This handout is to use as a guideline for your rehabilitation after anterior cruciate reconstruction. You may vary in your ability to do these exercises and to progress from one phase to the other. Please call the doctor if you are having a problem with your knee or if you need clarification of these instructions.
1. Protect the reconstruction – avoid falling
2. Ensure wound healing
3. Attain and maintain full knee extension
4. Gain knee flexion (knee bending) to 90 degrees
5. Decrease knee and leg swelling
6. Promote quadriceps muscle strength
7. Avoid blood pooling in the leg veins
Use the CPM machine at home as much as possible. At least 10 hours per day. You may move the CPM to a sofa, the floor or onto a bed as you change positions and locations. Use the CPM at night while sleeping. Slow the speed at night to facilitate sleeping. Extension (knee straight) on the machine should be set at minus five degrees at all times to help your knee extend. It is very important that you straighten the knee completely! The CPM should be programmed to include an extension pause of 5 seconds (in other words, when the knee is straightened out, it pauses to allow you to stretch it out straight). This flexion setting will start at around 30 – 40 degrees and should be gradually increased to at least 90 degrees as you can tolerate more bending of your knee. When a meniscus repair is done along with the ACL reconstruction, limit knee flexion to 90 °. Continue to use the CPM after surgery until your first post-operative visit. Do not place a pillow under the knee for comfort. This can lead to knee stiffness.
Your knee brace is set to allow your knee to bend and straighten from 0 to 90 degrees. Use it when walking. In some cases, you may be sent home with the brace locked at 0 degrees (fully straight). After you arrive home, and the anesthetic nerve block has worn off, re-set the brace to allow 0 to 90 degrees of motion. For patients with a patellar tendon autograft (from your own knee), put as much weight on your operated leg as possible when walking. You should use the crutches in the beginning, but can discontinue the crutches when you have confidence in the knee to support you. In some cases, crutches and restricted weight bearing may be necessary for longer periods. The doctor or physical therapist will give special instructions in these cases. In cases where hamstring autograft or allograft is used, you will be advised to put partial weight (50%) on your leg with crutches and brace for the first 6 weeks after surgery. In cases where a meniscus repair is done along with the ACL reconstruction, the brace should be locked fully straight when walking for the first 6 weeks after surgery.
If you are experiencing pain, swelling, or discomfort, we suggest icing for 15-20 minutes with
at least a 60-minute break in between. Use your cryocuff or 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.
Remove your bandage on the second morning after surgery but leave the small pieces of white
tape (steri strips) across the incision. You can wrap an elastic bandage (ace) around the knee at
other times to control swelling. You may now shower and get your incision wet, but do not
soak the incision in a bathtub or Jacuzzi until the stitches have been removed.
Take an aspirin each morning, wear an elastic stocking (TED) below the knee, and do at least
10 ankle pump exercises each hour to help prevent phlebitis (blood clots in the veins) until
your first post-operative visit.
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.
Perform exercises without brace. See “Knee Exercises” handout for illustrations.
Days per Week: 7 - Times per Day: 3-4
Quadriceps setting - 1-2 sets of 15-20 reps
Heel prop - 5 minutes
Heel slides with towel assist - 1 set of 5 to 15 minutes
Sitting heel slides - 1 to 2 sets of 15 to 20 reps
Straight leg raises - 1-2 sets of 15-20 reps
Patellar mobilization - 1 set for 1 to 3 minutes
Hip abduction - 3 sets of 10 reps
Ankle pumps - 1 set of 2 to 3 minutes
Prone hang - 5 minutes
• You can start formal physical therapy about 3 to 5 days after the operation.
• You can start PT here at MGH, or we can refer you to a local PT convenient to you.
• We ask that your PT follow our written protocol.
• If your PT has questions, please ask them to call us to discuss them.
