Ive heard of gung ho mental, but you are their king.....

[celinenj03]

Feeny, you are awesome. I love this list. I read it OFTEN. I never had the improvement in my leg until I added squats and leg extensions. People underestimate just how detrimental atrophy can be to the knee. Also, we think our leg is back to normal muscle wise, but most often it is NOT. Even though I feel like it's just about strong enough, I know I have a ways to go. One should work out hard for a year after ACLR to get back to where they were pre-injury. THANKS for bumping this.

[rugby nut]

Cheers Feeny for putting this back on top. It's just about THE definative list.

[feeny]

I didnt bump it - someone else did. Glad its still of value though.

I think it was bumped by ermintham who was asking what to avoid if he had a hamstring graft.

Well, I *did* have a hamstring graft - and I do all those exercises! The thing with hamstring graft is to be gentle on your hamstrings for the first few weeks. Over one year on and my hamstring is still not the same... but it probably never will be - I am two tendons shorter in one leg - even though it doesnt interfere day to day with my activities at all.

So, ermintham, I suggest you take it easy on the hamstring exercises - and listen to your body. I was doing the swissball hamstring exercises at around week 4-6 - it may have been later - its so long ago I dont remember - but I put alot of work into rebuilding my hamstring exercises. It does pay off !!

I am now regularly doing one legged swissball hamstring curls, sumo squats and one legged hamstring curls on the hamstring-curl machine. Always focus on technique rather than weight lifted.

A hamstring should be 80-100% the strength of a quad. For us ACLr people it should be closer to 100%. That means whatever weight you can do with a leg extension machine you should be able to do 80-100% of it with a hamstring curl. The balance is important for knee health!

Now leg extension is an exercise that you should not attempt too soon after ACLr, no matter what graft type - I didnt do them for 6 or so months, even though my OS said I was fine from 3 months if i recall.

PS - Might ask kneeguru to sticky this list...

[ermintham]

oh ok....but now its like 8 day post op for me... and i cant seem to be able to do SLR, coz i end up using my hamstring muscle, which will then hurt...

anyway i read tt pple who had hamstring autograft shldnt do heel raises for flexion as this exercise uses the hamstring muscles.
instead shld be sitting on th edge of the bed....and using the gd leg to help flex it

wonder how true is tt....hmmm

[loz8]

feens you really are a SUPERKNEEGEEK!
great work big man.
loz

[Mirek]

Great List Feens, and thanks for the message.  I have fewer than 20 posts, so cannot reply yet.  I will be needing this soon - chack my new post.

Mirek

[ermintham]

hi regarding adhesions.....how do u know if u have them? im 3 weeks post op.....there's still swelling and it feels tight around my incision area...will the patellar mobilisations help?

[ermintham]

http://www.athleticadvisor.com/images/Acrobat/knee%20rehab.PDF

this is nt bad too

[feeny]

Those are great exercises for the first 4-6 weeks!!

[HaRry_28]

Hello Feens, remember me? Well just wanted to ask you how your rehab has gone thus far? Its harry78 from back in the day. Great post by the way.

[loz8]

Thought it might be you Harry, how is your knee now?
Loz

[HaRry_28]

Hi loz, long time no talk,eh?

My knee is good, in fact it has beared up very well thus far, and am still very much working on it still to keep it like this at 18 months post op. As you know its the rehab that has gone on before that dictates the health of the knee and health and fitness overall. I still have slight crepitus but nothing that disturbs the right knee's biomechanics and general function.
How is your knee loz and feens?

Harry

[loz8]

good to hear harry, i have posted an update so not too hijack feens awesome post!

Loz

[ermintham]

how do we make the quads of our injured leg work? im using a stepper....but i dun find it workin....only the other quad..

and how to train hamstrings?

[GBJames]

Very helpful list.

I too had a hamstring graft so am going to work alot on that area. They don't feel too sore so far (day 4 post op).....

On the cardio front pre my op I did a lot on fixed "spinning" bikes where you can really crank up the resistance and also "climb" whilst out of the seat. Not sure what impact this will have on hamstrings but keen to give it a go.

