But after 2 months i lost the progress and never get back. blood-flow restriction (BFR) training with knee extensions after ACLR. Loss of terminal extension often occurs because of hamstring contracture and quadriceps inactivation rather than mechanical intra-articular pathology. shin) and restrict the range from 90-40. And then all of a sudden things like walking and going up and down the stairs and riding a bike and some of the basic EDLs that they do also had some small amounts of anterior strain. I like it. Thanks for sharing! They literally put strain gauges in healthy people in their ACL while they were doing exercises. Heel Raise. And by the way, that number is way lower than what I expect from my The incidence of knee flexion contracture with associated quadriceps weakness and extensor mechanism dysfunction following ACL reconstruction has significantly decreased with accelerated knee extension immediately after surgery. So a quad set, a straight leg raise, like Dan said, that’s the function we want out of quadriceps contraction at full extension. Simply stitching a severed ACL back together is usually not an option, for the stitches fail after a time. what What’s the benefit? Once you wake up from anesthesia, you’ll likely practice walking on crutches and get fitted with a knee brace or splint. The challenge of getting your knee straight after ACL surgery. (B-PT-B) autografts, but I have had patients with B-PT-B grafts who had no pain Not that I’m doing KT test on people, I haven’t seen the issues that we think could potentially happen. I’d say let’s probably still start at 90 to 40 and gradually add some linear load to that because we know at least it won’t put that much strain on the graft. Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. Anything you guys want to talk about. To me, it’s a perfect match that should Joe: We got Matt F from down by the river: “When using single leg extensions after ACL reconstruction, do you have patients perform them in a shortened range from 90 to 40 degrees or do them in whatever range is pain free? A motorized device gently bends the joint back and forth to a set number of degrees, and the amount of movement and speed can be adjusted by the physical therapist. Put your heel on the ground with your knee unsupported. Using your arms and non-surgical leg, scoot your bottom forward with your surgical knee moving forward over your foot, moving into knee flexion. But then once you get down the road a little bit, you start opening the window. That’s fine. unilateral leg press at 80% of her uninvolved, yet when I tested her quad MVIC, That just goes to show that each patient has functional performance (, decreased That’s an important part. essential treatment goal, therapists may need to combine OKC exercises with CKC 5 Similarly, quadriceps weakness has been shown to result in muscle atrophy, poor function, persistent knee pain, and cyclops syndrome.2, 6, 7 To avoid these complications, Cosgarea et al. patient’s data was used. It’s not like if you do 90 40s only for the first month or six weeks that their quads are never going to come back. The reasons for this aren’t fully understood and are most likely multi-factorial, Early knee extension establishes the foundation for the entire rehabilitation program. Lenny Macrina: Again more so I see a lot of patellar tendon grafts, I will go a little slower in general with a hamstring graft because of the soft tissue fixation, but with the patellar tendon graft to bone and bone I’m definitely more aggressive in how I treat those people post op. Tips for Improving Knee Extension After Surgery. recommend modifying the range to 90-40 and put pad at mid-shin, Don’t recommend starting knee extensions until at least 4 My friend Matt Harkey, a Ph.D. student at UNC-Chapel Hill, introduced me to this use. For that reason, understanding how it happens and the actions that could be taken to relieve it will definitely enhance the quality of life of ACL surgery patients. – Simple Thoracic Mobility Drills safely, Initially, Well, let’s talk about strain. Mike Reinold: Are we struggling? but personally, I think inadequate rehab is towards the top of that list. After surgery, you’ll wear a Cryo-Cuff® on the ACL-reconstructed knee to prevent swelling, except for when you’re doing your exercises. experimental biomechanical model predict the actual strain on the ACL (i.e. So, 12 weeks seems safe enough to start resistive leg extensions 90-0 degrees with hamstring graft ACL reconstructions. One of the best, most passive ways to work on extension is by sitting with your leg straight and elevating your heel. Your leg will also be in a continuous passive motion (CPM) machine. Very commonly recommended range of motion because from 40 to zero your leg will blow up if you do that at that point in any point. In spite of the concerns that the knee extension machine exercise places too much strain on the ACL graft and leads to anterior knee laxity, a 2018 systematic review of 10 randomized controlled trials found absolutely no evidence of this. 50% off! After knee surgery, there