1. Protect the reconstruction, avoid falling
2. Ensure wound healing
3. Maintain full knee extension (straighten knee fully)
4. Begin quadriceps muscle strengthening
5. Attain knee flexion of 120 degrees or more
6. Decrease knee and leg swelling
7. Normal gait without crutches
Use the cryocuff or ice bags to decrease swelling for 20 minutes three times a day after each
exercise session.
In cases where the patellar tendon autograft is used, you can begin placing all of your weight
on the operated leg when you walk unless otherwise instructed by your surgeon. Discontinue
using your crutches when you are comfortable doing so. Continue using your brace when
walking outside of the home. Within one or two weeks, you can usually discontinue use of the
crutches if you have good control of the leg and are sure that you will not fall or get injured.
Concentrate walking normally, in a heel-strike to toe-off pattern, without a limp. Occasionally
(every one or two hours) practice standing on your operated leg, with your knee fully straight,
for 10 to 20 seconds.
In cases where hamstring autograft or allograft is used, you will be advised to put partial
weight (50%) on your leg with crutches and brace for the first 6 weeks after surgery.
In cases where a meniscus repair is done along with the ACL reconstruction, the brace should
be locked fully straight when walking for the first 6 weeks after surgery.
Continue using the elastic stockings (TED) for the lower leg and wrapping the knee with an
elastic bandage (ACE) to control swelling.
Days per week: 5-7 - Times per day: 1-2
Utilize a stationary bicycle to move the knee joint and increase knee flexion. If you cannot
pedal all the way around, then keep the foot of your operated leg on the pedal, and pedal back
and forth until your knee will bend far enough to allow a full cycle. Most people are able to
achieve a full cycle revolution backwards first, followed by forward. You may ride the cycle
with no resistance for up to 10-15 minutes, 1 to 2 times a day. Set the seat height so that when
you are sitting on the bicycle seat, your knee is fully extended with the heel resting on the
pedal in the fully bottom position. You should then actually ride the bicycle with your forefoot
resting on the pedal.
Days per week: 3 - Times per day: 1
Aqua-jogger exercise or Flutter kick swimming - 20-30 minutes
Days per Week: 5-7 - Times per Day: 1-2
Quadriceps setting - 1-2 sets of 15-20 reps
Heel prop - 5 minutes
Prone hang - 5 minutes
Heel slides with towel assist - 1 set of 5 to 15 minutes
Straight leg raises - 1-2 sets of 15-20 reps
Standing hamstring curl - 3 sets of 10 reps
Standing toe-raises - 3 sets of 10 reps
Hip abduction - 3 sets of 10 reps
1/3 knee bends - 3 sets of 15 reps
Wall slides - 3 sets of 15 reps
If you did not have a meniscus repair, you can start the Leg Press and Hamstring Curl machine during this
phase under supervision of a physical therapist if you have achieved the following goals:
1. Full passive knee extension
2. Full extension while quadriceps setting
3. Flexion of 125 degrees
4. Minimal swelling
1. Protect the reconstruction; avoid falling
2. Maintain full knee extension
3. Attain full knee flexion
4. Walk with a normal heel-toe gait with no limp
5. Muscle strength and conditioning improvements
The brace is discontinued after you see your surgeon at your 6-week post-operative office visit.
Concentrate on walking with a heel-toe gait without a limp. In some cases, use of the brace
will continue if the knee requires a longer period of protection.
