How To Program Leg Extensions Safely After ACL Rescontruction (3 Phases)

Learn how to program leg extensions after an ACL reconstruction!

AFFILIATES:

Follow Us:

Introduction (0:00)

Are Leg Extensions Safe After ACL Reconstruction?

Are Leg Extensions Functional?

Straight Leg Raises & Quad Sets (0:26)

Disclaimer (0:49)

Always consult with your physical therapist and surgeon prior to initiating any new exercises! Also, these phases are meant to be a guideline, not hard and fast rules!

Phase 1 (1:14)

Time frame: 0-4 weeks (approximately!)
Exercise: Isometric leg extensions performed between 60-90 degrees of knee flexion.
Research: Smidt 1973 demonstrated isometric knee extension is strongest between 45-75 degrees of knee flexion and Beynnon 1995 demonstrated that there's no strain on the ACL at 60 or 90 degrees of isometric knee extension at 80% intensity
Parameters: For the non-surgical limb, continue to train it hard through a full range of motion to minimize atrophy and deconditioning. For the surgical limb, dosage is extremely variable. It's largely based on tolerance. Sample 1: 2-3 sets of 10-20 repetitions for 1-2 second holds at 40-60% intensity every other day. Sample 2: 3-5 sets of 20-30 second holds at 30-50% intensity every day.

Key Points: 7/10 RPE or less, no increase in swelling, no increase in baseline pain

Phase 2 (3:12)

Time frame: 4-12 weeks (approximately!)
Exercise: Isometric leg extensions and restricted range of motion (40-90 degrees)
Research: Mikkelsen 2000, Isberg 2006, Heijne 2007, Fukuda 2013
Parameters: Keep training the non-surgical limb! For the surgical limb, ramp up the intensity of the isometrics. The reduced range of motion can be trained using hypertrophy parameters such as 3-5 sets of 10-15 repetitions every other day around that 7/10 RPE. Once again, this is extremely variable based on tolerance and swelling.

Phase 3 (4:03)

Time frame: 12+ weeks (approximately!)
Exercise: Isometric leg extensions and simultaneously progressing toward full range of motion
Research: Same as above
Parameters: Keep training the non-surgical limb! For the surgical limb, slowly ramp up the speed and intensity of the isometrics. Rate of force development is extremely important so reaching your peak intensity in a shorter time span will be important (don't rush it, though). Additionally, you'll be working toward full range of motion knee extensions as tolerated. Continue with your hypertrophy parameters at sufficient intensity. The goal is that both quads are even stronger than they were prior to the initial ACL injury.

Summary (4:34)

You don't have to be fearful of leg extensions if you understand the research. Progress gradually just like you would with any other exercise after a surgery or injury while respecting pain, swelling, tissue healing timelines, etc.

Outro (5:18)

We also have a blog on the topic written by Nicole Surdyka, DPT, CSCS that you find here:

-----
Disclaimer: The information presented is not intended as medical advice or to be a substitute for medical counseling but intended for entertainment purposes only. If you are experiencing pain, please seek the appropriate healthcare professional.
-----
References

[ERehab]

3 Clarifying Points:

1. Quad sets and SLRs do strengthen the quads to some extent (minimally with a very low ceiling), but they are often prescribed for extended periods of time despite their inability to progressively load the quads. Use them initially for their intended purpose and then move on.

2. The phases are very rough guidelines. There are a lot of individual factors at play here.

3. The isometric knee extension angles might not be perfect because of how the machine is set up, but the suggestions remain the same. I would actually measure the angle for testing and training in the clinic. Since I recommended such a wide range (60-90 degrees), you can always err on the side of caution (staying closer to 90 degrees).

[MrMonsterdz]

We can't thank you enough for this great simplified direct information... keep up the good content

[pkramerable]

This is easily the best post I've seen on this topic. Thank you. 👍

[jchex]

Theses ACL videos are awesome! I was taught to avoid knee extension exercises early on in my rehab/therapy experience (Teching, Fitness Training, and University studies) at all cost because of shear forces and to some extent, compressive forces. At the time I wasn't sure what these forces were as most schools don't cover arthrokinematics in depth, unless you are going to grad school and diving into the research. I'm learning that these forces are just a part of all joint movements as they produce torque about said joint. Not sure if therapists bought the idea that closed-chained exercises were superior to open-chain exercises or that the shear forces created by knee extensions were sufficient to cause osteoarthritis down the road. Anyway, I wasn't familiar with the research but I did happen to see these exercises in ACL rehab a lot so it just created a lot of confusion on the topic. I thank you and Dr Sam Spinelli for speaking on the topiic. Keep up the good work!

[ijazasif]

hi sr
my acl surjry four month completd
Rom 120%
aftr exrsize knee Rom 125
u r vidios very helpfull for me

[mikehall]

Great video. I've had an ACL reconsrruction of my left knee years ago and my right knee has been replaced and a year later I shattered my femur right about the knee. I'm have had 3 surgeries on each knee. When I do leg extensions with my right knee I get some pain in the knee cap. Should I stay away from extentions or limit them to 45-60 degrees at most? Thanks, Mike

[iwantlee]

0:43 that exercise, whatever it's called, hits the rectus femoris though. People forget that it crosses the hip and is both a quad muscle and a hip flexor muscle.

[iamgreg]

Doc I had a ruptured patellar on my left knee in 2016, I done the rehab has prescribed, my leg still buckle. Any advice?

[katariadhruv]

Is it safe to perform prone or seated hamstring curls post ACL repair(not reconstruction) and meniscus repair considering that no graft has been taken from hamstring. Would request you to make a video for the same.

[tonib]

Hi, is the surgical leg the leg that is directly in from of the camera?

[akalapov]

What about training the hammstrings timetable after a hammstring graft?

[rameesmonremy]

Sir 1 year ago I did acl.surgery I have knee extenshion now it will dificult ??

[gemiao]

May I ask how long it takes for MCL to bend and step on a fixed bike after being damaged

[dominicdominic]

Does this work for patellafemoral pain too? Experiencing pain at around 70 degrees of knee extension

[David.Eng.]

How might these protocols differ for someone who used a patella graft? Will the effected patella slow this process?

[diegojuarez]

Thank you so much for this informative video. So performing leg extensions right away won’t loosen the screws/anchors used for patella graft ACL? I would appreciate your reply. Thank you

[atinmondal]

How much weight should I put on during leg extension exercise

[hyitsdom]

Any suggestions if dealing with knee clicking/locking when doing extensions on surgical knee? Weight doesn't matter will happen with empty vs loaded at nearly full extension.

[TopBoi]

Is it normal if when doing these you feel clicks in your knee on the operated knee. I am 3 months post aclr surgery and my knee clicks and feels snappy even if I straighten my leg in the air without any weight let alone with weight.

[swapnilnehe]

How to strengthen Hamstring muscle after ACL reconstruction