ACL Rehabilitation Phase 3

What is ACL Rehabilitation Phase 3?

The anterior cruciate ligament (ACL) is one of the four major ligaments of the knee that connects the femur to the tibia and helps stabilise your knee joint. It prevents excessive forward movement of the tibia in relation to the femur as well as limits rotational movements of the knee. An ACL injury is one of the most common injuries of the knee. An injury to the ACL commonly occurs during sports or activities that involve twisting, overextension, landing from a jump incorrectly, and abrupt change in direction or speed of movements.

ACL rehabilitation phase III is a late postoperative physiotherapy course for recovery after ACL reconstruction surgery. ACL reconstruction is a surgical procedure to repair or replace a torn or damaged ACL ligament in your knee to restore knee motion and stability. ACL rehabilitation phase III is conducted 6 to 8 weeks following ACL reconstruction surgery where your physiotherapist will teach you specific exercises to restore knee mobility, strength, and improve range of motion. Adhering to the goals of the rehabilitation program is important to help you fully recover and resume your normal activities.

Phase III ACL Rehabilitation

By completing Phases I and II of your ACL rehabilitation, you will have built a base of strength and function, and your body is now prepared to regain much of your pre-rupture functionality, including power, endurance, flexibility, agility, reaction time, and more with phase III ACL rehabilitation. After completing phase III rehabilitation, you should be able to return to normal activities, such as walking, using stairs, and doing other jobs.

To begin Phase III ACL rehabilitation exercises, you should:

Have a range of motion in your surgical leg that is full and equal to your non-injured leg
Be able to perform normal daily activities without any problem or favouring your injured leg
Be ready to increase resistance in your strength exercises with weights and bands
Be able to perform double leg squats down to at least 60 degrees at the knee with equal weight on both legs and with proper mechanics

Goals of Phase III Rehabilitation

The goals of phase III ACL rehabilitation exercises include:

Perform single and double leg hopping in place with proper mechanics and no pain
Maintain a full range of motion equal to your other leg with minimal to no pain or swelling
Continue to improve the strength of your operative leg to 70 to 75 per cent of the strength of your non-operative leg by increasing exercise resistance
Continue to improve single-leg balance and improve motor control
Able to bend or extend your reconstructed knee to the same degree as the nonsurgical knee
Add sports-specific activities as you can tolerate

Exercises Involved in Phase III ACL Rehabilitation

Seated Passive-Assisted Knee Extensions

Sit in a chair and place the foot of your nonsurgical leg behind the foot of your surgical leg.
Now gently use the good leg to lift your operated leg as straight as you could while holding your operated leg relaxed.
Return to the starting position.
Do 10 to 20 repetitions, 2 to 3 times a day.

Standing Hip Flexion with Resistance

This is a weight-bearing exercise which is the next step from straight leg raises. Standing hip flexion challenges your single-leg stability on the stationary leg and the strength of your quadriceps and hip flexors of your moving leg.

Tie or loop a resistance band around a secure object like a table leg.
Place one ankle inside the loop and step away until there is slight tension on the band.
Stand upright and stiffen your quadriceps (the front thigh) muscle of the leg in the band, straightening and locking the knee.
Holding your quadriceps stiff, lift the leg in the band slightly and slowly kick forward.
Return to the starting position slowly.
Complete 12 repetitions, switch legs and do 1 to 3 times a day.

Standing Single-Leg Hip Extension with Resistance

Single-leg standing hip extensions challenge the stability of your stationary leg and the strength of the hip extensors of your moving leg.

Tie or loop a resistance band around a secure object like a table leg.
Place one ankle inside the loop and step back until you feel a slight tension on the band.
Stand upright and stiffen your quadriceps (the front thigh) muscle of the leg in the band, straightening and locking the knee.
Holding your quadriceps stiff, lift the leg in the band slightly and slowly kick forward.
Return to the starting point of the exercise slowly.
Complete 12 repetitions, switch legs and do 1 to 3 times a day.

Standing Single-Leg Hip Abduction with Resistance

Standing single-leg hip abduction challenges the stability and hip strength on your stationary leg and the strength of the hip abductors of your moving leg.

Tie or loop a resistance band around a secure object like a table leg.
Place one ankle inside the loop and step to the side until you feel a slight tension on the band.
Now, lift one leg slightly and move it out to the side. Ensure that the knee is kept straight in the band.
Stand upright and avoid leaning your body to the side.
Return to the starting stance slowly.
Complete 12 repetitions, switch legs and do 1 to 3 times a day.

Double-Leg Quarter Squats

Double-leg quarter squats enable a crucial transition to strengthen your hamstrings, quadriceps, and gluteal muscles further and also help to improve weight-bearing movements through the knees.

Stand with your feet shoulder-width apart.
Keep your folded hands in front of your abdomen.
Lower your buttocks down about 6 inches like you are going to sit in a chair.
Keep your trunk upright and limit any forward tilting.
Return back to the standing position.
Keep your weight evenly on both legs. Avoid transferring weight to the nonsurgical leg.
Do 12 repetitions, 2 to 3 times a day.

Double-Leg Heel Raises (Calf Press)

Heel raises enhance calf strength and boosts your ability to walk, jump, and later in your rehabilitation, run.

Stand with your feet shoulder-width apart in front of a table or counter for support.
Rise on your toes and slowly lift your heels using a 2-seconds count. Make sure that your weight is evenly placed on both legs.
Hold this position for a short period and slowly lower for 4 seconds.
Do 2 sets of 12 repetitions 1 time a day.

Single-Leg Heel Raises

This exercise too helps to boost your calf strength and your ability to jump, walk, and even run later in your rehabilitation.

Stand with your feet shoulder-width apart in front of a table for support and your hands held on the table.
Lift and hold the foot of your nonoperative leg off the ground.
Rise to a small degree onto the front of the foot and toes of your operative leg.
Holding your toes on the ground, raise the heel of your operative leg using a 2-second count, and then lower using a 4-second count.
Move straight up and down. Do not tilt forward. Do not use your arms to lift.
Do 12 repetitions, 2 times per day.

Standing Anterior Reach

Standing anterior reach boosts the strength and stability of your stationary or motionless leg.

Stand upright with your hands held just in front of your abdomen.
Bend one knee as you reach the other foot forward as far as you can under control.
Slightly touch your heel down for additional stability.
Return to the standing upright position.
Complete this movement 12 times. Moving slowly improves the benefit.
Switch legs and do 1 to 3 times daily as directed.

Side Step-Ups

This exercise helps to develop strength and stability and is vital for developing base lateral movement skills.

Stand next to a 2- to 6-inch step board.
Place your nearest foot up on the step board.
Now, lift yourself up on that foot, placing your weight through the heel.
Simultaneously, lift your opposite knee in the air to a 90-degree angle.
Slowly return to the starting position, stepping totally off the step board.
Do 12 repetitions, switch legs, and 1 to 2 times a day.

Front Step-Ups

Stand behind a 6-inch step board.
Place one foot onto the step and step up with your weight on the heel.
As you step up, lift your other knee forward and up until your thigh comes to 90 degrees at your hip.
Slowly return to the starting position, stepping totally off the step board.
Do 12 repetitions, switch legs, and 1 to 2 times a day.