Continue to use the cryocuff for 20 minutes after each workout
Days per week: 3 - Times per day: 1
Quadriceps setting - 1-2 sets of 15-20 reps
Heel prop - 5 minutes
Prone hang - 5 minutes
Heel slides with towel assist - 1 set of 5 to 15 minutes
Straight leg raises - 3 sets of 10 reps
Standing hamstring curl - 3 sets of 10 reps
Standing toe-raises- single leg - 3 sets of 10 reps
Hip abduction - 3 sets of 10 reps
Squat to chair - 3 sets 15 reps
Wall slides - 3 sets of 15 reps
Single leg strengthening progression - see timeline
Days per week: 5-7 - Times per day: 1-2
Hamstring stretch - 3-5 reps holding 15 to 30 seconds
Quadriceps stretch - 3-5 reps holding 15 to 30 seconds
Calf Stretch - 3-5 reps holding 15 to 30 seconds
Days per week: 2-3 - Times per day: 1 - 3 sets of 20 repetitions
The following exercises may be added to your exercise program about 6 weeks after surgery:
Seated Leg Press - Roman Chair
Hamstring Curl - Calf Raise Machine
HIP Abductor/Adductor Machine - Hip Flexor Machine
Days per week: 1-2 - Times per day: 1 - Duration: 20-30 minutes
The following can be performed for conditioning: stationary bicycle, walking, rowing,
elliptical trainer, and water workout
At this time, it is important to begin the development of single-leg strength. Begin to follow
the “Progression for Single Leg Strengthening” included in this packet.
Frequency: 3 times a week - 3 sets of 10-15 repetitions
• Leg Press
• Hamstring Curl
• Wall Slides
• Roman Chair
• Chair Squat
• Calf Raises or Calf Raise machine
• Hip Abductor/Adductor machine
• Hip Flexor machine
• Single leg strengthening progression
• Hamstring, Calf and Quadriceps stretching
• Quadriceps setting 20 repetitions, 3 times a day with heel prop
If you do not have access to gym equipment, the following exercises from Phase 2 can be
substituted using ankle weights (Start with one pound and add one pound a week until 5
pounds): Straight leg raise, Side lying abduction, and Standing hamstring curl
• Avoid pain at the patellar tendon site
• Avoid pain and/or crepitus at the patella
• Build up resistance and repetitions gradually
• Perform exercises slowly avoiding quick direction change and impact loading
• Exercise frequency should be 2 to 3 times a week for strength building
• Be consistent and regular with the exercise schedule
• Warm-up prior to exercising by stationary cycling or other means
• You are “warmed –up” when you have started sweating
• Gently stretch all muscle groups next
• Do exercises involving multiple muscle groups first and individual muscle groups last
• Do aerobic workouts after strength workouts
• Cool-down by stretching after finishing exercise
1. Knee extension weight lifting machine
2. Running
3. Jumping
4. Pivoting or cutting
5. Lunges
6. Stairmaster
7. Step exercises with impact
1. Regain full muscle strength.
2. Work on cardiovascular conditioning.
3. Sports-specific training.
You should continue muscle-strengthening exercises from Phase 2 and 3 on a three times a
week basis. At this time, you can decrease the number of repetitions per set from 15 to 10.
This will allow you to work with more resistance. Remember to do all exercises slowly, with
good form. You may begin to hold dumbbells when doing the chair squat, single-leg 1/3 knee
bends and single-leg wall slides. Weights can be increased when you can do a particular
weight easily, for 3 sets of 10 repetitions, for 3 consecutive workouts. At all times, be cautious
of pain or crunching at the kneecap or patellar tendon while exercising. You may use
resistance machines at your gym, but do not use the knee extension machine and do not do
lunging or high impact drills.
You can use the elliptical trainer, stationary bicycle, rowing machine or swimming workouts to
build cardiovascular fitness. Three to five times per week for 20 to 30 minutes is sufficient for
improvement in this area. Please note that excessive long duration cardiovascular exercise can
retard or delay muscular strength development when strength improvement and gains in
muscle size are the programs’ primary goal.
At this time, light running on a soft level surface with a sports brace can begin if your surgeon
advises. You need to have full range of motion, good strength and no swelling to run safely. If
you run, 3 times per week for 10 minutes is advisable for the first 2 weeks. If there is no pain
or swelling, you can increase your running time by 1 minute per session for a maximum of 30
minutes. Walking and hiking on gentle trails can also be used for conditioning activity.
With the approval of the doctor and physical therapist, you can begin the Jump and Plyometric
Training Progression that is included in this packet.
• To build muscle strength and size, the amount of resistance used must be gradually
increased.
