As all of us know if you have been training for any length of time you will get injured.  Also, as we log those training hours, the knees can take a beating.  After teaching and training numerous police and military athletes that have experienced knee injuries have first-hand experience in surgeries and rehabilitations, to include my own.  Being a trainer that has to help people get back to work asap, I have found that this program has worked for many that have had arthroscopic knee surgery.  The program is designed to get you back running and hard core training in 12 weeks.  Be sure that you show this to your Physical Therapist and Doctor prior to starting this program.  Good luck!



Arthroscopic Knee Surgery
Rehabilitation Program

Week One

1.    Speak with a staff physical therapist before leaving the hospital. Always follow the doctor's orders. Get this program approved by the Dr. and Therapist before starting.  
2.    Bend your knee slightly under the supervision of the physical therapist.  If they allow it.
3.    Receive a list of approved exercises before you are released to return home.
4.    Walk with a cane, walker or crutches the same day you have surgery.
5.    Use a knee brace if necessary. Take care not to become dependent upon the brace.
6.    Ice Ice Ice?. They will tell you how much. If not.  1st day Ice all day, change it every couple of hours.  For the next 3 days Ice at least 5 times for 20 minutes.

Week One
Day One and every day until finished with rehab
Exercise 5 minutes out of each waking hour the first week you are at home.

1.    Foot Pumps-Pull toes up toward you and then push them away from you.  20 reps

2.    Quadriceps Flex- Lie or sit in your favorite recliner and tighten your thigh muscles as tight as possible. Hold the contraction at the peak for five seconds, then rest for two seconds. Repeat the exercise 10 times, rest for a minute and then complete another set of 10. Complete this as soon as the first day post-op, as it is intended to strengthen both the knee and surrounding muscles, and can be completed while wearing a knee immobilizer.

3.    Stretch; keeping your injured leg straight, bend forward at the waist and try to touch your toes. Hold this stretch for 10 to 12 seconds, then rest and repeat three to four times.

Day 3-4

4.    Straight Leg Raise -Lie flat on your back and tighten your thigh muscles as tight as possible. Raise the entire leg that you had surgery on as high as possible, keeping your muscles tight. Hold the leg at the peak for five seconds, then lower it to the floor and rest for two seconds. Repeat the exercise 10 times, rest for a minute and then complete another set of 10. Complete this as soon as the first day post-op, as it is intended to strengthen both the knee and surrounding muscles, and can be completed while wearing a knee immobilizer.



5.    Passive Knee Flexing-This exercise is to strengthen and stretch the muscles and ligaments of the knee joint after surgery or to treat pain. Sit up straight on a chair with the feet flat on the floor. Then use the uninjured leg to gently push the injured knee so that it bends as far back as comfortably possible. Hold for 5 seconds, relax and repeat 30 times, two to three times a day.

6.    Quad Push Down and Leg Lift
Some post-knee surgery patients find it difficult to isolate their quadriceps muscle. Placing a full roll of toilet paper under your heel may provide tactile assistance. The push down and leg lift combine two important post-surgery home exercises: the quad set and the leg lift. Lie supine and place the toilet paper roll under the ankle of your injured leg. Press your heel against the roll, as if you were trying to crush it. Then, keep your quadriceps contracted and raise your leg as high as it will go. Lower to the roll and repeat for two sets of 10 repetitions.

7.    Prone Hangs
Prone hangs use gravitational forces to facilitate leg extension. Lie face-down on your bed, with your legs extended. Keep your knees, calves feet and ankles off the bed, and rest your head in whatever position is comfortable. Allow your legs to hang in the position for as long as possible. Read a book, watch television or ask a friend to massage your back to distract you from the pain.

8.    Assisted Heel Slides
Regaining leg flexion is as important as regaining flexion. The assisted heel slide uses a towel to help you bend your knee. Sit in an upright position on an exercise mat, placing a long towel around the foot of your injured knee. Hold each end of the towel with each hand. Pull on the towel ends as you slide your heel along the mat, bending your knee and drawing your heel toward your body.

