At about four weeks removed from surgery, this patient presented as doing and feeling fairly well. At this point, regular daily tasks return to normal for the most part. The patient is walking normally and is feeling less overall soreness and discomfort. The patient presented today with completely normal range of motion in the surgically repaired knee.
Knee flexion increased to 145 degrees and extension increased to 5 degrees. We will no longer focus on range of motion during treatment but rather check it quickly each week to make sure that normal motion is maintained.
As far as exercises and strengthening goes, the next month or so is kind of the doledrums of ACL rehab. I say that because the type of exercises don't really change much but rather are progressed in weights/repetitions (reps) and patients get eager to do more. It is my job to vary things just enough to keep the patient sufficiently challenged and interested.
The goal for the next two months is gaining muscle strength and mass. To that end, with each workout, the goal is to fatigue the quadriceps primarily and the hamstrings to a lesser degree. The overload principle is applied with strength exercises where each exercise should be done at an intensity (weight/reps) that induces fatigue. Ideally the number of reps should be three sets of 8-10 reps and the weight adjusted accordingly to achieve that number of reps. This will result in the greatest strength gains.
The patient is given instructions to continue with the prescribed exercises two additional times beyond the therapy session each week with a rest day in between workouts.
Below is a list of strength exercises performed by the patient during this visit:
- Double leg press 9pl 2x10
- Two up, one down leg press 7pl 2x10 (eccentrics)
- Single leg press 6pl 3x10 (involved leg)
- Steamboats for balance x 20 reps each direction
- Lateral step downs 4" 3x10
- Forward step ups 12" 3x10
Hamstring strengthening for this patient is still avoided because of the surgical procedure to attempt to harvest a hamstring tendon graft. Hamstring strengthening will begin in two weeks.
In general this patient is progressing very well and certainly faster than some. Each patient progresses at his or her own rate so what is shown here may be somewhat different for another patient depending on a number of factors.
In coming posts, I may fast forward a few weeks because what I described above does not change much in activities and exercises. Looking forward, our goals are to light impact at weeks eight and nine and interval jogging possibly as early as week 10.