• The exercises should be specific to the target muscles
• The amount of resistance should be measurable and gradually increased over a longer
period of time
• To avoid excess overload and injury, the weight or resistance must be gradually increased
in increments of 5 to 10 %
• Resistance can be increased gradually every 10 to 14 days when following a regular and
consistent program
16
• Adequate rest and muscle recovery between workout is necessary to maximize the benefit
of the exercise
• If the PRE principle is followed too strictly, the weights potentially will go higher and
higher.
• At a certain point, the joints and muscles will become overloaded and injury will occur.
• This eventuality can be avoided by refraining from using excessive weight during strength
training.
Days per week: 2-3 - Times per day: 1 - 3 sets of 10-15 repetitions
• Emphasis is to build muscle strength using BOTH legs
• Progress according to the PRE principle
• Leg Press
• Hamstring Curl
• Wall Slides (hold dumbbells for resistance)
• Roman Chair (strengthens hamstrings)
• Chair Squat (hold dumbbells for resistance)
• Calf Raises or calf raise machine
• Hip Abductor/Adductor machine
• Hip flexor machine
• Single leg strengthening progression
The following exercises can cause injury to the knee and are usually not recommended at this
time:
• Leg extension machine (quadriceps extensions)
• Stairmaster or stair climber machines
• Lunges
• Squats past 90 degrees of knee flexion
• High Impact and plyometric exercises
Continue with the program outlined in phase 4
Continue with the program outlined in phase 4
Refer to Speed and Agility Progression
Refer to Jump and Plyometric Progression
To reach your ultimate goal of returning to sports participation, you must follow an orderly
sequence of drills that are designed to re-train the muscle-to-joint coordination that is necessary
to provide the proper control of your knee. The following time-table illustrates an ideal
progression sequence:
Running slowly - 12-16
Golf - 16-20
Roller blading - 18
Tennis - 20-24
Return to sports practice - 24-32
Full return to sports - 32-36
The sports physical therapists can provide you with specific instructions for each step in the sequence.
You should discuss the timing of return to sports activities and brace use with your surgeon
Quadriceps setting to maintain muscle tone in the thigh muscles and (extend)
straighten the knee. Lie on your back or sit with the knee extended fully straight
as in the figure. Tighten (contract) and hold the front thigh muscle (quadriceps)
making the knee flat and straight. If done correctly, the kneecap will slide slightly
upward toward the thigh muscle. The tightening action of the quadriceps muscles
should make your knee straighten and be pushed flat against the bed or floor.
Hold 5 seconds for each contraction. Do 20 repetitions three times a day. Also
try to do any time your knee is out of CPM.
Patellar Mobilization to prevent scar tissue from binding the kneecap.
With the knee fully straightened, grasp the edges of your kneecap between your
thumb and index finger. Move the kneecap side to side and up and down.
Heel Slides to gain knee flexion. While sitting or lying on your back, actively slide
your heel backward to bend the knee. Keep bending the knee until you feel a stretch
in the front of the knee. Hold this bent position for five seconds and then slowly
relieve the stretch and straighten the knee. While the knee is straight, you may repeat
the quadriceps setting exercise. Continue this exercise until you can fully bend your
knee equal to the unoperated side. Also, as you start to gain flexion, you can assist
your efforts to gain flexion by assisting the heel slide with a towel. For patients who
have had a meniscus repair along with the ACL reconstruction, limit knee flexion to
90° . See illustration. Repeat 20 times, three times a day.
Sitting Heel Slides to regain the bend (flexion of the knee).When sitting in a chair,
slide the heel backward as if trying to get the foot underneath the chair (figure 5).
Hold 5 seconds and slowly relieve the stretch by sliding the foot forward. You can
help with the opposite foot if necessary. For patients who have had a meniscus repair
along with the ACL reconstruction, limit knee flexion to 90° . See illustration.
Repeat 20 times, three times a day.
