Physical Therapy

Treatment Plan

Injury Overview
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 Joe Biden is a 17-year-old athlete who participates in various sports such as football,
basketball, baseball, and track. Recently, Joe tore his ACL (anterior cruciate ligament) during his
latest football game. A tear in your ACL results in about 9 months to fully recover. Common
problems to be resolved include loss of motion, weak quadriceps, stiffness, swelling, and pain.
Tearing your ACL results in the inability to walk without crutches for 1-2 weeks after surgery
and 4-8 weeks to regain full use of your knee.
Since an ACL tear is a very common injury in athletes, I have decided to develop a lesson
plan overviewing the therapy and rehabilitation a patient would undergo from the time of the
injury, to walking without crutches. Normally, this therapy would institute a much larger range
of therapy, exercises, and milestones that the patient would experience in their recovery,
however, I am going to be concentrating a smaller portion of the treatment process.

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Initial Report

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Preparation for Surgery:
Goals:
Control pain and swelling
Reinstate original range of motion
Restore ample muscle strength for daily life
Mentally prepare for surgery

Before entering surgery, it is important for the patient to reduce the common symptoms of an
ACL tear. Doing so can help prevent symptoms such as pain and stiffness from becoming worse
after surgery. Also, developing this strength and motion may help prevent arthrofibrosis if you
have surgery too soon.
Arthrofibrosis occurs when there is a buildup of scar tissue around a joint. This condition is
common after surgery and even more common in knee injuries. Arthrofibrosis can be detrimental
to the patient’s recovery as it greatly inhibits range of motion and increases pain.
To reduce the swelling, the patient should apply ice or an Aircast knee Cryocuff (if available) for
about 20 minutes, 2-3 times a day. Also, taking an over-the-counter anti-inflammatory
medication, such as Ibuprofen, Advil, Motrin, Aleve, or Tylenol will help control inflammation
and pain in the injury. Take these medications in 2-tablet amounts twice a day for 7-10 days
following the injury.
You should attempt to achieve full range of motion as quickly as possible. Quadriceps isometrics
exercises, straight leg raises, and range of motion exercises should be started immediately.

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 Pre-Surgery Therapy

Self-Administered Therapy and Pain Management:

Applied ice and/or the provided Aircast knee Cryocuff machine to anterior cruciate
ligament for 20 minutes, 2-3 times a day
Took over-the-counter anti-inflammatory medication

Recommended Pain and Swelling Management:

Continue to apply ice or Aircast knee Cryocuff
Continue to take two 200 mg Ibuprofen tablets as needed

Recommended Range of Motion Exercises:

Begin to strengthen and prepare knee for surgery through range of motion exercises
Instructed extension exercises:
o Passive knee extension – lie face down on table with legs hanging off table until
maximum extension achieved; 3-4 times a day for 15 minutes
o Heel Props – place heel on rolled towel to lift thigh off table; gently rest leg into
extension; 3-4 times a day for 15 minutes
Instructed flexion exercises:
o Heel slides – Lie flat on back and pull heel towards butt to maximize extension;
hold for 5 seconds, repeat 3 times with rest between reps; 3-4 times a day
o Wall slides – Lie on back and put injured leg foot against wall, slide it down the
wall, applying some pressure with other leg; 3-4 times a day for 15 minutes

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Patient Take Home

At-home Therapy:
Notes:
Ice or Cryocuff 2-3 times per day; 20 minutes
Exercises:
1. Passive knee extension; 3-4 times a day; 15 minutes
2. Heel props; 3-4 times a day; 15 minutes
3. Heel slides; 3-4 times a day; repeat 3 times; hold 5 seconds
4. Wall slides; 3-4 times a day; 15 minutes

