Effective ACL Rehabilitation with Fitter

January 01, 2004

by Cindy Merrick M.S.P.T. and Lisa Lehman, S.P.T.

Active participation in an effective rehabilitation program following and ACL reconstruction is crucial to the functional outcome of the lower extremity. Treatment protocols must be specifically designed for patients based upon their pre- and post-operative state. A successful rehabilitation program helps the patient achieve full motion, early weight bearing, appropriate patellar tracking and strength gains of the VMO and posterior knee musculature. Improving coordination, agility, balance and endurance will also aid in the return to full participation in pain-free activities.

This article presents a Fitter rehabilitation protocol specifically designed for the patient following ACL reconstruction. This program, based on recent research and clinical experiences, is designed to incorporate techniques for ROM and strength while preserving the stability of the knee joint.

Use of the Fitter can easily accommodate the needs of a post surgical ACL individual. By adjusting the tension, one can vary the required muscle contraction. The tension ranges from 0 (passive) to 4 (maximum resistance).

This variable becomes significant during the progressive states of the rehabilitation program. Passive, isometric and isotonic exercises can all be performed on the Fitter.

All major muscle groups surrounding the knee can be strengthened with the Fitter. It provides unique techniques to actively strengthen the posterior musculature of the knee, important in preventing anterior excursion of the tibia. By emphasizing closed kinematic chain activities, the Fitter also places a functional stress on the lower extremity in ways similar to weight-bearing activities. Thus, the Fitter provides inherent joint stability and a strenuous workout without the sheering forces seen in most open chain activities. By carefully selecting proper foot position while exercising, the Fitter can also emphasize appropriate patellar tracking by recognizing the VMO and lateral stabilizers.

It is, however, the clinician’s responsibility to recognize the signs and symptoms of an exercise inappropriate for a specific individual. The chart below progressively outlines several ACL rehabilitation exercises using the Fitter.

Effective ACL Rehabilitation with Fitter

Developed by Cindy Merrick and Lisa Lehman of Therapy in Motion in conjunction with the University of Oklahoma

     Phase 1
Days 1-7
Phase 2
Weeks 2-3
Phase 3
Weeks 4-5
Phase 4
Weeks 6-12
Phase 5
Mos. 3-4

1. Heel Slides

 

Sit in chair. Place uninvolved foot on platform with involved foot resting on top. The uninvolved leg performs the active movement passively taking the involved leg through the available ROM

Rationale: restore ROM, prevent adhesions

 

 

Tension:
0

ROM:
0-90

Time: 
5-10 
mins

Tension: 0

ROM:
5 -110

Time:
5-10 mins

     

2. Wall Leg Press

 

Sit on platform. Place feet on wall with knees bent at 20. Push into the wall with the feet maintaining the bent knee position.

Rationale: increase gastrocnemius & soleus strength, promote poster knee stability, improve venus return & decrease edema.

 

Tension: 2-3

Reps: 
10-20

Sets:
3-4

Tension: 2-3

Reps 
15-25

Sets: 
3-4

Single Leg Tension: 4

Reps:
10-20

Sets: 
3-4

Single Leg Tension: 4

Reps:
15-25

Sets:
4-5

Single Leg Tension: 4

Reps:
15-25

Sets:
3-4

Hold each rep 5-10 seconds, Keep knee bent at 30°

3. Quad/ Hamstring Co-Contractions

 

Sit on platform, placing uninvolved leg on edge. Lift involved leg six inches and hold. Slowly push into Fitter with uninvolved lower extremity, holding involved lower extremity in air.

Rationale: co-activates quads & hamstrings, increases hip flexor stability, provides sensory motor input from uninvolved leg contractions.

 

Tension: 2-3

Reps:
10-20

Sets: 3-4

Tension: 2-3

Reps:
15-25

Sets: 3-4

     
Keep knee bent at 30°

4. Hamstring Strengthening

 

Sit in chair. Place foot on far edge of platform. Bend knee in attempt to pull foot to chair.

Rationale: increase hamstring strength, improve posterior stability of knee.

 

Tension: 4

Isometrics ROM: 0-90

Tension: 1-2

Reps: 10

Sets: 3

ROM: 0-105

Tension: 2

Reps: 10-15

Sets: 3-5

ROM: 0-120

Tension: 2-3

Reps: 15

Sets: 3-5

ROM: 0-130

Tension: 3

Reps: 15

Sets: 3-5

 

5. Reverse Action Hamstrings

 

Sit on platform with edge of seat placed on far edge of Fitter. Pull buttocks to feet.

Rationale: increase hamstring strength, contract hamstring in reverse action.

   

Double Leg Tension: 1-2

Reps: 10

Sets: 3-4

Single Leg Tension: 1-2

Reps: 10

Sets: 3-4

Single Leg Tension: 2-3

Reps: 10

Sets: 3-4

Increase Tension

Increase Reps

Increase Sets

6. Quad Strengthening

 

Sit on chair placing foot on platform. Press foot into Fitter to straighten the leg.

