On July 17, 2007 I had an ACLr Allograft and a Lateral Meniscus Trim (also a grade 2 MCL sprain when injured).
I wanted to track in one spot all of the exercises I have been assigned at PT (and a few I added on my own with an OK from my PT) and a time line of when assigned– these are all in my Post-Op diary too but they are scattered in with everything else including pre-surgery exercises: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=38125.msg308214#msg308214Week #0:Day 2:Exercise #1: Quad Sets.
I do these while sitting on my couch with my brace on and locked in full extension. Basically you just flex your quad muscles while feeling as if you are pushing the back of your knee down into the couch. I hold the contraction for about 2 seconds and then repeat for a total of 20 repetitions. I was told you can’t overdo this exercise so if you can do one set of 20 every hour (or every other hour) that’s great.Day 3: * From this point forward all exercises are done twice daily – except quad sets which I do more frequently for the first couple of weeks.
* I should also point out that for the first week I had my brace on in the locked position 24/7 except when doing the exercises.Exercise #2: Straight Leg Raises.
I do this lying on my back with my upper body sitting up a little so I am propped up on my elbows – my good leg is pulled in so my left knee points up in the air. I am not doing these exercises with my leg brace on because I do not have any extension lag (my leg does not bend when I raise it – I can keep it perfectly straight – if there was extension lag I would have to do these with the brace on and in the locked position). This exercises starts like a quad set where you flex your leg to lock it out straight. Raise the leg to about the height of the opposite knee (or whatever feels comfortable), hold for just a brief moment (I was told you do not need to leave it up in the air) and then lower back to the starting position. Completely relax the leg for a moment and then repeat (don’t just keep it flexed the entire time). I am doing 2 sets of 15.Exercise #3: Straight Leg Raises - Abduction.
This is similar to the above exercise but just lying on your non-injured side You will raise and lower your injured leg). The only difference is on this one I do not fully relax in between repetitions but continually do 15 in a row, take a break for a moment, and then do my 2nd set of 15.Exercise #4: Heel Slides.
Sit on the floor with both legs extended out straight in front of you. Take a rolled up towel and holding it by the ends in both hands loop the middle over the ball of your injured leg. With assistance from your hands pulling the towel slide your heel towards your butt along the floor so your knee starts to rise of the floor. When it wont go any further hold that position for 5 seconds and then release and slide your heel back to the starting position (getting it back to the starting position is often harder then pulling it to you – sometimes I actually had to scoot my body away from my heel to get the leg straight again). Do 1 set of 15 repetitions. As my leg got stronger (a few weeks later I would alternate between using a towel to assist some days and just using the strength of the leg to pull the heel on other days – if you had a hamstring graft that might be tougher in the beginning so the towel would probably make much more sense).Exercise #5: Calf Strengthening with Exercise Band.
This starts seated on the floor like the above exercise but loop an exercise band (elastic) around the ball of your foot and hold the ends in both hands. Pull back on it to get the tension to whatever amount you feel you can handle. Now just extend the ball of the foot away from you like you are pressing down on a gas pedal in your car and then relax and bring it back. Make sure you keep the leg straight and on the floor the whole time. Do 2 sets of 30 repetitions. This will later be replaced with exercise #16: Standing Calf Raises.
Exercise #6: Seated Calf Stretch.
This starts off the same as the above exercise so you are seated on the floor with a towel around the ball of your foot and you are holding the ends of the towel in both hands. Flex the quad and press the back of the knee into the floor (like the quad set) and then pull with the hands to pull the top of the foot towards your knee. You want to make sure that you are not lifting your heel off the floor and going into hyper-extension (I was told no hyper-extension until after 12 weeks). See note at Week #5, day 35 for an alternate way to stretch the calf.
Exercise #7: Quad Set with Towel.
I do my quad sets a little different when I am doing my actual set of PT exercises, but when I am just sitting on the couch I do exercise #1. Sit on the floor like the above exercises and place a rolled up towel under your knee (not too large – it might be 1 to 2 inches tall before you compress it). Flex your quad and press the back of the knee down into the towel like you are trying to push the towel into the floor, hold for 2 seconds and then release. You might notice your knee cap move a little when you do this – and that is OK. You also want to keep an eye on your foot so it doesn’t start to lift up to high and go into hyper-extension. Do 2 sets of 20 repetitions.Week #1:Day 7:Exercise #8: Push ups.
I checked with my PT to see if these would be OK and he said they would. I do 2 sets of 20 pushups twice per day with my regular pt exercises. I keep my left knee on the ground (good leg) and I keep my brace on in the locked position raised off the floor (I started doing them without the brace on Day 17).Day 11:* I checked with my PT if I could start using my home gym for upper body exercises twice per week and was given the OK. So I do incline bench press, lat pull downs and bicep curls twice per week. On the days that I do the incline bench press I do not do any push ups.Day 12:* I started going for short 10 minute walks today (with crutches and unlocked brace). Week #2:Day 14:
Exercise #9: Tibialis Anterior Strengthening with Exercise Band.
