Hamstring Tendon Rehabilitation Protocol: Step-by-Step Exercise Program & Arthrometer Testing Guide

Navigate your ACL reconstruction recovery with our step-by-step Hamstring Tendon Rehabilitation Protocol. Discover exercises for each stage, from early recovery to advanced training, including arthrometer test timelines to monitor knee stability.

Early Stage Post-Operative Rehabilitation (Weeks 1-2) - Hamstring Tendon Rehabilitation Protocol

Objective:

Control inflammation and swelling.
Achieve full knee extension.
Restore quadriceps function.
Maintain mobility in other joints.

Frequency:

Perform exercises 3-4 times per day.

GNRB or Dyneelax Test: No

NEVER PERFORMED during this phase to avoid additional stress on the ACL graft.

Too Early

It is too early to perform an arthrometer test on the graft at this stage

Quadriceps Sets:

While sitting or lying down, tighten the quadriceps (the large muscle on the front of the thigh) by pushing the knee down towards the floor.
Hold for 5 seconds, then relax.
Repeat 10-20 times.

Straight Leg Raises:

While lying on your back, tighten the quadriceps and lift the leg straight up about 12 inches off the floor.
Hold for 5 seconds, then lower slowly.
Repeat 10-20 times.

Hamstring Curls:

While lying on your stomach, bend the knee and bring the heel towards your buttocks.
Hold for 5 seconds, then lower slowly.
Repeat 10-20 times.

Ankle Pumps:

While sitting or lying down, move the ankle up and down.
Repeat this motion for about 2-3 minutes.
Perform this exercise as often as possible throughout the day to promote blood circulation.

Intermediate Stage Post-Operative Rehabilitation (Weeks 3-6):

Objective:

Improve range of motion.
Strengthen muscles around the knee.
Enhance proprioception (awareness of joint position).
Initiate gait training.

Frequency:

Perform exercises 2-3 times per day.

GNRB or Dyneelax Test: Safe at Week 4

Translation Test: Yes, but maximum push 100N
Rotation Test: No

Walking applies 300N to the graft, so a 100N translation test at 6 weeks is safe. Yet, no rotation test should be conducted then.

Arthrometer tests performed at this stage will indicate if it is safe to perform certain type of exercises.

Mini Squats:

Stand with feet shoulder-width apart.
Slowly bend your knees, lowering your body a few inches.
Hold for a moment, then slowly return to the starting position.
Repeat 10-15 times.

Step-ups:

Stand in front of a sturdy step or box.
Step up onto the step with your operated leg, followed by your other leg.
Step back down and repeat.
Repeat 10-15 times.

Stationary Bike Riding:

Begin with a low resistance and a comfortable seat height.
Pedal for 5-10 minutes, gradually increasing the time as tolerated.

Hamstring and Quadriceps Strengthening:

Continue with exercises from the early stage, like hamstring curls and quadriceps sets, but add resistance bands or weights as tolerated.
Perform 10-15 repetitions.

Heel Slides:

While lying on your back, slowly slide the heel of your operated leg towards your buttocks, bending the knee.
Slide the heel back to the starting position.
Repeat 10-15 times.

Balance and Proprioceptive Training:

Perform balance exercises such as standing on one leg, initially with support and then without as able.
Use a wobble board or Bosu ball for advanced exercises.

Discover Proven Outcomes

Case Studies

Read the following study to understand the importance of using arthrometers after ACL Reconstruction surgeries. These allow to personnalize the rehabilitation programs of each patient to maximise the chances of success of the surgery and rehab!

2017 - ACL Grafts Compliance During Time: Influence of Early Solicitations on the Final Stiffness of the Graft after Surgery

DOI: 10.24966/ORP-2052/100035

Stéphane Nouveau, Henri Robert, Thimothee Viel,

Late Stage Post-Operative Rehabilitation (Weeks 7-12):

Objective:

Continue strengthening exercises.
Improve balance and proprioception.
Begin functional and sport-specific training under supervision.

Frequency:

Perform exercises 1-2 times per day.

GNRB or Dyneelax Test: Week 12

Translation Test: Yes, but maximum push 134N
Rotation Test: Yes, but maximum torque 3N/m

A test may be repreated around week 12 to monitor changes in knee joint laxity and provide feedback on the progress of rehabilitation. Walking applies 300N to the graft, so a 134N translation test is safe. Yet, no rotation test should be conducted then.

