Return to Practice Progression 120 -150 days
a. Gym and PT (see table 2)
b. Pool and Swimming progression 1 hour Including Aqua jogging with
Buoyancy vest (table 1)
c. Continuation of Bike 1hr/day with progression of time, load and speed
d. Stairmaster, Elliptical to enhance cross training diversity.
e. PEP program to start as a 15 -20 minute warm up 3x /week to all field
training, all elements (See ACL Prevention Program)
f. Run and Sprint Box progressions on field or court. Start at 15 minutes.
Box at 10 yards lengthening to 40 yards. You must be able to sprint box
both ways by 120 days. Once you are at full speed on the box drill,
then you may begin to return to practice as outlined below. You must
continue box on daily basis even though you transition back into
practice!
g. Practice criteria and on field progressions non-contact drills only
during practice x 28 days
h. Practice May play criteria on field progressions contact drills only
during practice x 28 days once safely and effectively passed non-contact
drills
II. Return to Play/Practice/Compete Progression 150-180 days
a. Gym and PT ( see table 2)
b. Pool and Swimming progression 1 hour Including Aqua jogging with
Buoyancy vest (table 1)
c. Continuation of Bike 1hr/day with progression of time, load and speed
d. Stairmaster, Elliptical to enhance cross training diversity.
e. PEP program (See ACL Prevention) to start as a 15 -20 minute warm up
3x /week to all field training, all elements
f. Run and Sprint Box progressions on field or court. Start at 15 minutes.
Box at 10 yards lengthening to 40 yards. You must continue box on
daily basis even though move into practice!
i. Continue on field progressions contact drills only during practice
x 28 days. Once you have safely and effectively passed contact
drills then you are ready for competition progression, can
progressively start games 15 minutes, 20, 25, 30. Up to 90 minutes
by 180 days. Full release when one can play 90 minutes with
comfort.
3 L's of ACL Injury Prevention on the field:
1) Soft Landing following jumps at all times.
2) Stay Low while running at all times.
3) Keep your knees in Line with your feet at all times.
Table 2 – In Physical Therapy REHABILITATION PROTOCOL
Massotherapy:
• Draining massotherapy of knee and calf
• Decontracting Massotherapy of the quadriceps and ITB
• Decontracting Massotherapy of the hamstrings muscles starting from week 2-3 (patients treated
with autografts, paying attention to the harvesting area), or starting from week 1 (patients treated
with allografts).
ROM exercises and joint mobilization:
• Passive mobilization of the patella
• Manual and self assisted passive mobilization in order to improve flex-extension
• Posterior chain stretch on the wall
• Active mobilization using a stationary bike (improving ROM as much as possible) or sliding the
heel on the wall or following an imaginary path while lying on the bed
Stretching:
• Hamstrings
• Triceps surae
• Quadriceps (when a 130° flexion is reached)
• Ilio-psoas
• Tensor fasciae latae
• Postures for the posterior muscular chain
Strength recovery:
• Electrostimulation (even with co-contractions)
• Quadriceps/hamstrings co-contrazctions
• Hip Flexors, adductors, abductors and extensors with weights and tubing
• Soleus with tubing
• Knee flexors starting from week 4-5 (patients treated with ST-G grafts) or from week 3 (patients
treated with PT grafts)
• Closed Kinetic Chain exercises:
o Leg press with elastic resistance from week 2-3
o Leg press with weights, wall slide, step-up from week 4-5
• Open Kinetic Chain exercises:
o Last 30° knee extension (VMO) performed with natural weight from week 2-3, then using
weights (from proximal to distal position)
o Leg extension ROM 90-40° from week 5
• High velocity isokinetic training (limited ROM ) from week 6
• Full weight-bearing exercises:
o Plantar flexion of the foot with full weight bearing in eccentric-concentric mode
o Knee movement control exercises (varus-valgus) lateral step-up like
o Strengthening exercises for trunk and deep abdominal muscles (core stability)
o Eccentric control exercises with natural weight bearing using differents motor patterns
Proprioception:
• Walking using a correct gait cycle
• Exercises with proprioceptive board without weight bearing (bi and monopodalic) progressively
increasing weight in stand position
• Bipodalic and Monopodalic stops on bouncer
• Proprioceptive paths
• Proprioceptive exercises for trunk muscles (core stability)
Sport specific and skill exercises:
• Running and skipping on bouncer
• Bipodalic and monopodalic jumps on elastic leg press (plyometric exercises)
• Aerobic training: stationary bike, stepper, cross trainer, running on treadmill at slow speed
• Sport spcific exercises using equipment specific to sport of desired return
Rehabilitation
Criteria to Advance to Phase IV
Regularly completing isotonic strengthening program in supervised physical therapy
Starting to transition strengthening activities to local gym or athletic team’s weight room
Approximately 70-80% strength vs. contralateral (uninvolved) lower extremity
Demonstrates appropriate control of knee with neuromuscular retraining exercises in the physical therapy clinic
Rehabilitation
Phase IV- Advanced Functional Activities (10 weeks- 6 months)
The primary goal of the fourth phase of rehabilitation is to prepare the athlete for return to sport. Running, cutting, and jumping are near universal requirements of the sports in which athletes most often tear their ACL’s.
be cognizant of other tasks which are important parts of the sport to which the athlete hopes to return
&ladder drills or other simulated running tasks, then advance to interval jogging.
Once 70-80% of their pre-injury speed, cutting drills begin.
&Land based jumping, jumping up to a box and/or completing all plyometrics activities by landing on two legs