This one I only do at PT, not at home, but you can if you want - it strengthens the muscles in the front of the shin. It is similar to the calf strengthening exercise but you anchor the band on the far side of your foot so you get the resistance as you pull your toes toward your knee. I was told to do as many as I can until it burns. This will later be replaced with exercise #19: Heel Walking (which hits the same muscles and is easy to do at home).
Exercise #10: Quad Sets with E-stim.
This is one that I can only do at PT - Basically just quad sets but hitched up to a mini electric stimulation hand held devise. Two pads are attached to my leg (one close to the knee and one further up the thigh). I was told to do 30 reps of flexing the quads as hard as I could. The machine tells me when to flex, and if I contract hard enough it will add some current to flex me even harder – I hold this for 5 seconds and then it has me rest for about 5 seconds. It keeps adjusting up or down in intensity to match how hard I can flex.Exercise #11: Stationary Bike.
Quarter or half turns to start. I started today just rocking the pedals back and forth. On Day 16 I got my first full revolution by day 21 I was riding normally again. I do the stationary bike 5 times a week. At home I use a recumbent, and at PT I use an upright (I also started riding my actual mountain bike on day 46.Day 16:
* Started on 1 crutch today and also did my first full revolution (backwards) on the bike today.[/i]
Exercise #12: Seated Leg Press.
This is another I can only do at PT. I used both legs and started with 30 pounds. I think my good leg was doing all the work and my injured leg was just along for the ride.Exercise #13: Straight Leg Raises - Adduction.
This one you lie on your injured side and your good leg (which is higher up) then steps on front your injured knee so the foot is flat on the floor just in front of the knee. You now flex the injured leg and lift it off the floor towards the ceiling (most people can only lift it a few inches at first) then relax and lower back to the floor. 2 sets of 15.Day 19:
* I am starting to do many of my PT exercises with my good leg also now (not every session but every now and then).Week#3:Day 23:
Exercise #14: Terminal Knee Extensions.
Anchor a band to something stationary in front of you and then around your leg so that it anchors to you at the height of your knee, just behind your knee. Now back up until it is taught. Next bend the injured knee forward without moving the foot and then straighten the leg back to 0 degrees extension. I did 2 sets of 15 of this and by the end of the last set my knee was feeling pretty worked (had some pain with this but it seemed OK). I was told the weight distribution should be about 95% of my weight on my uninjured and 5% on my injured leg.
Exercise #15: 3 Way Balance Exercise.
For this next exercise I stand just on my injured leg with the knee at 0 degrees extension (or close to it). I stay balanced on this leg for 30 seconds. The first 10 seconds my good leg is extended straight out in front of me, then straight to the side for 10 seconds, and finally straight behind me for 10 seconds (for all of these the good foot is about 1 foot off the floor). That would be 1 set and I do 5 sets total. This was much easier than I thought – I was able to keep my balance and my leg felt strong throughout (maybe 23 years of martial arts has made a difference).Week #4:Day 28:
Exercise #16: Standing Calf Raises.
I was told to replace calf strengthening Exercises #5 with this one. Just standing on the floor and using both legs slowly go up as high on the balls of the feet as you can, then slowly lower back to the floor. 2 sets to failure, or 2 sets of 30. This replaces exercise #5: Calf Strengthening with Exercise Band.Day 30:
* Started doing the single leg press today with just the injured leg. He had me put my foot up a little higher than normal to shift some of the work off my quads and onto my glutes.Exercise #17: Step - Lateral Step Ups.
These next 2 exercises I did in pre-surgery to get ready. I stand on a step (short one) and balance on my injured leg. I then slowly lower myself so my left leg (good leg) touches the floor, and then back up again to the starting position. I found initially I could only lower myself and inch or 2 before it started to hurt and I would come back up but as I got stronger I gradually increased the height of the step. He had me initially only do 1 set of 15 but soon got up to 3 sets of 15.Exercise #18: Step - Front Step Ups.
This time I put the step in front of me. Starting from the floor I would just step up onto the step and then back down again. Initially I was told I could do it all just using my injured leg, or I could pause on the step by putting my left leg down. As I progressed I was told to just tap the step with my good leg while at the top and really focus on squeezing the thigh muscle. I did 2 sets of 15. At 7 weeks I was told I could stop doing this exercise.
At 8 weeks I started doing this at PT again, but we increased the height of the step to at least double a normal step (more like a short bench). I was told to start with my injured leg on the step and using an explosive movement drive all the way up (I could also assist with a push-off from my good leg), and then a controlled motion all the way down (I never touched my good leg to the step). At 9 weeks I was told to start holding a 10 pound dumbell in each hand when doing the high step ups.Exercise #19: Heel Walking.