Heel Prop to straighten (extend) the knee. Lie on your back with a rolled up towel
under your heel or sit in a chair with the heel on a stool as shown. Let the knee relax
into extension (straight). If the knee will not straighten fully, you can place a weight
(2 to 5 pounds) on the thigh, just above the kneecap. Try to hold this position for 5
minutes, three times a day. While maintaining this extended position, practice
quadriceps setting.
Prone Hang to straighten (extend) the knee. Lie face down across your bed so that
the kneecap is just off the edge of the mattress. Let your leg drop down toward the
floor so that your knee straightens fully. If the knee will not fully extend, then attach
a weight around the ankle to help pull the leg down. Use an amount of weight as
described above for the heel prop exercise. Try to hold this position for 5 minutes,
three times a day.
Straight Leg Lift
The quality of the muscle contraction in this exercise is what counts the most, not just the ability to lift the leg!
1. Tighten the quadriceps (quadriceps setting) as much as you can, push the back of the
knee against the floor.
2. Tighten this muscle harder!
3. Lift your heel 4 to6 inches off the floor
4. Tighten the quadriceps harder again.
5. Lower your leg and heel back to the floor.
Keep the quadriceps as tight as possible.
6. Tighten this muscle harder again.
7. Relax and repeat
If the knee bends when you attempt to lift the limb off of the bed, do not do this exercise.
Keep trying to do the quadriceps setting exercise until you can lift the limb without letting the
knee bend.
Hip Abduction
Lie on your unoperated side. Keep the knees fully extended. Raise the
operated limb upward to a 45 degree angle as illustrated. Hold one
second, then lower slowly.
Ankle Pumps to stimulate circulation in the leg.
Move your foot in an up and down motion 30- 40 times a minute.
1/3 Knee Bends
Stand facing a table or desk with the feet about 1 foot apart.
Lean forward at the hips and bend the knees as if starting to
sit down. Lower the hips about 5 or 6 inches, pause 1 to 2
seconds and return to the full upright position.
Wall Slides
Stand upright with your back and buttocks touching a wall. Place the feet about 12 inches
apart and about 8 inches from the wall. Slowly lower your hips by bending the knees and
slide down the wall until the knees are flexed about 45 degrees (illustration). Pause five
seconds and then slowly slide back up to the upright starting position. Do 3 sets of 10 to 15
repetitions.
Hamstring Stretch
Perform this stretch in the position illustrated at the right.
Bend slowly forward at the hips, keeping the knee fully extended until you feel gentle
stretch in the back of your thigh and knee. Hold the stretch for 15 to 20
seconds and repeat 3 to 5 times.
Quadriceps Stretch
This stretch is performed in the position illustrated at the right. Lean gently
Backward as if bringing you heel toward the buttock. When a stretch is felt
in the front of the thigh and knee, hold 15 to 20 seconds for 3 to 5 repetitions.
Calf/Achilles Stretch
In the position illustrated, keep the heel flat on the floor and the knee fully extended.
Lean forward at the hips with the arms supporting your weight. When you feel a
gentle stretch in the back of your calf and knee, hold for 15 to 20 seconds, 3 to 5
repetitions.
Squat to Chair
In the chair squat exercise, you lower your buttocks toward
the chair until your buttocks touch the chair. Do not sit or rest at the chair,
but instead immediately and slowly return to the standing and starting position.
Remember to keep your head over your feet and bend at the waist as you
descend. After the first week, you may hold dumbbells while
performing this exercise. Start with 3 to 5 pounds each hand.
You may add 2 to 3 pounds per week until you reach 10 pounds in each hand.
Standing Hamstring Curl
Stand facing the wall, using the wall for balance and support.
while standing on the unoperated limb bend the knee of the operated side and
raise the heel toward the buttock. Hold this flexed position for one second. Slowly lower the
foot back to the floor. Keep the thighs
aligned as illustrated.
Standing Toe Raises
Stand facing a wall, hands on the wall for support and balance.
keep the knees extended fully. Tighten the quadriceps to hold
the knee fully straight. Raise up on ‘tip-toes’ while maintaining
the knees in full extension. Hold for one second, then lower slowly
to the starting position.
