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Author Topic: Jake's LOA Rehab Plan  (Read 4101 times)

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Offline Jakem

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Jake's LOA Rehab Plan
« on: June 25, 2005, 09:08:33 PM »
Thanks to this wonderful message board and great information from so many of you especially Laurie, Heather, JaneB, Knicknack and many others I was able to educate myself on this horrible affliction and to try to find a way out.  I studied the literature of Shelbourne, Millett, Steadman and others.  From this I designed the ideal rehab protocol for myself.  Of course it is ideal and there will be many setbacks along the way.  Also, I won’t blindly follow it because any new activity that causes and increase in pain and heat or swelling will be discontinued and I will go back to the basics. 


Day 1   6/24   Arthroscopic surgery to remove scar tissue.  Use narcotics every 4 hours after surgery.  Also take non-steroidal anti-inflammatory such as ketorolac.  Also may take intravenous corticosteroid during surgery.  Drain will be installed.  Leave hospital that day.  Use crutches with no weight bearing.  Drive home in back seat with leg locked at zero and elevated with pillows and use Cryo/Cuff.  At home start CPM immediately set at -5 to 90 degrees for 2 hours.  Do 2 hours on and 2 hours off until midnight.  When not doing CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Do ankle pumps throughout the day.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.  Use Cryo/Cuff continuously.
Day 2   6/25   Walk partial weight bearing with crutches.  Start with just feather touch weight bearing and gradually increase weight bearing with crutches as the week progresses.  CPM set at -5 to 90 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Do ankle pumps throughout the day.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.  PT consists of passive ROM including Patella Mobilization (5 min), wall slides (5 min), prone hangs (5 min, add ankle wt as necessary and as tolerated) and extension stretching.   Also do quad sets (1 x 10), straight leg raises (1 x 10).  Use cryo cuff continuously all day.  Continue to take narcotics every 4 hours round the clock and anti-inflammatory.
Day 3   6/26   Walk partial weight bearing with crutches.  CPM set at -5 to 95 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Do ankle pumps throughout the day.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.  Use cryo cuff continuously all day.  Continue to take narcotics every 4 hours round the clock and anti-inflammatory.
 

Day 4   6/27   Walk partial weight bearing with crutches.  CPM set at -5 to 100 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Do ankle pumps throughout the day.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Stop using Cryo Cuff continuously and instead use cryo cuff 20 minutes on, 40 minutes off all day.  Continue to take narcotics every 4 hours round the clock and anti-inflammatory.
Day 5   6/28   Walk partial weight bearing with crutches.  CPM set at -5 to 105 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Do ankle pumps throughout the day.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.  Continue to take narcotics every 4 hours round the clock and anti-inflammatory.
Day 6   6/29   Dr Appointment.  Get cortisone shot if necessary.  Ask to take Klefex for infection.  Take first shower.  Walk partial weight bearing with crutches.  CPM set at -5 to 110 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Do ankle pumps throughout the day.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.  Continue to take narcotics every 4 hours round the clock and anti-inflammatory.
 

Day 7   6/30   Walk partial weight bearing with crutches.  CPM set at -5 to 115 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Do ankle pumps throughout the day.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.  Continue to take narcotics every 4 hours round the clock and anti-inflammatory.
Day 8
Week 2   7/1   Walk without crutches if possible.  Minimize walking.  Discontinue ankle pumps.  Continue to take anti-inflammatory but if possible only take narcotic at night to sleep.  CPM set at -5 to 120 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.  Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.
Day 9   7/2   CPM set at -5 to 125 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.   Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.
 

Day 10   7/3   Start stationary bike with no resistance and low RPM with leg at 10 degree flexion at bottom for 30 seconds as part of PT.  CPM set at -5 to 130 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.   Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.
Day 11   7/4   CPM set at -5 to 135 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.   Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.
 Day 12   7/5   Increase bike to 1 min.  CPM set at -5 to 140 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.   Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.
 

Day 13   7/6   Dr Appointment?  Get cortisone shot if necessary.  Take 2nd shower.  CPM set at -5 to 140 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.   Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.
Day 14    7/7   Discontinue narcotics at night if possible, but continue to take anti-inflammatory.  Increase bike to 2 min.  CPM set at -5 to 140 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.     Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.
 