9.    Assisted Prone Leg Extension
Your physical therapist may have performed manual leg flexion on your injured leg, but you can also use your non-injured leg for assistance. Lie on your stomach with your legs extended. Place the ankle of your non-injured leg under the ankle of the injured leg. Use your good leg to help you bend the injured leg. Go to the point of pain, take a few breaths, and then bend a little bit more. Perform two sets of 10 repetitions. When your doctor or therapist tells you that you are ready for strength exercises, place the good ankle on top, and use it to apply resistance as you attempt to bend your knee.
 
 
Week Two
In week 2 schedule a set time for 30 minutes to 1 hour to do PT 3 days a week.  Do the day one exercises and stretch every day.
Use a heating pad for 10 minutes as you do quadriceps and hamstring flexes, to thoroughly warm up the knee, and surrounding muscles.  
Once finished with your PT, Ice for 20 minutes to keep the swelling down. Also Ice 3-5 times a day for 20 minutes. Remember swelling is the enemy.  Massage the knee and the incisions 3-5 times a day from now on.

1.      Ball Squeeze/Isometric Squeeze
Try the ball squeeze to work the inner thigh muscles, which provide support to your knees while you're walking, running or playing sports. Sit on the edge of a chair or counter and hold a fitness ball between your legs. Slowly squeeze your legs together, compressing the fitness ball as much as you can. Hold for 10 to 15 seconds, then relax. Repeat this exercise two to three times as part of your rehab exercise routine.

2.    Stationary Bike
Riding a stationary bike is an effective and low-impact way to work out all the muscles in your legs as well as increase the range of motion in your injured knee. Use a stationary bike that has adjustable resistance settings. Start on a low resistance to warm up your knee and leg muscles. Adjust the seat height so you can achieve a 110-degree bend (about ½ way between straight and 90 degrees) in your injured leg. Bike comfortably for 20 minutes, increase the resistance slowly.

3.    Heel Slides
About two weeks following surgery, begin to improve your range of motion and flexibility, and continue to reduce swelling. One way to strengthen your flexibility is by working on heel slides. Lie flat on your back, on a hard floor if possible. Bend the injured knee as much as possible, sliding your heel toward your hip as far as you can. You will likely feel some pain, but continue the exercise as long as it is bearable. Repeat between 10 and 20 times; if possible, loop a towel around your foot and pull it gently toward your hips to help increase your range of motion.  


4.    Hamstring Contraction
This exercise is one of the easiest to do, and helps strengthen and exercise the hamstring muscles after your surgery. It requires no movement in the knee. To do hamstring contractions, sit or lie on the floor with your knees bent and legs together. Place your heels on the floor so your toes are pointed up in the air. Slowly press your heels against the floor and pull them slightly back towards your body until you feel a contraction in your hamstring muscles. Hold this contraction for 10 seconds, then rest. Repeat four to five times. Do the exercise three to four times a day as part of your recovery routine.


5.    Squats-Body weight only
Focus simply on keeping your knee stable and lower your body weight about a quarter of the way of a normal squat. Progress to a half squat and full squat in the next few weeks, completing three sets of 10 to 20 repetitions each time. Be sure to tighten your stomach muscles, and add weight, with either a dumbbell or a barbell, as your knee gets stronger.

6.    Calf Raises
Stand on a stair or block of wood, with your heels hanging off the back edge. Raise up onto your toes, while keeping your legs straight. Aim for three sets of 10 to 20 repetitions, or until your knee feels fatigued.


Week Three
This is the week that PT usually includes weight bearing exercises like walking on the elliptical, tread mill for 10 minutes to start.  I would still focus on the Bike.  Weight is also added if you can tolerate it.  These can be added on or used in place of the previous exercises.  You must stretch every day!
Use a heating pad for 10 minutes as you do quadriceps and hamstring flexes, to thoroughly warm up the knee, and surrounding muscles.  
Once finished with your PT, Ice for 20 minutes to keep the swelling down. Also Ice 3-5 times a day for 20 minutes. Remember swelling is the enemy.  Massage the knee and the incisions 3-5 times a day from now on.