Basically just walk around on the heels of your feet with the toes pulled up as high as you can get them. You do this until the front of the shin is feeling a good burn. This replaces exercise #9: Tibialis Anterior Strengthening with Exercise Band.
Week #5:Day 35:* Increased standing calf raises to 3 sets to failure and I can also start doing them on a step. In addition I can do those 1 legged or both legs depending on how it feels.
* I can also start stretching my calf the way I was doing it pre-surgery - he had me put the ball of my foot on a telephone book and then lean forward so my hands and/or forearm are on a table and just relax into the stretch (he didn’t want me to just stand on a step and sink because he said too many other muscles are involved to keep balance and keep you from sinking to far down). This replaces exercise #6: Seated Calf Stretch.Day 37:Exercise #20: Bridging.
This exercise is a basic bridging exercise to work the hamstrings and glutes. Lie on your back and then pull your feet towards your butt so your knees are pointing up (like the end of a heel slide). Now just raise your hips off the floor, pause when as high as you can go, then lower – 2 sets of 15 reps. I was told initially don’t worry if my good leg did more work – which it did – my injured knee and quads also really felt this one (almost like a stretch). This will later be replaced with exercise #25: Physioball Bridging (or if I am tired I still do this one).
Exercise #21: Proprioception Balancing.
Stand on just my injured leg and close my eyes. See how long I can balance without opening eyes, touching the other foot down or touching anything with my hands – if any of that happens re-start the timing. Then do the same with the good leg. I went back and forth for about 3 to 5 minutes and would say at this point I was balancing for about 30 to 40 seconds on each side. I have not talked to my PT about this yet but I think I will do my first balancing exercise in one of my daily pt sessions and then this one in my 2nd daily pt session – but not both each time.
Exercise #22: Step - Step Downs.
I started on the step and basically just stepped down like going down a flight of stairs (leaving my good leg up on the step), and then stepped back up. I did this about 30 times today and was told to gradually work up to 3 sets of 15 (I was basically doing these at home already but just on a shorter step). You really want to focus on your control as you lower yourself. I was told to imagine an egg on the floor and you want to lower youself slowly so you don't just fall off and crush the egg (in the beginning that will be very difficult but that is what you are working towards).
Exercise #23: Standing Hamstring Curls.
This exercise is a standing hamstring curl with a 5 pound weight on my ankle. I did 3 sets of 15 and these were pretty easy. At 7 weeks I was told on one day do this with exercise 25: Physioball Bridging, and on the next do just exercise 31: Chair Walking – no need to do all 3 on the same day.
Exercise #24: KAT Balancing.
This exercise is the same 3 way balance exercise #13 I have been doing (hold good leg out in front, to the side and then behind me for 10 seconds in each position) but I did it standing on a piece of equipment called the KAT. It is basically like a balance/wobble board but you have a little hand squeeze thing to pump up the base to set the amount of wobble it has. This too was pretty easy. I do this at home on a wobble board. At 13 weeks I started balancing on one leg (on the wobble board) and my PT I would basically play catch with a weight ball.Week #6:
* I was told at this point I should be doing 3 sets of each exercise (or more if indicated) of all my different exercises but that I could drop down to just 1 session of exercising per day (and to push myself hard when I feel strong).Day 44:Exercise #25: Physioball Bridging.
This exercise is bridging on the ball (which I had already started to do on my own, but this version is more difficult). I would lie on my back with my heels up on the ball. The firsts step is to raise your butt so there is a straight line from your shoulders on the floor, to your butt and through to your heels (you should look like a straight plank of wood). Next you pull your heels to your butt bending at the knees and driving your hips straight up (at the top of this position you want a straight line from your knees to your butt and through to your shoulders on the floor) – this motion will roll the ball towards you, you then extend the feet away from you (this rolls the ball away from you) and you are in the straight plank position again, and then relax back down to the floor. The goal is 3 sets of 15 (although on my first day trying this on the 3rd set I got to the point where I just bridged to the plank and back down again). This replaces exercise #20: Bridging (although when I am tired or sore I still do the straight bridging). At 7 weeks I was told on one day do this with exercise 23: Standing Hamstring Curl, and on the next do just exercise 31: Chair Walking – no need to do all 3 on the same day.Exercise #26: Balancing - Dumbell Pickup.
This is another new balancing exercise (I was told to just do one balancing exercise per training session and just pick from the various ones I have). Stand on bad leg, hold a weight in opposite hand (just 2 pounds) and then bend forward and set the weight on floor, hover for a moment, then pick up weight and stand back up. I can rest in between or do as many as I want without putting my good leg down (I was also told to mix up trying to bend my leg to lower myself which works the knee more, or just bend more at the hip which works the hamstring more.) Another way to do this is start with the weight in your hand, bend down and place it on floor, stand back up, pause for a moment on one leg, then bend down, pick it up, stand back up and pause again on one leg (that would be 1 rep, and since it is 2 motions you would just do 5 reps for each set).