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KNEE CONDITIONING THERAPY CHECKLIST

POST-OPERATIVE PROGRAM ACL RECONSTRUCTION


Depending on the nature of surgery and the discretion of your physician, weight-bearing status will change. Usually begin with partial weight bearing and progress to weight bearing as tolerated. Bracing will be at the physician's discretion.

0-2 WEEKS
SECTION I: RANGE OF MOTION EXERCISES Days per week: 7 Times per day: 3-4 In order for you to regain adequate range of motion, we have devised the following exercises for you to do. All of these exercises are to be done slowly. Extension/Flexion - 1 set x 20-30 repetitions For this type of passive seated extension/flexion, find a table that you can hang your legs over; your legs will hang at approximately 90 degrees while you are seated. Then, take your uninjured lower leg, place it underneath your operated lower leg, and lift up as high as you can go for extension. Hold at the top of that range of motion for 3-5 seconds. Release and allow the legs to hang at approximately a 90-degree position. Next, do what is called passive flexion, which requires taking the uninjured lower leg, placing it over the top of the operated lower leg, and pushing the operated leg back as far as you can go under the table or desk. Again, when you reach that maximum paint, hold for 3-5 seconds. This is done without your brace. Quad Sets Plus Straight Leg Raises - 1-2 sets x 15-20 reps Seated on the bed or floor, with the legs straight, bend the uninjured leg, and straighten the operated leg. Begin this exercise by first contracting or tightening the top of the thigh muscles, followed by a lift off the floor or bed of 2-3 inches. Hold this lift for approximately 3 seconds; then lower the leg to the start position. Relax the leg before beginning the next repetition. To help straighten the knee, place a towel under the heel (operated side) to allow gravity assist in straightening. We also suggest using leg and gluteal muscles to pull the back of the knee down. Next, wrap a towel around the ball of the foot, relax the ankle, and pull to stretch the calf muscles. Hold each straightening exercise for one minute and the calf stretch for 30 seconds. Do 45 repetitions. This is done without your brace. 1/3 Knee Bends (without cord) - 3 sets x 10-30 repetitions

This exercise is performed while standing, with the feet shoulder width apart, and the hands on the hips. Begin with the knees slightly flexed and bend approximately 3-4 inches. This exercise should be done slowly at a cadence of one second down and one second back up. For the first few days put more of your body weight on the uninjured leg. Your goal is to achieve equal distribution of body weight on each leg. Be sure to do both legs. This is done with your brace. Toe and Heel Raises - 3 sets x 20-30 repetitions Following the one-third knee bends with both legs, you can perform toe and heel raises. While in a standing position, rock up on your toes and back on your heels. This will provide some range of motion as well as stretching. This is done with your brace. SECTION 2: ICE Days per week: 7 Times per day: 3-4 If you are experiencing pain, swelling, or discomfort, we suggest icing for 15-20 minutes, with at least a 60 minute break in between. Place ice in a zip lock bag, and/or in a towel and apply to the injured area. Never place ice directly on the skin. SECTION 3: BODY LINES STRENGTHENING (Do all exercises slowly) Days per week: 5 Times per day: 1 If you are wearing a post-operative brace, perform the exercises with the brace on. 1/3 Knee Bends (both legs) - 3 sets x 30-50 repetitions For this exercise, we suggest beginning with the knees slightly bent, approximately 1-2 inches. Make sure to stand on the cord with your feet shoulder width apart. Draw the handles up to waist level and hold. This procedure loads the muscles surrounding the knee joint. Starting from that slightly flexed position, bend 4-5 inches, one second down and one-second back up. Keep your head up and your back straight. Seated Hamstrings (Carpet Drags) - 3 sets x 10-20 repetitions Sit, facing the door jamb. Place the Body Lines ankle strap around your lower leg. Attach the Body Lines to the ankle strap hook. It is best to sit toward the front of the chair so that, as you place your toe into the carpet and lift your heel, you have a better angle of pull. This exercise requires you to pull back as far as you can go in a very slow fashion. Lift the foot up and return it to the start position. Always remember, the toe remains on the carpet throughout the full range of motion as you are doing this exercise.