Rationale: increase quad strength, can promote appropriate patellar tracking and provide close kinematic chain rehabilitation.

 

Tension: 4

Isometrics ROM: 90-49

Tension: 1-2

Reps: 10

Sets: 3

ROM: 90-30

Tension: 2

Reps: 10

Sets: 3-4

ROM: 90-20

Tension: 2-3

Reps: 15

Sets: 3-5

ROM: 90-10

Tension: 3-4

Reps: 15

Sets: 3-5

ROM: 90-0

Increase Benison

Increase Reps

Increase Sets

7. Sitting Leg Press

 

Sit on platform with feet placed on edge of Fitter. Straighten legs to move platform away from the Fitter.

Rationale: increase quad strength, provide close kinematic chain rehabilitation.

   

Double Leg Tension: 2-3

Reps: 10

Sets: 3-4

ROM: 90-30

Single Leg Tension: 20-3

Reps: 10-12

Sets: 3-5

ROM: 90-20

Single Leg Tension: 3-4

Reps: 12-15

Sets: 3-5

ROM: 90-10

Increase Tension

Increase Reps

Increase Sets

ROM: 0-10

8. Hip Extension

 

Stand on edge with back towards platform, weight on uninvolved leg. Bend involved knee & place bottom of foot on edge of platform (could be performed with involved leg as weight bearing pillow).

Rationale: increase glutea strength, provides co-contraction efforts.

   

Tension:
1

Reps:
10

Sets:
3-4

ROM:
90-30

Tension:
2-3

Reps:
10-12

Sets:
3-4

ROM:
90-20

Tension:
3-4

Reps:
12-15

Sets:
3-5

ROM:
90-10

Increase Tension

Increase Reps

Increase Sets

ROM:
90-0

9 & 10. Hip Adduction/ Abduction

 

Stand with uninvolved leg on end of Fitter. Place involved foot between foot plates and pull involved leg towards body.

Rationale: increase adductor/abductor strength, initiate VMO strengthening.

 

Tension:
1

Reps:
10-20

Sets:
3

Tension:
1/2-3

Reps:
10-22

Sets:
3-4

     

11. Single Leg Mini-Squats

 

Stand with involved leg on platform and uninvolved leg off to side. Slowly flex involved leg and hold at 30°.

Rationale: increase eccentric quad strength, provide closed kinematic, chain rehabilitation.

     

Tension:
4

Reps:
8-10

Sets:
3-4

Use poles

Tension:
4

No poles

Add handheld dumbbell weights

Tension:
4

Increase Weights

Increase Reps

Increase Sets

12. Step Ups/Downs

 

Slowly step up and down from platform. Secure platform stability by setting tension at 4. Stepping may be in lateral & forward fashion.

Rationale: provides eccentric quad strengthening.

     

Emphasize step downs

Use poles & uninvolved leg to push up

Tension:
4

Reps: 10

Sets: 3-5

Step up & down

No poles

Add hand weights

Tension:
4

Reps:
1-12

Sets:
3-5

Increase Weights

Increase Reps

Increase Sets

13. Balance Activity

 

Stand on platform with weight on involved extremity, poles in each hand. Maintain balance as long as possible. Progress to balancing with eyes closed, balancing while foot in plate, balancing without poles.

Rationale: improve proprioceptive input

   

Tension:
4

Use poles

Eyes open

Tension:
4

Use poles

Eyes closed

Tension:
4

Use poles

Eyes open

Foot in plate

Tension:
4

Use poles

Eyes closed

Foot in plate

14. Runner’s Lunge

 

Assume runner’s start position with hands on floor. Place involved foot against platform and press back into platform to achieve contraction of heop extensors, hamstrings, quads & calf muscles.

Rationale: increase strength of major leg muscles, improve endurance.

   

Tension:
1-2

Reps:
10-15

Sets:
3-4

ROM:
90-40

Tension:
2-3

Reps:
10-15

Sets:
3-4

ROM:
90-30

Tension:
3-4

Reps:
10-15

Sets:
3-4

ROM:
90-10

Increase tension

Increase reps

Increase sets

ROM:
90-0

15. Lateral Shifts

 

Place feet in footpads. Perform small side-to-side movements using poles for stability. Progress by increasing ROM and not using poles.

Rationale: improve balance & motor coordination.

       

Use poles

Short range Tension:
2-3

Reps:
10-15

Sets:
3-5

Full range Tension
3-4

Reps:
15-25

Sets:
3-5

16. Front to Back Shifts

 

Stand on platform. Face the end with uninvolved foot in front of involved foot. Slowly move platform in a front to back fashion. Keep knees bent, use poles for support, progress to positioning feet side-by-side or with involved foot in front.

Rationale: improve balance, proprioception, coordination& weight shifts.

     

Use poles

Foot in back

Tension:
1-2

Reps:
15-20

Sets:
3-5

Use poles

Side by side

Tension:
3

Reps:
15-20

Sets:
3-5

Use poles

Foot in front

Tension:
3-4

Reps:
20-30

Sets:
3-5


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