Department of Physical Medicine and Rehabilitation

Medical School of Brawijaya University

Fast walking
Water aerobics
Swimming (crawl stroke, flutter kick)
Cross-country ski glide machine
Walking on soft-platform treadmill
Trampoline

Squatting
Kneeling
Twisting and pivoting
Repetitive bending (such as stair climbing)
Jogging
Jazzercize
Racquetball
Tennis

Basketball
Swimming (frog or whip kick)
Bicycling
Stair-step machine
Stationary bicycle
Rowing machine
Leg extension weight machine
Power yoga
Preoperative therapy concentrates on reducing the pain
and swelling and attempting full ROM.

Decreasing joint effusion is key to all these goals.
It is done through compression, elevation, cryotherapy
(application of cold), and electrical stimulation.
If all else fails, the knee may be aspirated by syringe.
Inhibiting joint effusion is vital if they are to restore
ROM and inhibit atrophy of the quadriceps muscle.

A six-week rehabilitation program before surgery
allows them to build good quadriceps and hamstring
strength.
If the knee responds well, surgery may not be needed.
Even if surgery is necessary, your postoperative
rehabilitation program will be easier with well-toned
muscles, and your likelihood of full recovery will be
greatly improved.
During the first week after surgery,
Rehabilitation is mostly passive.
The leg may be placed in a continuous passive motion
(CPM) machine for many hours a day to gently
increase its range of motion.
CPM assists patellar mobility and reduces scarring of
the patella.
Regular icing and elevation are used to reduce
swelling.
The goal is full extension (or 10 degrees short of that)
and 70 degrees of flexion by the end of the first week.

By week two
Begin gait training so that they are comfortable with
full weight-bearing and comfortable with crutches.
If strong enough, you can walk without the crutches
but using a brace.
Begin isometric exercises and slowly increase the
ROM.
As soon as the swelling is controlled, use a stationary
bike and can start gluteal strengthening exercises to
stabilize the pelvis.
These exercises include isometric pushes of the leg
against a wall and inner and outer thigh exercises with
a ball.
Balancing on either foot stimulates isometric toning of
the quadriceps and hamstrings and helps reestablish
proprioception (ability to know where your leg is),
which is diminished after an ACL tear.
By week three,
Begin more active quadriceps strengthening with
increased range of motion, using a Thera-Band or a sport
cord on both the uninjured and the injured leg.
The uninjured leg is strengthened to increase pelvic
stability.
Walking in water, running in a pool, and walking
backward on a treadmill are excellent exercises at this
stage.


Nonimpact reciprocal or elliptical trainers can be used
to strengthen your muscles and maintain your aerobic
capacity.
You can use the leg press and balance board and do
hamstring strengthening exercises.

At four to six weeks,
Start using a cross-country ski machine, such as the
Nordic Track.

At about eight weeks,
Focus on the proprioception and coordination by
stepping forward, stepping backward, and balancing
on a slide board.
Add stair climbing on the StairMaster, both forward
and backward.

By the third to fourth month,
Begin running figure eights.
Although the patients are not allowed to participate in
vigorous sports for at least six and preferably nine
months, they can mimic the movements of the sport
they love.
If its tennis, for example, begin to move forward to
back and side to side, with stops and starts.
After four months
Attempt pliometrics (jumping and explosive types of
training).
A functional brace is generally recommended for
sports activity for at least the first year after surgery.
Be warned that a knee without pain is not an
indication that the ACL is completely recovered.
ACLs are not totally healed (the graft isnt fully
mature) until about nine months after surgery.
Many ACLs are reinjured because patients resume
sports activities too soon.

MCL and LCL injuries come in three grades: Grades one
and two are partial tears of varying degrees, while grade
three is a complete tear.
Unless accompanied by other ligament tears, MCL and LCL
injuries are generally treated without surgery.
Lower-grade injuries are milder than higher-grade ones
and require less rehabilitation.
The protocol is similar to that for ACL injury (preoperative
and postoperative), but the time required for healing is
shorterusually only four to six weeksbecause you do
not need to wait for a tendon graft to mature.

PCL tears rarely require surgery but the rehabilitation
protocol is the same as for ACL injuries (preoperative
and postoperative).
The only major difference is that the posterior cruciate
ligament is at maximum stress across the knee when it
is flexed.
Therefore extension exercises are emphasized more
than flexion exercises.
Depending on its severity, a meniscal injury may or
may not require surgery.
When the tear is minor, after the pain and other
symptoms abate, prescribe a course of exercises.
If no surgery is needed, once the swelling has
subsided, move rapidly into resistance exercises.
If surgery is called for, one of two procedures will be
done: suturing of the meniscal tear or, in extreme
injuries, full or partial removal of the meniscus.

One goal of rehabilitation is to protect weight loading
of the knee, especially loading in flexion, until at least
six to eight weeks postoperatively.
CKC exercises are started early, with flexion limited to
70 to 80 degrees.
OKC exercises are avoided until at least six months
after a meniscal repair.
Starting to move as early as possible after surgery is
critical.