Seated Leg Press
Use an amount of weight that feels easy enough to perform 20
repetitions as the starting weight for this exercise. Use this weight
for the first week before raising the weight. The weight may be
increased by about 5 pounds every 7 to 10 days thereafter, as long
as you can perform 20 repetitions per set for 3 sets. In this exercise,
avoid letting the knees snap or drop suddenly into extension when
reaching the fully straightened position. Avoid starting the exercise
with the knees excessively bent. Do not bend the knee so far that
your calves and back of thighs touch. Adjust the seat position to
limit the excursion of the machine.
Resisted Hamstring Curls
If you have access to a hamstring curl machine (illustration), you
may start using it. As with the leg press, start with a reasonable
weight and use that weight for the first week. You may increase
the weight by 3 to 5 pounds every 10 days as long as you can perform
3 sets of 20 repetitions slowly, with good form. If you do not have
access to a hamstring machine, continue doing the standing hamstring
curl adding an ankle weight for resistance. Start with 3 to 5 pounds and
add 1 pound per week until you build to 10 pounds for 3 sets of
15 repetitions.
Additional Weight Training
Hip Abductor/Adductor Machine
Calf Raise Machine
Roman Chair
Hip Flexor Pulls
Single Leg Strengthening
Step Up- Down Exercise
Place the foot of the operated limb on the stool. Maintain balance, if necessary,
by holding onto the wall or chair (illustration). Standing sideways to the step,
slowly step up onto the stool and slowly straighten the knee using the quadriceps
muscles. Slowly lower the opposite foot to touch the floor. Do not land on the
floor, just touch gently and repeat the step up
Single Leg Wall Slide Exercise
Stand on the single leg with your back and buttocks touching a wall. Place the foot
about 6 inches from the wall. Slowly lower your body by bending the knee and slide
down the wall until the knee is flexed about 45 degree (illustration). Pause five seconds
and then slowly slide back up to the upright starting position. Keep the hips level
and be sure you are using your knee muscles to perform the exercise.
Single Leg Squat Exercise
In the single leg squat exercise, you stand on the single leg and then lower
your buttocks toward the chair. Slowly return to the standing and starting
position. Remember to keep your head over your feet and bend at the
waist as you descend. You do not have to squat all the way to the chair,
instead, try to stay in a comfortable range of motion where there is no
knee pain. As you gain strength, try to do the exercise without holding
on to anything.
Progression for Single Leg Strengthening
These instructions estimate a time period of 10 to 12 weeks for you to progress through the
whole program. This time line will vary for different people and knees. Your ability to
progress through this program may be limited by the presence of other knee problems. It is
recommended that you follow this program as written, step-by-step. The progress of your
strengthening will be evaluated by the physical therapist using these particular drills and the
timeline in the progression.
Step Up-Down Exercise
Start with a step of 3 inches in height.
Start with 3 sets of 5 repetitions
Add one repetition per set, per workout, until you can do 3 sets of 10 about 2 weeks
If pain free, progress to a step of 6 inches in height
Repeat progression starting with 3 sets of 5 repetitions
Add one repetition per set until you can do 3 sets of 10 (about 2 weeks)
If pain free, progress to a step of 9 inches in height (the height of a standard stair) Repeat
process of progression from 3 sets of 5, to 3sets of 10 (about 2 weeks)
At this point, you can begin to add the single leg wall slide exercise. The strength workouts
should be practiced 3 times a week (every other day).
Single Leg Wall Slide
Start with 3 sets of 5 repetitions
Add one repetition per set, per workout, until you can do 3 sets of 10 (about 2 weeks
minimum)
At his point, you can begin to add the single leg squat exercise. The strength workouts should
continue every other day at the most, with more time between workouts if the knee gets sore
after a session.
Single Leg Squat
Start with 3 sets of 5 repetitions
Add one repetition per set, per workout, until you can do 3 sets of 10 (about 2 weeks
minimum).