Seated Leg Press (Gas Pedals) - 3 sets x 15-30 repetitions You are seated during this exercise, with the handle of the Body Lines placed on the ball of the foot. This is a leg press, so have your leg high enough so that you press and push out against the handle. Do not do a leg extension type exercise. Do this exercise under good control. As you bring the leg back, make sure that the knee comes toward the chest. Repeat. On every 5th repetition, hold the leg press position for 15-30 seconds. This holding allows the quadricep muscle to contract isometrically during that time frame. SECTION 4: STATIONARY CYCLING (Uninjured only) Days per week: 5-7 Times per day: 1-2 This exercise requires using the uninjured leg only, while the injured leg is placed on a chair or stool. The purposes of single leg cycling are to promote blood flow to the injured limb and to create a neural "crossover" effect from the uninjured leg to the injured leg. Generally, the time frame is anywhere from 10-15 minutes. SECTION 5: FREE/MACHINE WEIGHTS Days per week: 3 Times per day: 1 Upper Body/Trunk Only We suggest that you do not use any lower extremity free or machine weights. If you are doing free or machine weights for the upper body and trunk, we suggest a very light resistance of 3 sets of 15-20 repetitions. Do not place yourself in a compromising position with your recently operated knee.

2 - 6 WEEKS
SECTION 1: RANGE OF MOTION EXERCISES Days per week: 7 Times per day: 3-4 Extension/Flexion - 1 set x 20-30 repetitions For this type of passive seated extension flexion, find a table that you can hang your legs over; your legs will hang at approximately 90 degrees while you are seated. Then, take your uninjured lower leg, place it underneath your operated lower leg, and lift up as high as you can go for extension. Hold at the top of that range of motion for 3-5 seconds. Release and allow the legs to hang at approximately a 90degree position. Next, do what is called passive flexion, which requires taking the uninjured lower leg, placing it over the top of the operated lower leg, and pushing the operated leg back a far as you can go under the table or desk. Again, when you reach that maximum point, hold for 3-5 seconds. This is done without your brace. Quad Sets Plus Straight Leg Raises - 1-2 sets x 15-20 reps 3

Seated on the bed or floor, with the legs straight, bend the uninjured leg, and straighten the operated leg. Begin this exercise by first contracting or tightening the top of the thigh muscles, followed by a lift off the floor or bed of 2-3 inches. Hold this lift for approximately 3 seconds; then lower the leg to the start position. Relax the leg before beginning the next repetition. To help straighten the knee, place a towel under the heel (operated side) to allow gravity assist in straightening. We also suggest using leg and gluteal muscles to pull the back of the knee down. Next, wrap a towel around the ball of the foot, relax the ankle, and pull to stretch the calf muscles. Hold each straightening exercise for one minute and the calf stretch for 30 seconds. Do 45 repetitions. This is done without your brace. One-third Knee Bends (without cord) sets x 10-30 repetitions This exercise is performed while standing, with the feet shoulder width apart1 and the hands on the hips. Begin with the knees slightly flexed and bend approximately 3-4 inches. This exercise should be done slowly at a cadence of one second down and one second back up. Be sure to do both legs. This is done with your brace. SECTION 2: ICE Days per week: 7 Times per day: 3-4 If you are experiencing pain, swelling1 or discomfort, we suggest icing for 15-20 minutes, with at least a 60 minute break in between. Place ice in a zip lock bag, and/or in a towel and apply to the injured area. Never place ice directly on the skin. SECTION 3: BODY LINES STRENGTHENING (Do all exercises slowly) Days per week: 5 Times per day: 1 1/3 Knee Bends (both legs) - 3 sets x 30-50 repetitions For this exercise, we suggest beginning with the knees slightly bent, approximately 1-2 inches. Make sure to stand in the cord with your feet shoulder width apart. Draw the handles up to waist level and hold. This procedure loads the muscles surrounding the knee joint. Starting from that slightly flexed position, bend 4-5 inches, one second down and one second back up. Keep your head up and your back straight. Seated Hamstrings (Carpet Drags) - 3 sets x 10-20 repetitions Sit, facing the door jamb. Place the Body Lines ankle strap around your lower leg. Attach the Body Lines to the ankle strap hook. It is best to sit toward the front of the chair so that, as you place your toe into the carpet and lift your heel, you have a better angle of pull. This exercise requires you to pull back as 4

