Phase 1: Early Rehabilitation (2-6 weeks post-injury/surgery OR Surgeon clearance.)

Description:

Phase 1 of the At Home, ACL Early Rehabilitation program focuses on transitioning from the acute phase where the primary goal is to manage pain, swelling and healing of the ligament/graft to a phase where the emphasis shifts to restoring range of motion (ROM), improving strength, and beginning to bear weight on the affected leg. 

This stage provides a foundation for more significant rehabilitation efforts in later phases.


Goals:
- Achieve nearly full range of motion (full extension and significant flexion).
- Begin strengthening the muscles around the knee joint.
- Restore weight-bearing capability.
- Decrease swelling and pain.

Outline:

Weeks 1-6:
1. Pain and Swelling Management:

- Emphasis and utilisation of Heat (local and global through Saunas), Cold plunge (3 minutes), Compression, and daily Mobilisations.

2. Range of Motion (ROM) Exercises:
- Use of PNF stretching to achieve full active & passive ranges of motion. 

- Daily joint mobilisations from Qi Gong/Junbi Undo to restore proprioception, energy flow in the fascia and build strength endurance.

- Mobility exercises that emphasise both inner and end ranges of motion of the lower body via the addition of isometric pauses in these positions.

3. Strengthening Exercises:

- Isometric Exercises will form the base of the strengthening exercises to "wake up" the inhibited/atrophied muscles around the knee and build back positional awareness.

- Emphasis will be placed on restoring all movements around the hips, knees and ankles, in particular tibial internal rotation, knee flexion and hip abduction/flexion/external rotation.

- Exercises will be performed between 30-120s to build muscular endurance. 

4. Balance Training:
   - Single-Leg Stands: Balance on the injured leg with the non-injured leg lifted; progress to exercises on unstable surfaces (e.g., balance pads).

   - Weight Shifts: Shift weight from one leg to another to promote stability and balance.

- Moving the body around the Leg initially.

- The utilisation of assistance from the hands, chairs, walls or bands will be used to support the leg and allow smooth, fluid movement in exercises to regain access into position safely.

5. Weight Bearing:

   - Begin to gradually increase weight-bearing activities as tolerated based on pain and swelling.

   - Use of crutches may still be necessary; transitioning to full weight-bearing will vary by individual.

6. Cardiovascular Conditioning: Optional

   - Stationary Cycling: will be used to build aerobic conditioning to promote range of motion and cardiovascular fitness.

   - Ski Erg: We will look to do anaerobic, HIIT with this equipment.

Expectations:

- Week 1-3:

  - Significant reduction in swelling and pain.
  - Ability to achieve about 90% or more of knee extension and flexion compared to the non-injured knee.
  - Initiation of light resistance exercises.

- Week 4-6:

  - Continued improvement in range of motion.
  - Strengthening exercises will begin to develop the movements and muscles around the knee joint.
  - Gradual progression to full weight-bearing without assistance, depending on progress.

- Overall Progress:
  - Patients should experience increased comfort and confidence in moving through exercises.
  - By the end of Phase 1, the focus should be on functional mobility, being able to walk without limping, and preparing for more intense rehabilitation efforts in Phase 2.