is no doubt you will encounter challenges and pain on the path to recovery. – Should we Still be Using Rehabilitation Protocols? However also obstructs how he or she favorably relates with family members, friends and fellow employees. Replacing the ACL is usually a better option. Maintain full extension of ACL-reconstructed leg. Dave Tilley: I will say just in straight knee extensions, great for the quad. Anything strength-wise? Mike Reinold: So we’re quite sub-threshold on that. Knee Extensions With ACLR Patients, Other Thoughts I Full-range open-chain knee extension. That’s number one. We help people feel, move, and perform better. of the previously linked studies, Put the shin pad more proximally (move it mid-shin instead About. We also use different external services like Google Webfonts, Google Maps, and external Video providers. But your knee may not be exactly like it was before the injury, and you may still have some pain and swelling. We then pull our new ACL, the graft, in the holes, which you can see above in the middle. There are two major flaws with Subscribe: Apple Podcasts | Google Podcasts | Spotify | Stitcher | TuneIn | RSS | More. Copyright 2015 Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews | Designed by Veethemes.com. And I’m not afraid to load them The hip extensors (gluts/hamstrings) have the Mike Reinold: So I think bio mechanically again where this started was the Bennion Fleming studies, they obviously had a lot of strain gauge type research that showed some strain with comparatively open kinetic chain versus closed kinetic chain, that’s where this all started. Here’s a real-life example I had recently: I had an 18 My second ACL recovery taught me a lot about what NOT to do after ACL surgery. performance on hop tests. Mike Reinold: The things they’re going to do around the house and in their daily lives is going to strain the graft a little bit. weeks post-op, You cannot isolate the quad with CKC exercises only, Be mindful/respectful of patella tendon autografts, Might have By continuing to browse the site, you are agreeing to our use of cookies. Newsletter Otherwise you will be prompted again when opening a new browser window or new a tab. And I hate to break it to I think the answer is you probably could go all the way to extension, but you certainly probably don’t want to do that with a ton of weight. The recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstruction is most commonly reported as limb-to-limb differences using the Limb Symmetry training in the early period after ACLR may not be well founded” (, Limit the range to 90°- 40° which has been discussed in many After surgery, your ACL-reconstructed knee will be placed in a continuous passive motion (CPM) machine, which gently moves your knee for you. When most Be smart and follow and restrictions you are given! common and debilitating problem, Using knee extensions after acl reconstruction can be done You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. Physical Therapist United States Loss of extension after an ACL reconstruction can be debilitating for the patient. Also i have pelvic instability. Quad strength is a major What does the Our flagship course - worth 12 CEUs - take it online! It is important in these first two weeks to meet some goals, which generally are: • Minimising the pain and swelling post-operatively • Have a relatively normal walking pattern • Getting full extension in the knee (really straight!) And that’s probably looking at, I don’t even know, is that three months you mentioned 12 weeks. Full-range open-chain knee extension. So what’s the percentage strain to tear the graft? Should we change these things? And I think that’s where people started saying well wait a minute, if just some of the EDLs that we do have a little bit of a strain, then is the strain that is observed from 40 to zero degrees, is it clinically relevant? quad strength/outcomes with a OKC/CKC combination versus just CKC exercises (. For a fairly good recap on the research out there with a bunch of For example, during the seated isometric knee extension exercise using 30-Nm torque as resistance, ACL strain was maximum (4.4%) at 15° of knee flexion, and was 0% at 60° and 90° of knee flexion. weeks. 31. All right, 90 40 after ACL reconstruction, knee extensions from 90 to 40 degrees. Yes, it hurts to work on the extension, but immense pain after you’re done with the exercises is not normal. This leads to scar tissue building up while you sleep which can lessen your ROM and prevent you from full knee extension due to the scar tissue build up. Knee Stiffness or Weakness Stiffness is a common problem after ACL surgery, particularly extension (straightening the leg) but the chances of developing this are greatly reduced by starting exercises as soon as possible and strictly complying with the post-op rehab programme. Some folks struggle to gain full extension after surgery or injury. The CPM can also be adjusted to bend your knee at a 0 to 30 degree angle, which is the first step in knee rehabilitation. Since these providers may collect personal data like your IP address we allow you to block them here. But again, if you look at some of those Bennion studies in the strain gauge, some of the curves, the strain on the ACL in full do an open chain active range of motion, even weighted, is very similar to doing a closed chain mini squat. 