After working up to the point where you can do 3 sets of ten of all three drills, you can hold
dumbbells to add resistance. Start with 3 pounds in each hand and add 1 to 2 pounds a week
until you reach 10 pounds in each hand. As you get stronger and gain better control of you leg
muscles, try not to hold onto anything for balance. When you return to sports or recreational
activities, you can decrease the strength workouts to 2 times a week and do 1 set of 10 of each
of the three drills only, as a maintenance workout.
Speed and Agility Progression
Goals
1. Safely recondition the knee for the demands of sports activity
2. Provide a logical sequence of progressive drills for pre-sports conditioning
3. Provide objective criteria for safe return to sports
Phases of Training
Straight ahead running phase
Direction change running phase
Unrestricted direction change and impact phase
Prerequisites
Full Range of Motion
Strength at least 80 % of uninjured limb
Thigh girth within ½ inch of unaffected limb
No tenderness at the graft harvest site
Symmetrical quadriceps and hamstring flexibility
Perform and pass functional tests
Obtain clearance from your doctor or physical therapist
Functional Tests
Before starting the running sequence you must be able to:
1. Hop forward on both legs at least 2 feet
2. Hop to either side at least 1 foot
3. Hop up and down on both feet 10 times
4. Jog with no limp for 100 yards
Warm-up, Stretch and Ice
Be sure that you warm-up and stretch before and after workouts. Generally, you should
do some walking, cycling or elliptical so that you break a sweat before starting the
running program. You can then stretch before beginning the running drills. Ice your
knee for 20 minutes following workouts and stretch all muscle groups as you are cooling
down.
Recommended Frequency
2-3 times per week
Criteria to Progress
Do not progress to the next step in the phase until the present step is pain free, and you
can perform with proper technique and without difficulty (muscle soreness or fatigue).
Add only one new step in the progression per workout.
I. Straight Ahead Running (16-20 weeks)
1. Run ½ speed 100 yards, 10 repetitions
2. Run ¾ speed 100 yards, 10 reps
3. Run ½ speed 100 yards, 3 reps; ¾ speed 100 yards, 3 reps; full-speed 50 yards, 4 reps
4. Continue ½ and ¾ speed 100-yard runs, for 3 reps each and add one 50-yard run each
workout until you can do (10) 50-yard full speed runs.
II. Basic Change of Direction Running (20-24 weeks)
Intensity: Progress drills from walking ½ speed ¾ speed full speed
Continue current workout from above (Step 4): Run ½ and ¾ speed 100 yd runs for 3
reps each. Run full speed 50-yard run for 5 reps
Progressively add each step below:
5. Zig-Zag run, round corners, 50 yards, 5 reps
6. Backward run 25 yards to gradual stop, then forward run 25 yards to gradual stop, 5
reps
7. Circle run 20 feet or greater diameter circle, 3 reps to left and 3 reps to right
8. Figure ‘8’ run 20 feet or greater length, 5 reps
9. Carioca 50 yards, 5 reps left, 5 reps right
III. Advanced Speed and Agility Running (24 weeks onward)
Intensity: Progress drill from walking ½ speed ¾ speed full speed
Continue current workout above and progress with below:
10. Run forward to plant-and-cut off of the unoperated limb, ½ speed, 5 reps
11. Run forward to plant-and-cut off of the operated limb, ½ speed, 5 reps
12. Zig-Zag drill with alternate limb plant-and-cut, 6 reps
13. Box drill 20 yards square, 6 reps, alternate sides
14. Shuttle run 50 yards with direction change every 10 yards, 5 reps
15. Agility run, 5 reps, alternate starting sides
Suggested Final Workout Summary:
1. 100-yard run ½ speed, ¾ speed and full speed each distance 2 reps each
2. Zig-Zag run, 6 reps
3. Forward/backward run, 6 reps
4. Circle run, 6 reps
5. Figure ‘8’ runs, 6 reps
6. Carioca, 6 reps each way
7. Shuttle run 50 yards with direction change every 10 yards, 6 reps
8. Box drill 20 yards square, 6 reps, alternate starting side
9. Agility run, 6 reps, alternate starting side
IV: Begin Sports Practice
Agility Drills
Shuttle Run
Box Drill
Agility Drill
Jump and Plyometric Training Progression
Goals
1. Safely condition the knee and lower limb for the demands of jumping and landing
during sports activity
2. Provide a logical sequence of progressive drills for pre-sports conditioning
3. Provide objective criteria for safe progression from training to sports participation
Phases of Training
Double-leg training
Double-leg complex training
Single-leg training
Recommended Frequency
2 times per week
Sequencing
Begin each training session with a warm-up routine. Perform the jumping drills listed in
the appropriate phase of your rehab. Be sure to limit your total contacts (or jumps) to the
suggested amount listed for each training session to prevent injury. Progress within the
phase as you master each exercise, performing each jump with proper technique and
without pain.
