Restoring Terminal Knee Extension Post Op ACL

This was an interesting case for me as I have not seen a lot of post op ACL in phase 1 or 2 of their rehab. Either way, restoring terminal knee extension is a predictor for success in return to sport. This DC student was doing his own rehab and was 1 month post op. He was about 30-90 for knee ROM, meaning his extension was 30 deg flexion and was limited to 90 degrees knee flexion prior to my intervention.

Mechanism of injury was a meniscal tear (medial I think) and also ACL rupture. He states having a high level of fear avoidance, but that was improved after attending my lecture and seeing how I do a lot of pain free techniques.

I apologize for the overall quality of the video, but I did not shoot it, it was shot in portrait by another student, so I had to crop and edit it a bit to make it look better on all screens.

In the treatment progression you can see me try

  • repeated end range loading into extension
  • tibial ER --> femoral IR
  • tibial medial glide, femoral lateral glide
  • wrapping with EDGE Mobility Band
Each variation of force, amount of glide/rotation significantly reduced pain and thus fear as we loaded further into end range extension. You can see the pre and post treatment below which took about 10 minutes or so.

Surprisingly enough, after restoring terminal knee extension, we check passive flexion and it had also improved to at least 120.

prone knee extension prior to intervention

prone knee extension after intervention