08 JUN


By Dean Phelps on Wednesday, 8th of June    Tag: , ACL Reconstruction, Benefits of Exercise, Gait Retraining Tips,

When the physio becomes the patient – what I learnt post ACL reconstruction and meniscal repair.

I’ve been a big believer in when your injured there is always something you can do! Rest is important, but rest doesn’t mean do nothing! So day 1 exercises began.

You can read

Part 1 – ‘OH THE PAIN’ Here

Part 2 – ‘RICE is not just for dinner’ Here

Isometric holds of all the major players from the core, hip to the knee. An isometric hold is a contraction of the muscle without a change in joint angle. There is good evidence that isometric exercise reduces pain, well I haven’t read anything post ACL, not saying it doesn’t exist, I just have not personally come across it in the vast world of research papers. But I thought why not give it a go and see what happens anecdotally. I didn’t feel it directly influenced pain, but indirectly it absolutely did.

Post operatively (even post injury) it is a normal phenomena to experience pain inhibition to surrounding muscles, that leads to a reduction in motor unit recruitment and over time atrophy of the muscles around the injured area.

Continuing this neural drive to the muscle through isometric holds kept all this to a minimum. So when it came to loading the leg in standing, walking ect the muscle could hold the joint! Sounds simple, and it was. I actually attribute this as a one of the components to returning my normal gait pattern very quickly.

It was suprising that at 4 weeks my gait was looking pretty normal and everyone commented on the fact how quick my recovery was. I was quick to say it has just begun and recovery lasts long beyond looking, even feeling normal again if you truly want the best outcome.

Another thing I worked diligently on was regaining knee extension. This is one thing that I think is historically is poorly done due to fear and a need to of protect the graft, don't shear the graft etc etc. Yes you do need to protect it, Yes limit sheering, but if you are smart, do it properly and clinically reason it you can achieve graft protection without being a worry wart.

I am also a big believer that the body is an adaptation machine. But is a double edge sword that works in both directions. Be cautious and over protective, promote mal-adaption. Be smart, load appropriately and with good clinical reasoning and the body will thrive and adapt fantastically.

So what was my exercise routine?

Isometric holds for all hip and knee directions from Day 1

Partial weight bearing from day 1 with a strong focus on a normal gait pattern

Active range of movement exercises of foot and ankle - very important as foot function improves knee forces and loads

Passive range of movement from day 5. Very gentle and within limits of pain, pain monitored during and post. This was both flexion in drop and dangle and extension with graded extension hangs.

Bike protocol from day 10 – beginning with Bananas from high seat position, achieving full rearward revolution 2 days later, then full forward revolution 2 days following that (day 14 post op) with no resistance. For some it takes longer, this is just a guide and what we managed to achieve.

I ditched the crutches at day 18, probably much longer then most and longer then I even I have previously recommend. But now from experience and thinking way too much post op I wasn’t going to walk until I felt my gait pattern was up to the load of my post op ghetto booty that had grown. Plus there is no point reinforcing a poor movement pattern for long periods for the sake of walking unaided, its just harder to break it long term.

These steps worked for me. They could work for other ACL sufferers, but there is a solid understanding and reasoning needed at each step and with guidence of a us here @ Fighting Fit Physio for ACL rehabilitation.

In my next blog I will touch on ‘Does a physio need a physio post ACL reco??’ and expand on an interesting concept.


Dean Phelps - Head Physiotherapy

Dean is a registered Gold Coast Physiotherapist with undergraduate and postgraduate studies in Human Movement and Exercise Science. His background has developed his vision for Fighting Fit Physiotherapy to focus on optimal health and peak physical performance for every single patient. Utilising his many qualifications, in depth knowledge of the body and passion for exercise he can provide a holistic approach to your treatment and exercise prescription to get the best outcome.


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