far as you can go in a very slow fashion. Lift the foot up and return it to the start position. Always remember, the toe remains on the carpet throughout the full range of motion as you are doing this exercise. Seated Leg Press (Gas Pedals) - 3 sets x 15-30 repetitions You are seated during this exercise, with the handle of the Body Lines placed on the ball of the foot. This is a leg press, so have your leg high enough so that you press and push out against the handle. Do not do a leg extension type exercise. Do this exercise under good control. As you bring the leg back, make sure that the knee comes toward the chest. Repeat. SECTION 4: STATIONARY CYCLING Days per week: 5 Times per day: 1 At this time, you can begin stationary cycling with both legs and the brace off, using a spin or light resistance mode. We suggest that you set the seat height higher than normal so that it is easier to complete the cycling motion. As the cycling becomes easier, you can adjust the seat height to your normal level. Begin very slowly; as the knee feels stronger and more comfortable, increase the rpms with a spin or light resistance mode. Start with approximately 15 minutes; your goal will be to achieve 30-45 minutes of cycling. SECTION 5: WATER WORKOUT Days per week: 3 Times per day: 1 Another excellent way of being able to perform some type of activity, and at the same time keep range of motion and work the cardiovascular system, is to use the aquajogger exercise program. It is essential to find a pool that is deep enough so that the feet do not touch the bottom. This exercise is totally non-weight bearing and will allow for a very low impact type of movement sequence. We suggest between 20 and 30 minutes of actual jogging in the water per session. This is done without your brace. SECTION 6: FREE/MACHINE WEIGHTS Days per week: 3 Times per day: 1 Upper Body/Trunk Only We suggest that you do not use any lower extremity free or machine weights. If you are doing free or machine weights for the upper body and trunk, we suggest a very light resistance of 3 sets of 15-20 repetitions. Do not place yourself in a compromising position with your recently operated knee.

6 - 12 WEEKS
SECTION I: RANGE OF MOTION EXERCISES Days per week: 7 Times per day: 3 5

Extension/Flexion - 1 set x 20-30 repetitions For this type of passive seated extension/flexion, find a table that you can hang your legs over; your legs will hang at approximately 90 degrees while you are seated. Then, take your uninjured lower leg, place it underneath your operated lower leg, and lift up as high as you can go for extension. Hold at the top of that range of motion for 3-5 seconds. Release and allow the legs to hang at approximately a 90 degree position. Next, do what is called passive flexion, which requires taking the uninjured lower leg, placing it over the top of the operated lower leg, and pushing the operated leg back as far as you can go under the table or desk. Again, when you reach that maximum point, hold for 3-5 seconds. This is done without your brace. SECTION 2:ICE As necessary SECTION 3: STRETCHING Days per week: 7 Times per day: 1 Hamstrings - 3-5 reps; old each 10-15 seconds This stretch can be performed while seated on the floor, with the legs straight. Sit up straight, with your hands on the floor on either side of you. Keep your back straight, exhale as you bend forward, and allow the hands to follow the floor near the legs. When you reach a point where you feel that you can no longer stretch without pain, hold for 10-15 seconds. This stretch concentrates on the back of the thighs. Ouadriceps - 3-5 reps; hold each 10-15 seconds This stretch is called a "stork" stretch. In a standing position, place your right hand on a chair or table top, keeping your right foot on the ground next to it. Lift the left leg behind you; simultaneously grab the left foot with the left hand and attempt to pull the heel of the left foot to the buttocks (if you cannot reach your foot, grasp your sock). Stretch slowly until you reach an endpoint, then hold for 10-15 seconds. This stretch will work the front of the thighs. Repeat with the right leg. Calf/Achilles Tendon - 3-5 reps; hold each 10-15 seconds An easy way to address these muscle groups is by standing facing a wall. Place both hands against the wall in a straight-on position. Next, place the right foot behind the left foot in a stride position. Keeping the right leg straight, bend the left knee and gradually bend the arms as if you were doing a push-up toward the wall. Once you feel that you have reached the endpoint on your calf and achilles stretch, stop and hold for 10-15 seconds. Return to the start position and commence with the next repetition. Repeat with the right leg.