Week 3   7/8   Must have full hyperextension by now.  Incisions should be closed.  Take 3rd shower.  Dr Appointment 7/13?  Get cortisone shot if necessary.  Start active heal slides for 5 minutes as part of PT.  Discontinue wall slides when you can do heal slides for full range of motion.  Increase bike to 3 min.  Start walking slowly on treadmill as part of PT for 30 seconds.  CPM set at -5 to 140 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.   Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.  Start upper body weights.  Start gentle massage as part of PT mid week on 7/12.
Week 4   7/15   Discontinue narcotic if not already done so.  Resume taking multi-vitamins.  Increase bike to 4 min.  Increase walking on treadmill to 1 min.  CPM set at -5 to 140 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 3 times per day (915 AM, 245 PM, 815 PM).  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on floor with heel on coffee table with pillow.   Sleep on living room floor with heel on coffee table with pillow from Midnight to 600 AM with leg in Dynasplint extension brace.  Gradually increase tension each night from 1 the first night to 10 by day 10.    Use cryo cuff 20 minutes on, 40 minutes off all day.   
Week 5
Month 2   7/22   If full hyperextension is maintained easily, discontinue use of brace at night and start sleeping in regular bed again.  If possible discontinue icing round the clock and only do it after PT.  Increase bike to 5 min.  Increase walking on treadmill to 2 min.  Add lying on side one leg extension/curl to PT 1 x 10.  CPM set at -5 to 140 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 3 times per day (915 AM, 245 PM, 815 PM).  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep leg elevated and fully extended by lying on floor with heel on coffee table with pillow.   
 

 Week 6   7/29   Add strengthening exercises to PT (one leg extensions and one leg curls and hip abductors with no weight 1 x 10).  Discontinue sideways leg extension/curl.  Increase bike to 6 min.  Increase walking on treadmill to 3 min.  Join YWCA.  Start aqua jogging in pool M-W-F 2 minutes per day at 245 PM.  CPM set at -5 to 140 degrees for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 2 times per day (915 AM, 815 PM).  Do Patella Mobilization an additional 2 times at 1200 Noon and 1000 PM.  When not doing PT or CPM keep leg elevated and fully extended by lying on floor with heel on coffee table with pillow.   
Week 7   8/5   Possible return to work if I make a miraculous recovery (Mon August 8th).  Discontinue use of CPM.  Start sleeping 10 PM to 8 AM.  Increase bike to 7 min.  Increase resistance and RPM on bike as tolerated.  Increase walking on treadmill to 4 min.  Add one minute of backward walking on treadmill.  Increase aqua jogging to 3 min at 2 PM.  Do PT twice per day (830 AM and 830 PM).  Do Patella Mobilization an additional 2 times at 200 PM and 1000 PM. 
Week 8   8/12   Discontinue anti-inflammatory if inflammation is gone.  Dr Appointment 8/13.  Get cortisone shot if necessary.  Increase bike to 8 min.  Increase walking on treadmill to 5 min.  Change aqua to 4 min aqua jogging followed by 5 min flutter kick with fins and board at 4 PM.  Do PT once per day (830 AM).  Do Patella Mobilization an additional 2 times at 400 PM and 1000 PM.   
Week 9   8/19   Likely return to work (Mon Aug 22).  Increase bike to 9 min.  Increase walking on treadmill to 6 min.  Increase to 5 min aqua jogging and 5 min flutter kick at 4 PM.  Do PT once per day (3 PM).  Do Patella Mobilization an additional 2 times at 500 AM and 1000 PM.   
Week 10
Month 3   8/26   Earliest possible full recovery.  Discontinue PT (except for leg extensions, leg curls and hip abductors with no weight) if full range of motion is maintained easily.  Discontinue backward walking.  Increase bike to 10 min.  Increase walking on treadmill to 7 min.  Continue Aqua 5 & 5.   Do Patella Mobilization 2 times at 600 AM and 300 PM.   Take 2 weeks vacation (Aug 29 to Sep 9) if Market doesn’t rally and Shipyard likely won’t let us carry over use or lose.
Week 11   9/2   Discontinue icing completely if possible.  Increase walking on treadmill to 8 min.  Increase bike to 11 min.  Continue Aqua 5 & 5.  Increase leg extensions, leg curls and hip abductors with no weight to 20 reps.  Do Patella Mobilization 2 times at 600 AM and 300 PM. 
 Week 12   9/9   Increase walking on treadmill to 9 min.  Increase bike to 12 min.  Continue Aqua 5 & 5.   Increase leg extensions, leg curls and hip abductors with no weight to 30 reps.  Do Patella Mobilization 2 times at 600 AM and 300 PM.  Dr Appointment 9/14?  Get cortisone shot if necessary.  Gabe’s Wedding 9/10.
 