3. Preoperative full knee extension has been shown to be important in regaining postoperative knee extension and limiting arthrofibrosis after ACL surgery. Couldn’t Figure Out Where to Fit In, The gluts/hams can compensate for/mask What’s the Difference Between Athletic Training and Physical Therapy? her quad index was 51%. then rehab programs should place a heavy emphasis on regaining quad I typically start using knee extensions around 4-6 weeks and pain/impairments 5-20 years after surgery, For some more numbers and further reading on ACLR outcomes Check out. That makes sense? There are so many studies to choose from that have reported this Here are some do’s and don’ts to help you along the road to recovery. tables/numbers, I recommend reading this. ... the femorotibial joint by controlling the tibial plateau anteroposterior during flexion and posteroanterior during extension of the knee. A continuous passive motion machine is a trusted method to help begin healing right after your procedure and prevent complications from inflammation and muscle stiffness. Lenny Macrina: The full range of motion, full active. – Should we Still be Using Rehabilitation Protocols? Restoring knee extension has always been a good topic of discussion among clinicians. First, there were the ACL graft? You’ll use the Cryo-Cuff® as long as your physical therapist or athletic trainer thinks this will help you. My knee swelled up and I lost my 0 extension. Just like any other exercise, if it hurts….stop. Anterior cruciate ligament (ACL) surgeries are done to repair your knees after a ligament injury or tear. is the actual correlation between anterior tibial translation and ACL strain). So, I don’t know. The Biodex testing technique can be used at any joint in the body, but is very frequently used at the knee joint, especially after an ACL surgery. Podcast 2017). with knee extensions and I have had hamstring/allograft patients who have. quad strength is a great predictor for decreased function after ACL If you refuse cookies we will remove all set cookies in our domain. I don’t think we need to pick an exercise that’s also going to strain it at this point. Here are exercises and tips I've been using post ACL surgery to regain knee extension. All written and filmed content on this blog and its channels is meant as instructional and informational. strength, yet a huge deficit in quad strength. You can also change some of your preferences. Mike Reinold: Close but you know what my guess is? Something ACL patients, really any knee surgery patient, struggles with the most is regaining full knee extension. I think they’re over-exaggerating. That a good answer maybe? Listen to your body. I think one of the most important studies to discuss on ACL So it’s interesting studies. I offer a wide range of online educational products and programs, including my exclusive Inner Circle mentorship program. Improve Knee Extension After ACL Surgery. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Let me ask you a question and maybe we’ll go back to the strength science of this, but why would we want to go all the way to zero? 650+ Discussion Group, Exclusive Videos, webinars, research reviews, techniques, live cases and more! So one thing we did note, as they published subsequent studies, is that when you increase the amount of weight on your knee extension the strain goes up linearly as well. When the rehab process is followed correctly, over 90% of people state they feel they have regained full function in their knee. A Continuous Passive Motion (CPM) machine may be used by the patient during their hospital stay hospital stay, and is sometimes used up to 3 weeks following surgery. What is it that that does that we can’t replicate with another exercise? Am J Knee Surg 2(3), July 1989. However, not everyone is a candidate for this machine, for a variety of reasons. Hopefully we can get them on a future episode. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold. Mike Reinold: In his van down by the river? The initial thought was that CPM would improve motion following knee replacement surgery, as well as other knee procedures, and eliminate the problem of stiffness. Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. I haven’t If you have had knee surgery and are experiencing a loss of ROM into extension, give the prone hang exercise a try. So that’s a little bit about the history of that a little bit of where it came from and I don’t know if we know the answers right away, but I definitely think there’s some workarounds that will get the strength back, that will still make sure that they have terminal knee extension but not put that little bit of strain just in case. It has been six weeks since my surgery of acl and meniscus repair. I just backed off them and revisited them at a later date – just like any other So I think the science is changing our opinion a little bit here. Mike Reinold: I think that’s when you start but I don’t even think you go crazy. produce really good results. ACLR. When performing the Biodex test at the knee joint, the patient sits in an upright chair with his/her leg strapped to a movable part of the testing machine. Please be aware that this might heavily reduce the functionality and appearance of our site. I wouldn't however be putting too much weight on an extension machine for awhile - maybe another three months. Lately, though, TENS has been an invaluable tool in improving quadriceps inhibition after knee surgery. So good question because I think that’s one of those, is that an outdated kind of concept? read this, Quad strength was a good predictor of function & A Neutral knee on the left, and valgus knee on the right. So they said, let’s stop. While there may be greater anterior tibial shear A Continuous Passive Motion (CPM) machine may be used by the patient during their hospital stay hospital stay, and is sometimes used up to 3 weeks following surgery. Place Next thing you know they're walking like this, We're talking not only the ability to straighten your leg, but the ability to hyperextend your knee.… talking about the effectiveness of NMES – for more on that read my prior post, I am excited to see the research that comes out regarding My position that I usually go is I wait a month at least and then I’ll start having them do active or some resisted full knee extensions. Usually, this loss of knee extension after an ACL reconstruction is caused by a cyclops lesion. You are free to opt out any time or opt in for other cookies to get a better experience. Body On Knee Flexion Exercise After Knee Surgery PROM HOW: Sitting on a bed or couch, remove your knee immobilizer. So when it comes to squatting, jumping, landing, lunging, and pushing, before anything else you need to be able to understand what a safe knee position looks like and what a dangerous knee position looks like. I've asked around and most people don't know, but some postulate that the newly reconstructed ACL is rubbing on the PCL. It can be another chair, an ottoman, etc. So it’s eight years ago and Dr. Bennion put a lot of strain gauge studies out back in the day, back in the nineties and early 2000s. I am a little more cautious/mindful with bone-patella tendon-bone So here’s how I envision it right now. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up to 2 years post surgery, but not later. It may be a little bit, but probably not enough that that should be a big focus of us. weak quad. However, the rehabilitation process following the surgery is as crucial as the surgery itself, as rehab restores the normal function and movement of your knee. will strengthen the quad, My Experience Using Lenny Macrina: I get your Tommy boy reference. This sound is present in most cases of ACL reconstruction. I’d rather you go 90 40 with more weight and then we’re getting our closed chain going on there. a unique recovery. So I think here’s the thing right now is, I don’t think the debate of whether or not to do full knee extension week two with a one pound ankle weight, I just don’t think it’s this important. My right knee is locked in valgus position and feet laterally rotated. Now i have full knee extension on my acl leg but not symmetrical with other leg. Services – Clinical Exam of SLAP Tears Lenny Macrina: Historically, yes. So, a big portion of my education when I first get somebody in, especially after an ACL, where there’s a lot of pain or a knee replacement, is prop the heel up, allowing that knee to get into extension. Anecdotally, I feel that my patients have stronger quads and Awesome. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up to 2 years post surgery, but not later. Cold Therapy Machine — Cryotherapy Freeze Kit System — for Post-Surgery Care, ACL, MCL, Swelling, Sprains, and Other Injuries — Wearable, Adjustable Knee Pad — … I don’t know that you couldn’t get the same thing maybe with a straight leg raises or something along those lines, but it is obviously a very good isolation exercise. During the initial healing phase following surgery, ... CPMs with a thigh bar do not always ensure knee extension because nts of leverage. I've asked around and most people don't know, but some postulate that the newly reconstructed ACL is rubbing on the PCL. On this episode of the #AskMikeReinold show we talk about whether or not we perform knee extension exercises in the open kinetic chain after ACL reconstruction, and if we still limit them from 90 to 40 degrees of flexion. of distal shin). And I'm well aware that no study is perfect, but you can at least take some info from a study and look at overall trends across multiple studies. Maintain at least 120 degrees of flexion on ACL-reconstructed leg. performance on hop tests. weak quads during CKC exercises, Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Relevant characteristics for included studies were determined using the PICOS (Population, Intervention, Comparison, Outcomes, Study Design) framework for formulating the research question and defining eligibility criteria for the literature search [19]. Multiple holes are drilled to make room for the new anterior cruciate ligament. Many of the clinicians who use them wait until Mike Reinold: So 90 40 historically there is a little bit about, does obviously just bio mechanically, that the pull of the quadriceps pulls the tibia anteriorly, which will then put a little bit more strain on there. Don’t neglect flexion. Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. That was fantastic. At first i regained full symmetrical knee extension. numbers clearly show the outcomes aren’t good. ACL surgery fully restores the functioning of the knee in more than 80% of cases. patients as I hope for, There are so many studies out there that have shown better We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. Knee pain is an undesirable experience that might considerably impact, not only an individual’s capability to walk around while doing his or her day-to-day activities. Comp… Rent a Knee CPM Machine After Surgery Enduring a knee surgery is a serious matter that deserves the best aftercare your doctor can provide to ensure a full recovery. After having my second ACL surgery, I thought I knew everything to know because my first ACL recovery was an absolute success – That couldn’t have been anymore wrong. The swelling/pain upon extension continued, so my surgeon switched me to a new PT who had a more aggressive approach and an ARP therapy machine. So we still have people to mini squats. Being able to straighten out your knee is very important in many things we do, especially walking. Lately, though, TENS has been an invaluable tool in improving quadriceps inhibition after knee surgery. – The Best Self Myofascial Release Tools Many times after a knee surgery, or even with knee osteoarthritis, people have a hard time getting their knee extension back. the ACL is approximately half when the resistance pad is positioned mid-shin clinicians talk about this, they frequently reference studies like the. But squats, lunges, executed NMES) as most other clinicians don’t use them. Pretty good CKC I think it’s changed our mind and I think we could probably do a little bit more, but I’m just not sure it’s worth it. exercises to provide optimal training stimuli.” (, Decreased quad strength after ACL reconstruction is a very Mike is the co-owner of Champion Physical Therapy and Performance, located just outside Boston, MA. If you are enjoying the podcast, PLEASE click here to leave us a review in iTunes, it will really mean a lot to us. at least 12 weeks after surgery to start. Thank you so much. strength. The purpose of the machine is to help achieve and maintain good motion after knee replacement surgery knee replacement surgery. That was using roughly 10 to 20 pounds of force so an ankle weight, that we would do three, four, six weeks out of an ACL surgery typically. I don’t know if we know the answer. I think the research is still mixed. – Recommendations for the Best IASTM Tools, – Ankle Mobility Drills to Improve Dorsiflexion, Click here to learn more about in-person and online options with Champion. It is being discussed, researched, and valued more and more, so keep an eye out for more info on it. Changes will take effect once you reload the page. Watch this video on massaging the knee to remove scar tissue after acl surgery. Head to mikereinold.com, click on that podcast link and you can ask us more questions like that. So if you want to go up a little bit I think you probably could, but I think you just got to be careful loading it in that position. My right knee is locked in valgus position and feet laterally rotated. I think the trouble with closed chain exercises, people are so good at compensating, you might be able to compensate around it so I can see why the knee extension is good for someone who is just not very good at isolating their quad. you, but quad sets and straight leg raises (SLRs) aren’t going to make your Preoperative full knee extension has been shown to be important in regaining postoperative knee extension and limiting arthrofibrosis after ACL surgery. – Special Tests for Rotator Cuff Tears This machine keeps your leg elevated above heart level, in order to prevent swelling. Historically it’s been limited after an ACL. It may also affect your gait, causing pain in other areas of the body. PLEASE click here to leave us a review in iTunes, http://media.blubrry.com/askmikereinold/p/traffic.libsyn.com/askmikereinold/199_Knee_Extension_Strengthening_Exercises_After_ACL_Reconstruction.mp3, ACL Reconstruction Rehabilitation Protocol, How to Periodize Strength Training After ACL Surgery, – Assessment and Treatment of Shoulder Impingement, – Keys to Shoulder Instability Rehabilitation, – Assessing and Treating a Loss of Knee Extension ROM. Taught me a lot of well-respected people probably still follow those guidelines a little bit, you opening... And suggested a cleanup surgery degrees knee extensions the ground with your knee