Knee Exercises for ACL Tear Without Surgery
So you’ve injured your knee and you would really like to avoid surgery.
Follow along as I take you through various exercises from the acute phase to return to sport and function for some exercises to try.
This program is certainly not intended as a one size fits all approach and not every exercise may feel good or be appropriate for you. If any of the following exercises are causing pain that is more than 3/10 on a pain scale for you, alternate exercises need to be explored.
For best results, consider booking an appointment here with one of our top Toronto Physiotherapists for some hands on care and a tailored exercise program to suit your individual needs!
Now let’s dive into knee exercises for ACL tears without surgery. If you’ve injured your MCL or LCL, these exercises can also work for you.
Acute Phase Exercises ~0-2 weeks post injury:
1— First priority - get the inflammation under control!!!
Here’s what’s important:
Gentle movement of the knee
Compression when weight bearing for extended periods (tensor bandage or tensor sleeve)
Elevation
Ice can be helpful in controlling inflammation in the first 24-48 hours, but there is increasing caution about overusing ice, as it may interfere with the natural healing process after that.
2— Next up - get it moving using gentle active range of motion within pain-free ranges.
Start in a tall sitting position with your legs out in front of you on the floor. Straighten (extend) your leg as far down as it will go. Now, slide your heel up towards your bum bending your knee (into flexion) as far as you can. At the end of that range of motion, you can GENTLY use a towel or your hands to try and bring the leg in a bit closer.
With both end ranges it is ok to push into slight discomfort, but it shouldn’t be painful. If you try a set of 10 of this movement, you will notice the knee start to gradually warm up & end ranges will increase a bit as you get through the set, without having to force it there.
Try and repeat 3 sets of 10. The sets may be better spaced out throughout the day in the very beginning, but there’s nothing stopping you from doing all 3 sets of 10 at once if you feel fine.
3— When the initial injury occurs and there is some swelling around the knee, the quadriceps which is the muscle found on the front of your thigh and other muscles surrounding the knee tend to shut down (become inhibited) and not fire as well as they should to protect the knee from further injury.
Quads activation seems like such a simple exercise to start with, but it’s very important to ensure that it’s firing properly, before moving on to other more advanced exercises. Start by simply trying to contract the muscles on the front of the thigh.
There is a cool neurological phenomenon that happens between the right and left side of our body. If you contract a muscle on one side of the body, it helps your brain figure out how to contract the same muscle on the opposite side.
So if your brain is having a hard time communicating with your quad to get it to fire, try the contraction on the uninjured side - bodies are cool!
Once you can get the quad firing properly and can see activation happening on the inside and outside just above the knee, place a rolled up towel under the knee and work on straightening the lower leg and raising it up towards the ceiling.
This exercise ensures the quad is firing in the end ranges of ext. Once you can get the leg completely straight and hold the contraction for 5 seconds, you can work on raising the straight leg up towards the ceiling from the hip.
4— Stretching of calf and hamstring often feel quite good - hold for 30 sec and repeat 3 times for each.
5— Gait retraining with or without aid. What this means: walking but trying your best to not compensate, or move “weirdly” because of the injury. Try your best to walk as typically as you can. Slow and steady wins the race here.
Subacute phase: Weeks 2-4 post injury:
We need to continue to work on mobility of the knee as we need to regain full extension (leg in straightened position) and functional flexion (~140 deg of a bend) of the knee. This is also where you can start to strengthen the leg and glutes.
1— Gentle biking on a stationary bike - start with just working on the bottom half of the revolution (half moon) in the bottom half of the circle if you can’t get your leg all the way around. Work your way up to a full revolution
2— Chair squats - stand in front of a chair or a bench so you have something to aim your butt towards! Think about shifting the weight into the back half of your foot and pretend as if someone is karate chopping you at the waist. Instead of lowering yourself straight down to the floor, think about aiming your hips back in a hinge position and sitting back as far as you can in the chair. Allow your trunk to hinge forward into a V as you do this. When you stand up, think about distributing your weight between both feet and then driving up with the weight in your heels. This particular form of squat will really emphasize the firing of the muscles on the back of your leg - glutes and hamstrings specifically
3— Wall squats - start with your back against the wall and walk your legs out in front of you. Start with ~ 45 deg bend in your knees and work your way down to 90 deg. You can also then eventually lift one leg for more of a challenge but keep your hips level. Hold each rep for 30-60 sec minutes and repeat a few times.