Week 13   9/16   Must return to work as all sick leave will be gone.  Increase walking on treadmill to 10 to 11 min.  Increase bike to 13 min.  Continue Aqua 5 & 5.  Increase leg extensions, leg curls and hip abductors with no weight to 40 reps.  Do Patella Mobilization 2 times at 600 AM and 300 PM. 
Week 14
Month 4   9/23   If full motion easily maintained and no swelling present, start resistance exercises (One leg press 0-9 lbs, toe presses for calf 0-9 lbs, one leg extension 0 lbs and one leg curl 0-1 lbs) once every 3 days.  Increase bike to 15 min.  Increase walking on treadmill to 12 to 15 min.  Continue Aqua 5 & 5.   Do Patella Mobilization 2 times at 600 AM and 300 PM. 
Month 5   10/24    Start running for 1 minute (week of 10/24 M-F, 10/31 M-TH-SU, 11/7 TU-TH-SA, 11/14 M-W-F-SU).  Decrease walk to 10 min.  Decrease bike to 10 min.  One leg press 10-19 lbs, toe presses for calf 0-9 lbs, one leg extension 1 lbs and one leg curl 2-3 lbs.  Discontinue aqua.  Do Patella Mobilization 2 times at 600 AM and 300 PM. 
Month 6   11/21    Increase running to every day (week of 11/21 1 min, 11/28 1.5 min, 12/5-12/25 2 min.  Decrease walk to 9 min.  Decrease bike to 9 min.  One leg press 20-29 lbs, toe presses for calf 20-29 lbs, one leg extension 2 lbs and one leg curl 4-5 lbs.  Discontinue patella mobes.
Month 7   12/26   Increase running to 3 min.   Decrease walk to 8 min.  Decrease bike to 8 min.  One leg press 30-39 lbs, toe presses for calf 30-39 lbs, one leg extension 3 lbs and one leg curl 6-7 lbs.  Decrease leg workout to once every 6 day.  Add isometric quarter squat.
Month 8   1/23   Increase running to 4 min.  Decrease walk to 7 min.  Decrease bike to 7 min.  One leg press 40-49 lbs, toe presses for calf 40-49 lbs, one leg extension 4 lbs and one leg curl 8-9 lbs
Month 9   3/1   Increase running to 5 min.  Decrease walk to 6 min.  Decrease bike to 6 min.  One leg press 50-59 lbs, toe presses for calf 50-59 lbs, one leg extension 5 lbs and one leg curl 10-11 lbs.  Add isometric half squat instead of quarter squat.
Month 10   4/1   Increase running to 6 min.  Decrease walk to 5 min.  Decrease bike to 5 min.  One leg press 60-69 lbs, toe presses for calf 60-69 lbs, one leg extension 6 lbs and one leg curl 12-13 lbs.  Add calf raises with no weight.
Month 11   5/1   Increase running to 7 min.  Decrease walk to 4 min.  Decrease bike to 4 min.  Start regular 2 legged squats 25-35, leg curls 15-20 lbs and calf raises 25-35 once every 6 days.  Discontinue leg extensions and isometric squat.
Month 12 End of first year   6/1   Increase running to 8 min.  Decrease walk to 3 min.  Decrease bike to 3 min.  Squats 38-48, leg curls 25-23 lbs and calf raises 38-48.   

Offline lefthand50

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Re: Jake's LOA Rehab Plan
« Reply #1 on: June 26, 2005, 06:04:32 PM »
Hey Jakem, good luck with this - be sure to add 'celebrate!' in there someplace :)
5/04, ACL recon, MCL, PCL sprains.  7/22 MUA.  9/20 LOA w/ MUA.  ROM 20-80 cold.  Steadman surgery July 20.  Follow along at http://bendthatknee.blogspot.com















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