Warm-up and Stretch
Generally, you should cycle, jog or use an elliptical trainer, rower or other device for 15
to 20 minutes so that you break a sweat before starting the program. After completing the
jumping drills, cool down by stretching for 15 to 20 minutes.
Criteria to progress
Do not progress to the next step in the phase until the present step is pain free, and you
can perform with proper technique and without difficulty (muscle soreness or fatigue).
Technical Essentials
Each hop or jump should be performed with concentration on good technique. Perform
each jump with a ‘stick’ landing, i.e. you should land and hold your balance momentarily
before proceeding to the next jump. Keep the feet apart and do not let the knees rotate
inward when taking off or landing. Soften the impact by landing on the balls of the feet
and land with some bend in the knees and hips.
Precautions
Do not begin jump/plyometric training without clearance from your doctor and physical
therapist. Jump training places heavy loads on the kneecap, patellar tendon and knee
joint surfaces. Pain at these areas during jumping exercises should be reported to your
physical therapist.
Beginning at Phase 3 (12-16 weeks) Limit 60 foot contacts/session
1. Double Limb (DL) hops on mini-trampoline
2. DL hops on soft surface (carpeted floor, gym floor)
3. DL Jump rope
Suggested Final Workout:
• DL hops on mini-trampoline x 30 repetitions
• DL hops on soft surface x 10 reps
• DL hops with jump rope x 20 reps
Beginning at Phase 4 (16-20 weeks) Limit 90 foot contacts/session
4. DL forward hop, 6-12” distance
5. DL side-to-side hops, 6-12” distance
6. DL broad jumps, 12-18” distance
7. DL broad jump-to-vertical jump
8. Jump rope, alternating single limb (SL) hops
Suggested Final Workout:
• Warm-up with DL jumps on mini-tramp or jump rope x 30 reps
• DL forward hop x 5 reps
• DL side-to-side hops x 5 reps each side
• DL broad jumps x 5 reps
• DL broad jump-to-vertical x 5 reps
• Jump rope, alternate SL hops x 30 reps
Beginning at Phase 5 (20-24 weeks) Limit 120 foot contacts/session
9. 90° DL Jump
10. 180° DL Jump
11. DL broad jump-to-vertical with 90°-180° turn
12. Single limb (SL) hops in place on mini-trampoline
13. Jump rope, double/triple SL hops, alternating feet
14. SL forward hop, 6-12” distance
15. SL side-to-side hops, 6-12” distance
Suggested Final Workout:
• Warm-up with mini-tramp or jump rope with DL SL hops x 30-60 reps
• DL forward hops (x 5 reps) and side-to-side hops (x 5 reps each direction)
• 90° to 180° DL Jumps x 5 reps each
• DL broad jump-to-vertical with 90° to 180° turn x 5 reps each
• SL forward hops (x 5 reps) and side-to-side hops (x 5 reps each direction)
During this phase, drills can be advanced with exercises jumping over cones/hurdles and
use of an agility ladder.