4— Bridging - double leg, work to marching then single leg. Keep your hips level (don’t let them drop to one side) and don’t lift up to high that your back goes into hyperextension. Try 3 sets of 10 of double leg then work up to that on each leg!
5— Clamshells - keep your top hip rolled forward and in order to keep it there you will only be able to lift your leg up a bit (otherwise your hips will roll back and you’ve gone to far). You should feel this in your upper hip (glutes) where i’m pointing in the picture.
6— Single leg balance - work up to different surfaces and eyes closed. Try to miminize your weight shift to each side (stay up tall). Think about doing up a zipper on a coat to help engage your core. Hold for 10 sec and repeat 5 times per side. Play around with different surfaces around your house for a balance challenge.
7— Monster walk - sit in a chair squat keeping your weight in the back half of your feet and then walk sideways 10 steps staying in your squat position. Repeat 10 steps in the alternate direction then repeat 3 times in total.If you’re feeling it more in your quad, you need to shift your weight a bit backwards.
8— Start Step ups/downs on a short step - think about driving through your heel on your step up and keep the weight in your heel as you step down. Be aware that your knee is tracking forwards and not collapsing inwards.
9— More Stretching!
Weeks 4-6 weeks post injury:
Strengthening
1— Squat clocks - sit back in your chair squat position and then tap one leg out and back to various points of a clock. Try and keep your stance leg and body stacked and don’t let them lean or shift. It’s simply your leg traveling out then back to start position to 3, 4, 5, and 6 o’clock then 6-9 o’clock on the other leg. Try 3x10/side and you should really feel the burn in your upper glutes!! If you’re feeling it more in your quad, you need to shift your weight a bit backwards.
2— Bridge walkouts and bridge on unstable surface like a roller - start in a bridge position then walk your feet out and back in keeping your hips level. You can also put an unstable surface like a roller under your feet and simply bridge up and down to increase the balance challenge. This can be progressed to rolling out and back in on the roller.
3— Sidelying leg lifts and small hip circles - start stacked on your side with your knees bent. Extend the top leg straight and place it slightly behind your body while keeping your top hip rolled forward. Start by lifting your leg up a bit then back to the starting position. For the circles, keep the leg extended behind the body but just parallel to it. Point your foot and draw small circles in both directions. You can try 2-3 sets of 10 with all of the above exercises.
4— Single leg romanian dead lift - no weights. Keep knee slightly bent then tip forward in an airplane position before returning upright. You have to keep both hips pointing forward the entire time - don’t let them rotate up towards the ceiling. You should feel this in your upper glutes and hamstring of your stance leg. Try 3 sets of 10/side.
5— Start bosu work or on a balance board
6—Stationary lunge - Spread legs out one in front and one behind and sink straight down. Try and get both knees as close to 90 degrees as you can as long as it’s not painful. Return to start position and repeat 2-3 sets of 10 on each side.
7— Step ups, step downs (increase height and perform as above)
8— Banded monster walk - Same cues as above but just using a band to increase the glute work! Reminder to always keep your feet hip distance apart and don’t let them come together to maintain constant tension and work for the glutes. Try 3x10/direction.
9— Modified Side Plank with Clamshell - Start in a side plank from your knees and lift your hips forward in line then up towards the ceiling. You should be able to draw a line between your head to your knees. Perform a clamshell with the top leg while holding the modified side plank position. This move gets both your core and glutes firing!! Try 3 sets of 10/side.
These exercises are just an example of many exercises that can be incredibly helpful in your rehabilitation journey with your knee.
If you’re keen to learn more or to get clarification on any of the exercises above, book in with one of our talented physiotherapists at our Toronto clinic here.
We are centrally located in the Annex neighbourhood of Toronto and very accessible to TTC!
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