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KEY POINTS OF REHABILITATION OF THE ANTERIOR CRUCIATE LIGAMENT
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translating the body on operated leg. During
the dynamic phase of the walking, the weight
of the body is partial, with quadriceps
contraction locking the knee in extension in
phase of support, alternating with quadriceps
slackness and flexion of the knee in swing
phase.
Getting a normal walking pattern, without
flexum, without limping, without pain, with an
actively locked knee in full extension during
propulsion in the support phase, is an absolute
necessity to remove permanently the crutches.
KEY POINT N° 4:
WAKENING
THE HAMSTRINGS, THEN
STRENGTHENING, THEM EVEN IN
THE LAST DEGREES OF FLEXION
The inhibition of medial hamstrings is almost
constant during grafts of ACL by semi-
tendinosus and gracilis. It is clearly noticed on
a patient laying in procubitus, knees bending
between 100 to 120 degrees, asking him to
resist to one traction toward extension, made
by examiner (fig. 3).
This position is also a position of exercises
where the therapist can visualy control the
presence of semi-tendinosus and gracilis
muscles in maximal flexion of the knee (120°).
The awekening with Swiss-ball in decubitus
dorsal position also allows to make them work,
and later, to strengthen them, associating
different types of contractions (static,
concentric, eccentric) in the same range of
motion (fig. 4a, 4b).
Strengthening the hamstrings, usually well-
made in the first 100 degrees of flexion, is often
negleted beyond this range of motion, knowing
that weakness and a delay of pre-activation of
this muscular group is a well-know recurrence
factor.
Fig. 4a:
Relaxing slowly the pressure of the heel
corresponds to an eccenteric work of hamstrings.
Fig. 3:
Work of the hamstringts in eccentric.
Fig. 4b:
Pulling down the hell corresponds to a
concentric contraction of the hamstrings.