Arthrometer tests performed at this stage will indicate if it is safe to perform certain type of exercises.

Leg Presses:

Start with a light weight and gradually increase as strength improves.
Perform 3 sets of 10-15 repetitions.

Lunges:

Step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle.
Push back up to the starting position.
Alternate legs and perform 3 sets of 10-15 repetitions.

Plyometric Exercises:

Begin with basic plyometric exercises like box jumps, hopping, or skipping under the supervision of a physical therapist.
Perform exercises in a controlled and safe environment to prevent re-injury.

Balance and Proprioceptive Training:

Continue with advanced balance exercises on unstable surfaces.
Incorporate sport-specific balance and coordination drills.

Hamstring and Quadriceps Strengthening:

Continue with resistance training, adding more weight as tolerated.
Perform 3 sets of 10-15 repetitions.

Agility Drills:

Initiate simple agility drills like ladder drills, cone drills, and zig-zags.
Ensure a good technique to prevent re-injury.

Stationary Bike Riding:

Continue cycling, increasing both resistance and duration as tolerated.
Aim for 20-30 minutes per session.

Advanced Stage Post-Operative Rehabilitation (Months 4-6):

Objective:

Return to sport-specific training.
Improve endurance, strength, and agility.
Enhance neuromuscular control.

Frequency:

Perform exercises 1-2 times per day or as recommended by your physical therapist.

GNRB or Dyneelax Test: Month 4

Translation Test: Yes, but maximum push 150N
Rotation Test: Yes, but maximum torque 3N/m

Month 5: Transaltion test at 200N Maximum.
Rotation Tests may also be performed starting Month 5.

Arthrometer tests are performed to assess readiness for a return to sports and to compare with pre-surgical measurements.

Sport-Specific Drills:

Gradually reintroduce sport-specific movements and drills.
Start with low intensity and gradually increase as tolerated.

Agility Training:

Continue with agility drills, increasing complexity and intensity.
Include multidirectional movements and rapid change of direction drills.

Plyometric Exercises:

Advance plyometric exercises to include higher intensity jumps, hops, and bounds.
Ensure proper technique to prevent re-injury.

Strength Training:

Continue with leg presses, lunges, and resistance training.
Add more sport-specific strength exercises.

Endurance Training:

Incorporate aerobic exercises like jogging, cycling, and swimming to improve cardiovascular endurance.
Start with low intensity and gradually increase as tolerated.

Balance and Proprioceptive Training:

Maintain a regimen of balance and proprioceptive exercises to ensure joint stability.

Flexibility Training:

Maintain a regular stretching routine to ensure flexibility of the knee and surrounding muscles.

Maintenance Stage Post-Operative Rehabilitation (6 months onwards):

Objective:

Maintain strength, flexibility, and functional stability.
Continue sport-specific training and conditioning.
Prevent re-injury through education and training.

Frequency:

Perform exercises and training routines as part of your regular fitness regimen, typically 3-5 times per week.

Arthrometer Testing:

As recommended by the physical therapist or orthopedic surgeon to monitor knee stability over time. Typically, this could be done annually or bi-annually depending on individual circumstances.

Exercises:

GNRB or Dyneelax Test: Month 6

Translation Test: Yes, any forces
Rotation Test: Yes, any torques

Last Tests should be done on Month 12.

Proper follow-up should be done to increase the chances of success of the ACL being stable again.

Sport-Specific Drills:

Continue with sport-specific drills and practice.
Include a proper warm-up and cool-down to prevent injury.

Strength Training:

Maintain a regular strength training routine focusing on lower body strength, core stability, and overall muscle balance.
Include exercises like squats, lunges, and leg presses.

Endurance Training:

Maintain cardiovascular fitness through aerobic exercises like jogging, cycling, and swimming.

Flexibility Training:

Continue with a regular stretching routine to ensure good flexibility and joint mobility.
Include dynamic stretching as part of your warm-up and static stretching as part of your cool-down.

Balance and Proprioceptive Training:

Incorporate balance and proprioceptive exercises as part of your routine to maintain knee stability.

Injury Prevention Education:

Learn proper techniques and strategies to prevent re-injury.
Modify training and competitive activities as necessary to prevent undue stress on the knee.

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