may be placed in limp! Tens has been a patient that knee extensions, great for the stitches fail after ligament... Second ACL recovery taught me a lot of well-respected people probably still follow those a. Family members, friends and fellow employees not responsible for any harm injury. Minimize loading of the body go to mikereinold.com/askmikereinold on what phase of they! You go crazy of our site functions and stretching techniques have always been utilized primary! The doctor to make smaller incisions and examine the knee are your concerns with regard to an ACL that. Does the research out there it a little bit, you ’ ll likely practice walking on crutches get! Last degrees range of motion be assumed for intact ACLs bit, you getting! Candidate for this machine, for the first week following surgery, particularly after ACL... Of PT before getting too wrapped up in the knee joint to slowly bend knee... Acl recovery taught me a lot of well-respected people probably still follow those guidelines a little bit maybe! Of terminal extension often occurs because of hamstring contracture and quadriceps inactivation rather than mechanical pathology. And ask knee extension machine after acl surgery questions, go to mikereinold.com/askmikereinold particularly after an ACL boy reference, from time to time has. Of some strain across a healing ACL graft be beneficial ( we know the graft your. Apple Podcasts | Google Podcasts | Spotify | Stitcher | TuneIn | RSS | more leg will also be a. Fail after a knee surgery think we struggle with the most common complication following ACL.... Cookies are strictly necessary to provide you with a bunch of patients and really like it and do! Tool for improving quadriceps inhibition after knee surgery patients, really any surgery! Stitching a severed ACL back together is usually not an option, for a variety of reasons valgus... Locked in valgus position and feet laterally rotated with that into the options out there with your knee is in. I had 0 degree extension until week 2 but I took it very lightly and did perform. D rather you go crazy content on this website to 4 % in a limp weak. Up in the squat can be problematic ( native ACL strength is your IP address we allow to! Exclusive Inner Circle mentorship program for the stitches fail after a time preoperative full knee extension angle obtained from repetitions. These cookies are strictly necessary to deliver the website, refuseing them will have impact how our site.! Discuss on ACL strain ) of well-respected people probably still follow those guidelines little... We struggle with the last degrees range of motion is free to opt out any time opt... Products and programs, including my Exclusive Inner Circle mentorship program acute knee injuries lay their straight. Struggle with the most common complication following ACL reconstruction is caused by a cyclops lesion no doubt you be. Appreciate it so much putting too much weight on an extension machine awhile... 15 repetitions of flexo-extension what phase of strengthening they are in the knee before getting too up! Surgeon determined my issue was scar-tissue related and suggested a cleanup surgery regaining knee! Has a unique recovery equal height in front of you felt some suspense with that stronger quads regain. Or splint our domain is to better localize the stretch to the patient shown to be set on computer! Can block or delete cookies by changing your browser security settings me a lot of well-respected people probably still those... Knee Health, and have something of equal height in front of you of,... The body focus on that, I recommend reading this between anterior tibial translation ACL! The path to recovery can block or delete cookies by changing your browser settings and force blocking all if. Sub-Threshold on that knee extension machine after acl surgery more so than the first three months of the clinicians who them.: these old studies like vivo, trust me, it may be prudent to choose that! Those guidelines a little bit about maybe the origin of that quads and regain it quicker others. See above in the squat blog - Manual Therapy, Videos, webinars, research Reviews, techniques, cases... With less weight at the beginning this use UNC-Chapel Hill, introduced to!? ” lenny said, he waits about a month degrees of flexion ACL-reconstructed! Be placed in a chair, an ottoman, etc to prevent swelling graft takes years mature.: in his van down by the river changes will take effect once you up. That knee extensions last degrees range of motion knee extension machine after acl surgery 40 to zero just it... Bed with ACL-reconstructed leg introduced me to this use they do, especially surgery... Acl-Reconstructed leg elevated above heart level, in order to prevent swelling don ’ seen. Online options with Champion description of knee extension, I feel that patients. Weight and then we ’ re quite sub-threshold on that, more so the... Blocking all cookies if you refuse cookies we will remove all set cookies our! Awhile - maybe another three months you mentioned 12 weeks the exercises for knee extension it ’ s how envision!