INERTIA: A Therapist's Thoughts

With the patient now three weeks removed from ACL reconstruction, we are continuing to see steady progress.  During this appointment, the patient reports the knee feeling a little warm and still a bit sore.  Both are not unusual complaints at this point as some effusion or joint swelling is still present from surgery. Looking at the knee, we see the incision is healing well, swelling is minimal and there are no signs of active infection. OK to proceed. 

After a brief bike warm-up, a few manual therapy techniques are used to work the scar and to mobilize the kneecap. I then do a few range of motion exercises for knee flexion and extension. A new measurement is taken and we record further progress: The patient's knee flexion has increased to 135 degrees. The patient's knee extension or straightening has also increased so that now there is actually about 2 degrees of hyperextension. Most people have at least a degree or two of hyperextension with some having as much as 10 degrees.  So this finding is completely normal. 

The same exercises performed at the last session were again repeated with progression of either increased weights or repetitions.  The patient progressed with balance exercises to include the use of resistive bands to provide additional challenge.  In addition to these progressions, we added both forward step ups on a 6" step and side step downs on a 2" step.  Both the step ups and step downs are excellent functional exercises as they closely relate to the task of climbing and descending stairs and work on quad strength and hip control, both important concepts in ACL rehab.