SECTION 4: BODY LINES STRENGTHENING (Do all exercises slowly) Days per week: 3 Times per day: 1 You must still wear your brace for all Body Lines exercises. This program simulates resistance training on an every other day basis. 1/3 Knee Bends (Single Leg) - 3 Sets x 15-30 repetitions A single knee bend is half of a double. Everything remains the same, except now you need a chair or stool on which to place a hand. With the right hand on top of the chair, while standing on the left leg, place the right leg behind you in a "stork" position. It is important to maintain good technique, with your head up and your back straight. Do this exercise slowly. Place the Body Lines in your left hand and stand on the cord about 12-16 inches from the end. Draw the cord up to waist level; begin the exercise. You are flexed at about one inch; your goal is to reach 4-5 inches of the 1/3 knee bend. When beginning, do not expect to achieve your full range of motion. Again, use the one second down and one second back time ratio. The final goal is to reach one set of 3 minutes nonstop on your operated leg. Seated Hamstring (Carpet Drags) - 3 sets x 10-20 repetitions Sit, facing the door jamb. Place the Body Lines ankle strap around your lower leg. Attach the Body Lines to the ankle strap hook. It is best to sit toward the front of the chair so that, as you place your toe into the carpet and lift your heel, you have a better angle of pull. The exercise requires you to pull back as far as you can go in a very slow fashion. Lift the foot up and return it to the start position. Always remember, the toe remains on the carpet throughout the full range of motion as you are doing this exercise. Forward/Backward-Walk/Jog - 10 minutes (1 min. intervals) This exercise can be added once the knee is on the way to recovery. This exercise is performed slowly, while in a slightly flexed position. Do one minute forward; turn around and do one minute backward. Repeat until you have reached a total of 10 minutes. As you are walking, remember to absorb and be quiet with your feet. This will place less impact and force on the knee joint. By the eighth week, you can begin jogging against the Body Lines. Prior to jogging, it is very important that you are walking comfortably with a balanced gait. *NOTE: For Sections 5-7, select one or more activities to meet your time schedule. A 4-5 day program is recommended. SECTION 5: CYCLING Days per week: 3-4 Times per day: 1 7

At this time, you can use either a stationary bike or begin using an outdoor bike. If you are using a stationary bike, you can leave the brace off, but if you venture outdoors, it is important that you wear your brace. When biking, it is important that you stay on the flats and remain on the seat. Your goal is approximately 30-45 minutes duration with progressive resistance. SECTION 6: WATER WORKOUT Days per week: 2 Times per day: 1 You can use either the aquajogger exercise and/or swimming at this point. If you choose to swim, use only the freestyle stroke with the flutter kick. If you do not have a strong flutter kick, we recommend using small fins; this will level your body for less drag in the water. Not just swimming, but also using a kick board can assist you in working the muscles surrounding the knee joint. Your goal is 20-30 minutes. This is done without your brace. SECTION 7: STAIR STEPPER (Stair Master, etc.) Days per week: 2 Times per day: 1 You may remove your brace while using the stair stepper or stair master. This exercise should be added only when the knee begins to feel like it can hold an adequate load. Begin slowly with light or easy resistance, under complete control and using a short stepping motion with no hyperextension. We suggest beginning with 5-10 minutes of exercise and slowly progressing to 20-30 minutes. Allow the knee to tell you how it feels. SECTION 8: FREE/MACHINE WEIGHTS Days per week: 3 Times per day: 1 Upper Body/Trunk Only We suggest that you do not use any lower extremity free or machine weights. If you are doing free or machine weights for the upper body and trunk, we suggest a very light resistance of 3 sets of 10-15 repetitions. Do not place yourself in a compromising position with your recently operated knee. SECTION 9: ADDITIONAL ACTIVITIES (These new activities last for a maximum of 20-30 minutes. obviously, the amount of time will be dictated by the activity selected. These activities are done with the brace.) Walking We suggest walking as much as you feel comfortable, but make sure that you have a proper gait. Rowing

You can ease into this activity by not extending fully or going beyond 90 degrees when you bring your knees toward your chest. Begin slowly so that the rowing motion can be performed smoothly and with no discomfort. Begin with 5 minutes of exercise and slowly progress to 10-15 minutes. BEGIN THE NEXT EXERCISES AT 8-10 WEEKS Hiking We suggest uphill walking and/or hiking only. Select your trails so that they are easy to maneuver, and when descending try to serpentine or move back and forth on the trail so that you do not have constant pressure on the front of the knee. Nordic Track The nordic track is another piece of equipment that you can use with no hyperextension. Begin very slowly. Start with 5 minutes and gradually increase to 10-15 minutes. Slide Board This particular exercise is similar to skating. It has a low impact result. Start slowly and gradually increase your time frame. You might want to start out with 3-5 minutes and slowly increase to 10-15 minutes.

