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As soon as possible the crutches are discarded and the physiotherapist should make sure the patient is walking normally and is able to deal with stairs, both up and down.
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Range of motion exercises are continued until the patient has full knee extension and flexion. The gains made during the first week after surgery are maintained during stage 3. Rehabilitation exercises are started as soon as possible and, as soon as 70 degrees of knee flexion is possible, static cycling can be initiated.
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Some surgeons like the patient to use a continuous passive movement (CPM) machine that automatically bends and straightens the knee, encouraging the dispersal of swelling and the restoration of range of movement.Īs long as the patient feels well enough following the anaesthetic, they are taught how to get around on crutches by a physiotherapist and a normal walking pattern is encouraged. Static quadriceps muscle contractions should be practised every hour, both to help decrease the knee swelling and to start the process of regaining strength. Full extension of the knee is further encouraged by getting the patient to lie on their front with the knee overhanging the physio bed. Initially, the heel is propped up with the knee unsupported in order to make the knee extend fully.
As in the pre-operative stage, this is acheived by using a cold compress to reduce swelling, at the same time as the patient undergoes early exercises to restore the range of knee motion.Įarly restoration of knee extension is considered most important. The goals of this stage are to reduce swelling and restore range of motion. Once the swelling around the knee has resolved then the surgery can take place, if it is appropriate.
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Mainly through what are called heel sliding exercises, where the patient uses a friction free surface to slide their heel towards their bottom. Through the patient lying on their front with their knee hanging over the edge of the bed.
Principally through applying a cold compress to the knee joint. This is achieved through progressing from non-weight bearing on crutches to what is called heel to toe walking. The aims of physiotherapy during this stage are to: In the long term, an unstable knee joint may lead to Osteoarthritis of the Knee. The degree of functional instability, and the level of sporting or occupational activity, largely influence the decision as to whether surgery is appropriate. The patient should have an opportunity to discuss all the available options and the most appropriate course of action decided, depending upon the patient’s activity level and age. It involves the patient having their injury evaluated and explained by a doctor and chartered physiotherapist. It must be stressed that this progamme is only appropriate if the surgeon uses a bone patella tendon bone graft.Īlthough it is called the pre-operative stage, this stage is undertaken whether the patient is going to have surgery or undergo a ‘conservative’ physiotherapy programme. In all cases, the surgeon dictates the type of rehabilitation followed, depending on the surgical technique used. The key observation made by Shelbourne was that the patients who achieved early full range of motion tended to do better.īased on these findings, a four stage rehabilitation protocol has been devised. Shelbourne and his colleagues astutely noticed that those patients who did not adhere to the ‘softly softly’ program used then, actually got better more quickly than those who did and, furthermore, they had less instability in the knee. You can also visit the Premier League safeguarding page for more information.The current thoughts on ACL rehabilitation are based on the so-called accelerated programme, first used in the early nineties by American surgeon Donald Shelbourne. Visit CEOP’s Thinkuknow website for advice and guidance on safe surfing and staying safe online for example when using mobile phones, blogs, social media, chatting, online gaming and emailing. You should contact the Police by calling 999 if you or anybody else is in any sort of danger. Visit the Child Exploitation and Online Protection website for confidential support if something has happened online which has made you feel unsafe, if you are worried about someone else or to report online abuse.
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To license Premier League match footage: Subscribe to the official Premier League YouTube channel: Former Football Club winger, Victor Moses celebrates putting Chelsea 2-1 up against Tottenham Hotspur with the most insane knee slide.