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舊 2012-07-06, 17:14   #22
Mike
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Rehab and Recovery

What to expect from rehab
Remember, surgery is the easy part. The hard work - and ultimately, your successful return to the slopes - depend on your dedication to rehab.

First of all, find yourself a good physiotherapist who has plenty of experience with ACL rehabilitation. Secondly, make sure you follow your surgeon's protocol and physiotherapist's instructions to the letter. The graft will be fragile at first, and the limitations of early rehab - which rapidly become frustrating as your mobility and strength increase - are specifically designed to protect it.

Make sure you are prepared to be quite immobile for at least a few days after surgery. Rest in the early stages is critical to the healing process. Don't make anything harder than it needs to be.

Physically, the first few days after surgery are the hardest. You'll spend most of this time lying down with your leg elevated; it's important to keep the knee above the heart (this encourages blood to drain out of the knee, reducing swelling) and to ice regularly. A cryocuff (a simple machine that allows you to continuously cool and compress the joint) is an excellent investment that is worth its weight in gold at this stage, as you can fill it with ice and it's good for 6-8 hours. This saves trips to the freezer for additional ice packs. Don't be tempted to put a pillow under the knee when you're resting or sleeping, even though this is the most comfortable position to be in. This encourages the knee to stay in a slightly bent position, which isn't a good idea when you're trying to regain extension (critical to walking with a normal gait, and one of the most important things after ACL surgery). Putting a pillow or prop under the ankle and leaving the knee unsupported allows gravity to encourage it into full extension.

In addition to pain from the surgery sites, something that's often overlooked is the "blood rush." This is where the surgical haematoma rushes down the leg when you go from a sitting to a standing position, and it causes pain in the calf that can be excruciating. It can't be entirely avoided, but moving very slowly to an upright position will help. If the pain seems unusually severe or persistent, don't hesitate to ask your OS or family doctor to take a look. Excessive pain, swelling and redness can all be signs of a DVT, so it's worth taking seriously.

You'll most likely experience lots of other additional aches and pains, and sensations so strange you have no idea how your leg could be producing them. (ACL surgery often involves severing a nerve, which leads to a lot of very unusual sensations as the nerve responds and regenerates.)

Early rehab exercises focus on regaining flex and extension while giving the joint time to heal. Later exercises work on restoring strength, and ultimately preparing for a return to activity. It's a long process, and at times can seem incredibly frustrating. Remember - it's a marathon, not a sprint, and it will be worth it in the end.

The following is an example of a standard ACL rehab protocol. Your individual protocol may vary depending on your surgeon's preferences and the type of graft used in your reconstruction.

Phase I: Pre-Operative Phase
Goals:
a) Restore normal motion of knee
b) Restore normal walking
c) Mentally prepare for surgery

Exercises:
a) Stretching, active assisted range of motion (movement of knee with help), pushing knee into extension (straighten).
b) Muscular strengthening
c) Balance training
d) Other physical therapy activities

Phase II: Immediate Post-Operative (Day 1 - Day 7)
Goals:
a) Reduce and control swelling and pain
b) Restore full passive knee extension (straighten)
c) Bend knee to at least 90 degrees
d) Walking with brace

Exercises:
a) Active movementof knee through partial range of motion
b) Tighten quad muscles with straight knee
c) Straight leg raises
d) Toe calf raises
e) Weight shifting, small squats and lunges
f) Walking

Phase III: Controlled phase (Weeks 2-3)
Goals:
a) Maintain full passive knee extension (fully straightened knee)
b) Progress flex of knee to 115-125 degrees
c) Reduce swelling
d) Improve muscle strength

Exercises:
a) Straighten knee with physical therapist helping pushing it straight
b) Leg press and hamstring curls
c) Toe calf raises and wall squats
d) Lunges (forward and to side)
e) Balance drills, stationary bike, pool program

Phase IV: Intermediate phase (Weeks 3-6)
Goals:
a) Improve leg strength
b) Improve muscle control and endurance
c) Normalize knee movements
d) Perform more functional activities

Exercises:
a) Step-up / step-downs
b) Lunges and squats
c) Leg press and toe calf raises
d) Hip strengthening
e) Balance and endurance training
f) Agility drills in pool

Phase V: (Advanced strengthening phase (Weeks 7-12)
Goals:
a) Maintain motion
b) Protect knee joint and cartilage in knee
c) Maximize leg strengthening
d) Promote more functional activities

Exercises:
a) Step-up / step-down on balance beam
b) Squats on uneven/unstable surfaces
c) Double and single leg jumps
d) Rotation movements at the knee
e) Agility drills with sideways and backward movements

Phase VI: Return to activity phase (Week 10/12 and beyond)
Goals:
a) Gradual return to sport activities
b) Continue muscular strengthening and endurance training

Exercises:
a) Lunges and advanced balance activities
b) Elliptical, cycling and running
c) Returning to skiing and other sports

*Must meet criteria set by physical therapist before returning to sport activities.
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