Exercise Regressions and Progressions for ACL Post-Rehab

I think key elements in ACL post-rehab (after being cleared from the medical professional) would include exercise regressions/progressions and loading. Individuals are generally advised to engage in strength training approximately 6-8 months after surgery (Augustsson, 2013). I believe that regressions are an important component at such a point. If, for example, I wanted to work on a knee dominant pattern leading to power based exercise, I would likely begin with:

 

Stability/Strength

Hip Bridges (bilateral)

Hip Bridges (torso elevated + weight)

Hip Bridges (single leg)

Hip Bridges (single leg + torso elevated + weight)

Narrow half-Kneeling (pad below knee)

Narrow Half-Kneeling Anti-Rotation (pad below knee)

Tall Kneeling Anti-Rotation (pad below knee)

Split Stance Anti-Rotation

Bilateral Deadlift

Suitcase Deadlift

Single Leg Deadlift

Assisted Split Squat

Assisted Split Squat + Counter Weight

Assisted Split Squat + Weight

Sliding Reverse Lunge + Weight

Rear Foot Elevated Split Squat + Weight

Single Leg Squat + Assistance

Single Leg Squat + Counter Weight

Single Leg Squat + Weight

 

Lower Extremity Power (Sagittal Plane)

Box Jump + stick the landing (bilateral)

Jump + stick the landing

Jump

Single Leg Box Jump (low height) + stick the landing

Single Leg Jump + stick the landing

Single Leg Jump

 

Lower Extremity Power (Frontal Plane)

Bounds + stick the landing

Bounds

Medial/Lateral Hop + stick the landing

Medial/Lateral hops

The strength progressions move from simple/supine positions to bilateral to unilateral leg motions to static half kneeling to dynamic half-kneeling to bilateral hip motions to unilateral leg hip motions to knee dominant to knee dominant and load to single leg knee dominant. I make sure people are single leg knee dominant (or at least rear foot elevated/split squat) before working really hard on plyometrics. My reasoning is that I want to control external loading through slow controlled motions before introducing ballistic motions that produce loads that are multiples of bodyweight.

**These were the regressions and progressions performed on myself after ACL surgery**

References

Augustsson, J. (2013). Documentation of strength training for research purposes after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 21(8), 1849-1855.

 

-Michael McIsaac