[ermintham]

wont's that be too much on the knees?

[GBJames]

spoke to my physio about this. he said that if your technique was correct i.e. you keep your heel down throughout the pedal stroke then there is relatively little impact upon the knee - other than articulating it. It works quads and hamstrings almost exclusively.

I was doing this about 4 months after an athrospcopy to repair a meniscus tear, but at that time without an ACL and it was fine.

[ermintham]

anyone know how to ensure the best adjustments to the seat for recumbent cycling?

fenny says its good for the vmo....

[jb-knee-geek]

for the home ACL rehabber's, you doing better than most! get off the internet and back to exercise.....

check it out: http://sportsmedicine.about.com/b/a/206300.htm

[Annika]

Awesome  .

I am about to have my op and I know now where to start day 1.

[jb-knee-geek]

I had to report back on the use of the foam roller to loosen up the IT Band.

There are several stretches to get the IT loose. For me, the foam roller rolling over the outer thigh (about 30 seconds) between hip and top of knee helps a lot. (another feeny idea!)

I was stretching and lite-jogging, then felt some tendonitis, when I got home I used the foam roller (in addition to other stretching), within an hour, my knee "clunked", like a knuckle crack, but, no tendonitis following day.

Foam roller IT Band stretch is now part of my ever increasing stretch routine.

[Mafesto]

This is a great list, im going to print it out and put it on the fridge.  Im 4 days post op so theres lots there to look forward to!

[contraaclr]

I had to report back on the use of the foam roller to loosen up the IT Band.

There are several stretches to get the IT loose. For me, the foam roller rolling over the outer thigh (about 30 seconds) between hip and top of knee helps a lot. (another feeny idea!)

I was stretching and lite-jogging, then felt some tendonitis, when I got home I used the foam roller (in addition to other stretching), within an hour, my knee "clunked", like a knuckle crack, but, no tendonitis following day.

Foam roller IT Band stretch is now part of my ever increasing stretch routine.

I agree. Rolling your thigh on a foam roller is one of the best ways to stretch/massage the IT band. There is a great demo on how to use a foam roller on the youtube web site:

http://www.youtube.com/watch?v=t32xJspx50o&NR=1

Here is a picture of the IT band. When you look at it you can understand how important it is to stretch it, as it has the potential to pull the patella laterally (to the outside of the knee).
http://www.ithaca.edu/faculty/lahr/LE2000/knee%20pics/knee%20pics/3Alateral-TFLsup.jpg
Here is another picture, along with some stretching exercises for ITBS:
http://www.aafp.org/afp/20050415/1545.html

[feeny]

Rockin Roller

*chortles at self as he cracks self up*

One other basic exercise I keep meaning to post here - I have been doing it the whole time (still do it!) and its a quad / vmo thing - just a variation on a quad set really - but I find it an excellent one... it combines a quad contraction with a leg raise and a hamstring flex all in one.

I do it on a bench... the floor works too - one leg straight out in front, the other one where ever its comfortable (usually dangling off the bench or half crossed off to the side somewhere) then:

1. Touch the knee back to the floor, and lift your heel as high as you can whilst the kneeback is touching the floor (Quad set).
Hold for 2-3 seconds then
2. Raise the leg into a leg raise, to an angle of about 30 degreess or so - enough that you feel the leg raise, and not too much that you strain your hip. The leg must remain straight the whole time. (SLR)
Hold for 2-3 seconds then
3. Slowly flex the knee trying to touch the heel to your bum, or as close as you can get to your bum, foot /heel not touching the surface or bench (hammy flex/ leg curl)
Hold for 2-3 secs in the flex position
4. Straight the leg back slowly so that the knee back touches the floor / bench again, with the leg straight, but do not touch the heel to the surface.. keep the quad contraction going the whole time
Hold for 2-3 seconds back in this starting position, heel not touching the floor.

Repeat again and again from step 2 onwards until your quads feel on fire.