Passive Knee Extension

Heel Props

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 Wall Slides Heel Slides

Post-Surgery Days 1-7

During Therapy:
Worked with patient and discussed treatment plan
Plan to meet days 1, 3, 5, 7 for checkup and manual therapy
Discussed simple at home pain and swelling management and range of motion exercises
Performed manual therapy on and around anterior cruciate ligament – help break down
swelling and scar tissue
Discussed limited use of hamstring muscles

Recommended at Home Pain and Swelling Management:

Continue to apply ice or Aircast knee Cryocuff 4-5 times a day for 20 minutes
Rest with leg elevated
o Change foot position often to prevent increased swelling
Take prescribed medication as directed on bottle label
May move around more as pain and swelling decrease

Recommended at Home Range of Motion Exercises:

Every 2-3 hours, begin passive knee stretch for 10-15 minutes

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 Being passive flexion exercise
o Sit on table edge and let leg bend from gravity; may use other leg to prevent too
much flexion; 4-6 times per day for 10 minutes
Use prescribe CPM machine (Continuous passive motion)
Start between 0-45 degrees; 6-8 hours per day; 2 weeks
o Increase as tolerated until 90 degrees is reached
Begin quadricep isometric contractions on day 2-3; 3 sets of 10, 3 times a day
o Rest rolled towel under extended knee, contract quad raising heel off ground; hold
for 6 seconds
Begin straight leg raises (SLR) on day 3-4; 3 sets of 10, 3 times a day
o Perform quad contraction in full leg extension; lift leg 45-60 degrees; hold for 6
seconds; gently lower leg back to the ground; relax muscles then repeat
o Perform with knee immobilizer on
May begin walking with one crutch on day 7
Patient Take Home

At-Home Therapy:
Notes:
Ice or cryocuff 4-5 times per day; 20 minutes each time
Avoid performing exercises is pain is too intense
Walk with only one crutch on day 7 if able
Remove knee immobilizer 4 to 6 times a day; 10-15 minutes each time
Exercises:
1. Passive flexion exercise; 4-6 times a day; 10 minutes each time
2. CPM machine; 6-8 hours per day; start 0-45 degrees, reach 90 degrees as tolerated
3. Quadricep isometric contractions on day 2-3; 3 sets 10 reps, 3 times per day
4. Straight leg raises (SLR) on day 3-4; 3 sets 10 reps; 3 times per day

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 Passive knee flexion Straight leg raises/Isometric Contractions

Post-Surgery Days 8-14

During Therapy:
Discussed progress and pain
Discussed more intense strengthening and range of motion exercises
Discussed over-the-counter anti-inflammatory drugs upon completion of prescribed drugs
Applied manual therapy to and around anterior cruciate ligament
Planned to meet days 8, 10, 12, and 14

Recommended at Home Exercises

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 Continue passive and active extension, passive and active flexion, quadriceps isometrics,
and straight leg raise
Begin partial squats; 3 sets of 10; 1 time per day
o Place feet shoulder width and slightly externally rotated
o Use table for stability, gently lower buttocks backward and downward into a squat
position; hold for 6 seconds and repeat
Begin toe raises; 3 sets of 10; 1 time per day
o Gently raise heel off floor and balance with balls of feet; hold for 6 seconds, relax
o May use table for assistance in balance
Informed patient of stationary bike use once at 100 degrees of flexion
o When pedal is at bottom, should be a slight bend in knee; adjust seat accordingly
o Slowly increase time of each session, starting at 5 minutes
o No – low resistance; maintain good posture
May begin walking without use of crutches on day 14

Patient Take Home

At-Home Therapy:
Notes:
Continue previous stretching and strengthening exercises
Continue icing knee
May walk without crutches on day 14 if able
Exercises:
1. Begin partial squats; 3 sets of 10; 1 time per day; hold 6 seconds
2. Begin toe raises; 3 sets of 10; 1 time per day; hold 6 seconds
3. If 100 degrees of flexion reached – stationary bike for 5 minutes, work up to 25 minutes

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Partial Squat Toe Raises

Stationary Bike

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2 Week Report

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