12 - 16 WEEKS
SECTION 1: RANGE OF MOTION EXERCISES As necessary SECTION 2: ICE As necessary SECTION 3: STRETCHING Days per week: 7 Times per day: 1-2 Hamstrings - 3-5 reps; hold each 10-15 seconds This stretch can be performed while seated on the floor1 with the legs straight. Sit up straight, with your hands on the floor on either side of you. Keep your back straight, exhale as you bend forward, and allow the hands to follow the floor near the legs. When you reach a point where you feel that you can no longer stretch without pain, hold for 10-15 seconds. This stretch concentrates on the back of the thighs. Ouadriceps - 3-5 reps; hold each 10-15 seconds 9

This stretch is called a "stork" stretch. In a standing position, place your right hand on a chair or table top, keeping your right foot on the ground next to it. Lift the left leg behind you; simultaneously grab the left foot with the left hand and attempt to pull the heel of the left foot to the buttocks. Stretch slowly until you reach an endpoint, then hold for 10-15 seconds. This stretch will work the front of the thighs. Repeat with the right leg. Calf/Achilles Tendon - 3-5 reps; hold each 10-15 seconds An easy way to address these muscle groups is by standing facing a wall. Place both hands against the wall in a straight-on position. Next, place the right foot behind the left foot in a stride position. Keeping the right leg straight, bend the left knee and gradually bend the arms as if you were doing a push-up toward the wall. Once you feel that you have reached the endpoint on your calf and achillies stretch, stop and hold for 10-15 seconds. Return to the start position and commence with the next repetition. Repeat with the right leg. SECTION 4: BODY LINES STRENGTHENING (Do all exercises slowly) Days per week: 3 Times per day: 1 1/3 Knee Bends (single Leg) - 3 Sets x 1-2 minutes A single knee bend is half of a double. Everything remains the same, except now you need a chair or stool on which to place a hand. With the right hand on top of the chair, while standing on the left leg, place the right leg behind you in a "stork" position. It is important to maintain good technique, with your head up and your back straight. Do this exercise slowly. Place the Body Lines in your left hand and stand on the cord about 12-16 inches from the end. Draw the cord up to waist level; begin the exercise. You are flexed at about one inch; your goal is to reach 4-5 inches of the 1/3 knee bend. Again, use the one second down and one second back up time ratio. Forward/Backward-Jogging - 10 minutes (with 1 min intervals) This exercise can be added once the knee is on the way to recovery. This exercise is performed slowly, while in a slightly flexed position. Do one minute forward, then turn around and do one minute backward; repeat until you have reached a total of 10 minutes. As you are jogging, remember to absorb and be quiet with your feet. This will place less impact and strain on the knee joint. Side-to-Side (Lateral Agility) - 2 sets x 30-50 repetitions This exercise begins by attaching the Body Lines in the door at approximately waist level. Place the aerobic belt through both handles and around your waist. Step away from the door until you feel the cord is taut and you are sideways to