[Nola]

Hey feeny,
My PT suggested the Muncie method to strengthen the VMO and to help with poor patella tracking.  Here is an article on PFS and a PDF file with the info on this simple yet effective exercise to be able to do at home without any special equipment.

http://www.physsportsmed.com/issues/2004/0704/labotz_pa.htm
http://www.kneeclinic.info/download/CKC_Patellofemoral_Problems_Info.pdf  It is on page 5.  He said it is an open chain exercise, but you basically lock out the knee before doing the leg raise so the graft is protected.  You can add small amounts of weight 3 - 5lbs when comfortable.

Here is also an article on ITBS, including using the foam roller you refer to often.  http://www.physsportsmed.com/issues/2000/02_00/fredericson.htm

[Jaspy]

Hi Feeny,

What a great list!

Your workout is quite extensive you must be really fit! 

Please can you explain what Lateral Heaves (hips up, using hamstring) - 1 set of 20 - 30 is in your 2nd workout.

I am only 6 weeks post ACL and have done most of the early exercises you list including the pool ones. I'm currently doing some of the 1 legged stuff.  I hope to include lots more of those you list in the future as most can be done at home without any special equipment and I'm not the gym going sort and I can't wait to replace my static bike rides with ones that have more scenery.

Thanks
Jaspy

[jb-knee-geek]

take a poll about AClr exercise - thanks

http://www.kneeguru.co.uk/KNEEnotes/node/464

[nerospiro]

hi all i agree great list feeny im just 12 weeks post op and cant wait to get to the stage where i can at least try all of them, hope everybodys rehab is going well, just wondered feeny are there any pains you still get apart from the muscle pain you must get from doing that workout  :)and are there anything you would change about your rehab want to do my best at this only want the one shot chrs .

[macker]

Pre op i was doing The Peterson step, another variation is the Poliquin Step, check this article out http://www.biggerfasterstronger.com/uploads2/PreventACLInjuries.pdf.  You may need to register to read, however you can get a basic membership for free.
Another great exercise was the 6 way lunge, http://www.bodybuilding.com/fun/peak43.htm, you have to go quite a way down the page.

[macker]

Two new exercises i have been working on are
Split squats http://www.exrx.net/WeightExercises/Quadriceps/BBSplitSquat.html

Calf raises http://www.exrx.net/WeightExercises/Gastrocnemius/BBStandingCalfRaise.html

The split squats are challenging and there are many progressions.

[feeny]

Nice exercises Macker!

I do similar ones - not quite the same - but very similar - the medicine ball lunge is similar to the split squat - and I do calf raises exactly the same as the exercise you list - except I dont use weights - but I do it on one leg instead.

How are you finding them?

[pete_duk]

thts a great list!im currently pre-op so ill look forward to getting into that!was wondering if you did any exercises pre-op that speed up the recovery?

pete

[feeny]

Yes, I did tons of pre-op exercises too - I should have a list of those someplace - let me see if I can dig them up as well.
The main two objectives of pre-op are mobility (as allowed, depending on injury) - if possible, free and full extension, and strength - get as much bulk into the quads and hamstrings as possible, as they will atrophy post-op!

Feens

[pete_duk]

Thanks feeny, i've pretty much been doin cycling (been doing short sprints in intervals on bike) for my quads in the gym as im a bit worried about doing any more damage using weights. I've got almost full range of movement on my injured leg, im just very slightly less than full extension but can fully bend the knee, the injured leg actully has a better range of movement than the other leg.

Pete

[macker]

Nice exercises Macker!

I do similar ones - not quite the same - but very similar - the medicine ball lunge is similar to the split squat - and I do calf raises exactly the same as the exercise you list - except I dont use weights - but I do it on one leg instead.

How are you finding them?

Great for building strength, and also flexibilty.

Here is a new set of exercises i have been working on.  Labelled potentiation combines plyometric and weight training exercises.
 http://www.pponline.co.uk/encyc/combining-plyometric-and-weight-training-exercises-increase-speed-and-power-41447

Have fun with them, i am loving them