Step-Ups
Use an exercise step or a small step stool to help strengthen your knees and relearn how to use stairs following your arthroscopic knee surgery. Step up with your affected knee onto the stool. Then bring your healthy leg up. Step down with your healthy leg first and then bring your affected leg back down to the ground. Repeat 10 times. As your strength increases, you can use a higher stool or opt for climbing an actual set of stairs.

Straight Leg Raise- In week 3 add a light ankle weight or perform the exercise against resistance, such as a band or a partner's strength.
Tighten your injured leg's thigh muscles by pressing the back of your knee flat to the floor. Maintaining this muscle contraction, lift the injured leg slowly until it is approximately 12 inches off the floor. Hold this position for five seconds before lowering your leg. Repeat 8 to 12 times.  

Knee Extensions- In week 3 add a light ankle weight or perform the exercise against resistance, such as a band or a partner's strength.
Sit or lie on the floor with a rolled-up towel under your injured knee. Relax your knee and leg muscles so your heel is resting on the floor. Contract your quadriceps muscles slowly to lift your lower leg as high above the floor as you can. Keep the back of your knee in contact with the towel at all times. Hold your leg in the air for five seconds, then return it back to the floor. Do 10 to 15 repetitions, then rest.

Static Hamstring Hold- In week 3 add a light ankle weight or perform the exercise against resistance, such as a band or a partner's strength.
Performing the static hamstring hold will help maintain the strength of your hamstrings -- your back thigh muscles -- post-surgery when other exercises are too difficult. Stand up on the floor or a mat and bend your affected leg until your foot is raised to a 45-degree angle. Hold this position for 10 seconds and lower your leg slowly. Repeat 10 to 20 times. As your strength increases, you can increase your hold time, add a light ankle weight or perform the exercise against resistance, such as a band or a partner's strength.


Heel Dig Bridge
Bridge poses can strengthen muscles in the backs of your legs as well as your hips, both of which can affect your knees. Lie on your back and bend your legs to 90 degrees, placing your heels on the floor and pointing your toes up. Press into your heels, use the backs of your legs and lift your hips off of the floor. Bring your hips up so that you form a straight line with your knees, hips and shoulders. Breathe normally and hold for six seconds before lowering back to the starting position. Repeat 8 to 12 times.

Standing Straight Leg Raises
Standing straight leg raises help rebuild the strength in your leg. Stand up tall with your feet shoulder-width apart. If you need to, stand near a counter or the back of a chair to support yourself. Slowly lift your affected leg forward while keeping your knee straight. Raise your leg as far as you comfortably can. Return to the starting position and repeat 10 times. To make this exercise more challenging, you can use an ankle weight. Start with 1 lb. and go no higher than 5 lbs. in ankle weights.

Standing Quad Stretch/You might not be able to do yet.  
This will help strengthen your thigh muscles as well as provide for flexibility in your knee. Stand straight up and bend your affected knee backward. Grasp your foot with your hand and slowly pull your heel toward your buttocks. You will feel a stretch in the front of your thigh. Hold this position for five seconds. Slowly lower your leg back to the floor and repeat. Repeat 10 times.
If unable to do yet:
Sit on the floor, loop a towel around your ankle and pull your heel to your buttocks, hold your max for 10 to 30 seconds.

Lying Hamstring Stretch/to be done every day for the rest of your life!
Lie on your back one leg flat on the floor, the other leg up in the air hands holding behind the knee aria with a slight bend in the knee.  Roll the foot left, right, then point and pull the foot.  10 reps each way.  Then straighten the knee grabbing the calf area, and pull the leg toward you until you feel the stretch.  Hold max for 10 to 30 seconds.  
I think this is the best low back and hamstring stretch you can do.
 

 
Week Four

If everything is going perfect you will be able to increase your elliptical/treadmill time, however I would stay on the bike, or elliptical until the 10th or 12th week.  That way you can get a cardio workout while rehabbing your knee.


Do not increase more than 10% a week.  This includes intensity, distance, time?.. You know the rule!

Exercises you can add when you feel ready:

Deeper Squats
Walking Lunges
Skaters? -very shallow ones at first
Planks- all around
Jump rope-with or without rope

Keep up with the above exercises 3-5 times a week and by week 12 you will be hard core training and running again!