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the door. Begin by placing a marker in front of the foot nearest the door; this will be a reference point for every repetition that you do. Start in a ready position, with the knees bent and your arms out in front of you. Out and back is one repetition. Always think of one foot being in the air at all times. Think of this exercise as being an ankle-to-ankle movement, which involves the leg closest to the door doing most of the work. To do the exercise on the opposite leg, turn in the belt and face the opposite direction so that your other side is facing the door. This exercise is excellent for balance, agility, and a power movement. *Note: Begin to prepare for a functional Body Lines test when you return to see us. The test will consist of 1/3 knee bends, doing one set of 3 minutes non-stop. You will also be tested on the side-to-side movement, with one set of 50 repetitions. Finally, you will be asked to forward/backward jog for a total of 10 minutes, switching at one-minute intervals. *NOTE: For Sections 5-7, select one or more activities to meet your time schedule. A 3-4 day program is recommended. SECTION 5: CYCLING Days per week: 3 Times per day: 1 You can use either a stationary or outdoor bike. If you are using a stationary bike, you can leave the brace off, but if you venture outdoors, it is important that you wear your brace. When biking, it is important that you stay on the flats and remain on the seat. Your goal is approximately 30-45 minutes duration with progressive resistance. SECTION 6: WATER WORKOUT Days per week: 1-2 Times per day: 1 You can use either the aquajogger exercise and/or swimming. If you choose to swim, use only the freestyle stroke with the flutter kick. If you do not have a strong flutter kick, we rec6mmend using small fins; this will level your body for less drag in the water. Your goal is 20-30 minutes. SECTION 7: STAIR STEPPER (Stair Master, etc.) Days per week: 1-2 Times per day: 1 At this point of your rehabilitation, you should be performing this exercise in a normal manner. Continue to progressively increase your intensity, and use a 20-30 minute basis for your workout program. SECTION 8: FREE/MACHINE WEIGHTS Days per week: 3 Times per day: 1 Upper Extremity 11

If you are doing free or machine weights for the upper body and trunk, we suggest a very light resistance of 3 sets of 10-15 repetitions. Do not place yourself in a compromising position with your recently operated knee. Lower Extremity You can begin doing lower extremity resistance training exercises with your brace on. We suggest 3 sets of 20-30 repetitions. The exercises we suggest are: Seated Leg Press/Hip Sled Hamstring Curls Calf Raises Abduct ion/Adduction We do not suggest doing any lunges or leg extensions. Another good exercise to add at this point in your program would be balance squats. Balance squats are an excellent exercise to develop muscle function for the lower extremity. By completing 3 sets of 10-20 repetitions, balance squats will increase your muscle strength and endurance. SECTION 9: ADDITIONAL ACTIVITIES You may now increase the time frame from 20 to 45 minutes, depending on your activity selection. These activities include: hiking, rowing, walking, nordic track, and slide board. A new activity could. be walking stadium stairs or steps. This form of exercise is an excellent strength builder, but be careful when you descend the steps. The front part of the knee can become irritated. We suggest that you do the stadium steps only once or twice per week. These activities are done with the brace.

16 - 20 WEEKS
Wear your brace for any rotating, cutting, start-stop types of activities/sports. If you begin lifting heavier loads, wear your brace. When in doubt, consult with your physician or physical therapist/trainer. SECTION 1: RANGE OF MOTION EXERCISES As necessary SECTION 2: ICE As necessary SECTION 3: STRETCHING Daily

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SECTION 4: COMPLETE FUNCTIONAL BODY LINES TEST 1/3 Knee Bends (Single Leg): 1 set x 3 minutes Side-to-side (Lateral agility): 1 set x 50 repetitions Forward/Backward Jog: 10 minutes (1 min. intervals) SECTION 5: BODY LINES STRENGTHENING Days per week: 3 Times per day: 1 1/3 Knee Bends (Single Leg) - 3 Sets x 1-2 minutes A single knee bend is half of a double. Everything remains the same, except now you need a chair or stool on which to place a hand. With the right hand on top of the chair, while standing on the left leg, place the right leg behind you in a "stork" position. It is important to maintain good technique, with your head up and your back straight. Do this exercise slowly. Place the Body Lines in your left hand and stand on the cord about 12-16 inches from the end. Draw the cord up to waist level; begin the exercise. You are flexed at about one inch; your goal is to reach 4-5 inches of the 1/3 knee bend. When beginning, do not expect to achieve your full range of motion. Again, use the one second down and one-second back time ratio. The final goal is to reach one set of 3 minutes nonstop on your operated leg. Side-to-Side (Lateral Agility) - 2 sets x 30-50 repetitions This exercise begins by attaching the Body Lines in the door at approximately waist level. Place the aerobic belt through both handles and around your waist. Step away from the door until you feel the cord is taut and you are sideways to the door. Begin by placing a marker in front of the foot nearest the door; this will be a reference point for every repetition that you do. Start in a ready position, with the knees bent and your arms out in front of you. Out and back is one repetition. Always think of one foot being in the air at all times. Think of this exercise as being an ankle-to-ankle movement, which involves the leg closest to the door doing most of the work. To do the exercise on the opposite leg, turn in the belt and face the opposite direction so that your other side is facing the door. This exercise is excellent for balance, agility, and a power movement. SECTION 6: ACTIVITIES Days per week: 3-4 Times per day: 1 Cycling You can begin cycling hills and also coming off your seat.

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Swimming Continue to increase intensity. Stair Stepper (Stair Master, etc.) Continue to increase intensity. SECTION 7: FREE/MACHINE WEIGHTS Days per week: 3 Times per day: 1 The brace should still be worn when you are doing your lower extremity activities. You may add 1/4 squats with a bar of 3 sets x 20-30 repetitions. Progressively increase your resistance, as it is comfortable for you. Step-Ups (Box or Bench) Begin your step-ups by using body weight only. Start with 3 sets x 20-30 repetitions. When you have accomplished this, begin to hold light weights, such as 5 or 10 pounds. SECTION 8: ADDITIONAL ACTIVITIES At this point you can increase your additional activity time from 20 up to 60 minutes, depending on activity selection. This includes: hiking, rowing, walking, nordic track, and slide board. 18 WEEKS Roller Blading We suggest roller blading on a flat surface with no hills. Begin slowly and progressively increase your speed. Stadium Stairs/Steps You may begin to use a jog going up stairs or steps, but walk down them. Introduction into Jogging Make sure that you have excellent shoes and look for soft terrain. We do not suggest that you jog on any surface or terrain with potholes where you might twist your knee. Early into the jogging, we suggest that you wear your brace. It is best to begin with a walk/jog. For example: walk approximately 200 yards, then jog 200 yards, etc., gradually increasing the amount of jogging. Do not start sprinting until you are running comfortably. Usually, sprinting will be the last form of your running motion that you will work on. Introduction into Golf 14

Begin your golf program with chipping and putting only. Once you have accomplished the short game, you can move to your irons and then to your woods. The key is making sure the knee is ready for the torque placed on it with the full golf swing.

20 - 24 WEEKS
SECTION 1: ICE As necessary SECTION 2: STRETCHING Daily SECTION 3: COMPLETE FUNCTIONAL BODY LINES TEST SECTION 4: BODY LINES STRENGTHENING Days per week: 2 Times per day: 1 1/3 Knee Bends (Single Leg) 2 sets x 2 minutes Side-to-Side (Lateral Agility) 2 sets x 50 repetitions SECTION 5: CONTINUE FREE/MACHINE WEIGHTS Begin parallels squatting and decrease the number of repetitions, while increasing the amount of weight lifted. With your resistance program, your goal should be 3 sets of 15-20 repetitions. SECTION 6: ACTIVITIES You may now exercise 20-60 minutes, depending upon your activity selection, such as: walking, hiking, stair stepper (stair master), cycling, swimming, jogging, roller blading, slide board, rowing, and stadium stairs. Introduction into Racquet Sports We suggest that you keep your brace on when beginning to play any type of racquet sports. For beginning tennis, start with ground strokes, and make sure they are easy to hit without unnecessary weight transfer or cutting. Following ground strokes, you may start volleying at the net. It is not necessary to engage in games or competition; this may place your knee in a sudden rotating or twisting motion. Again, begin every racquet sport under good control. Skill Drills

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We suggest you see the video to understand a little more about these drills. The intensity should start at about 50% of regular speed; progressively increase that speed as the knee feels comfortable in performing these exercises. Cariocas, box drills, and forward-backward drills can be a part of analyzing your return to sport. As you can see, the drills require some type of forward and backward movement, cutting or angulation, and proper technique.

6 MONTHS
Increase Racquet Sports Skills Introduction into Skiing Begin skiing only on well-groomed runs. It may be a good idea to ski only half days. Once you have accomplished this, you may gradually increase to a full day of skiing. Athletic Skill Drills In addition to the athletic skill drills mentioned between the 20th and 24th weeks, we suggest that you add 45 degree cuts, giradelli's, and start/stop drills. It would be a good idea to watch the video to familiarize yourself with these drills. 6 - 9 MONTHS We suggest that you discuss return to sport with your physician, as well as your physical therapist/athletic trainer. They will be able to give you insight into any activities you wish to perform. Some are: intro into baseball, football, basketball, soccer, volleyball, water skiing, and wind surfing.

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