ACL rehabilitation update

I am now 4 and a half months into my ACL rehabilitation after my right knee Anterior Cruciate Ligament (ACL) reconstruction with hamstring tendon graft.

So…what’s happened since my last blog on my ACL rehabilitation?  I’m pleased to say that particularly during the last three weeks, my pain and swelling have reduced dramatically. I now usually only have pain or swelling at the end of the day, after being on my feet for long periods. The range of movement in my right knee ACL has improved and I can now bend my knee to 120 degrees flexion. I can almost straighten my knee fully, however I am still about 3 degrees away from reaching full knee extension. The strength of my right leg has noticeably reduced, particularly in my vastus medialis oblique (VMO) muscle.

The VMO is part of the quadriceps muscle group which is an integral muscle for relieving knee pain and preventing tracking of the patella (knee cap). Weakness of the VMO can lead to a common condition called patellofemoral pain syndrome. Because the strength of my VMO is severely reduced, most of my current knee pain is a result of this patellofemoral dysfunction.

My current ACL rehabilitation program, as prescribed by the physiotherapists at Enhance Physiotherapy, is aimed at VMO strengthening, core and hip stability, and balance retraining.

Some of these ACL rehabilitation exercises include:
3 minute wall sit (see photos)
5 minute single leg balance on a wobble cushion (see photos)

I am also attending regular Enhance Physiotherapy Pilates and hydrotherapy classes.
Overall, the progression of my ACL rehabilitation in these first few months post-surgery has been slow and at times frustrating. However, because I now have adequate knee range of movement, I will be starting to train on the stationary bike this week and am very very excited! I am also hoping to commence running again in the next 2 to 3 months.

I’ll let you know how the patellofemoral dysfunction goes in my next blog.


Stef's rehabilitation Exercises
Stef’s rehabilitation Exercises

Stretching/Strengthening for the Psoas Muscle

Recently we asked our facebook friends what they’d like to know more about from our Physio’s.  One friend asked for information regarding stretching and strengthening of the Psoas muscle (pronounced Sow-us).

Psoas Muscle


Psoas Muscle location

So let’s start off by talking about where the Psoas muscle is and what it does. The Psoasmuscle group is one of your major hip flexors, and is divided into two parts – the Psoas Major (in purple) and the Psoas Minor (in yellow). Psoas Major attaches to each of the 5 vertebrae in your lower back then travels down and attaches itself to your femur bone (thigh bone) just below the hip joint. Along the way, Psoas blends together with another muscle called Iliacus (in red) and forms the muscle group known as Iliopsoas. The main role of the iliopsoas is to move your hip into flexion – bending your hip up. If you are currently sitting down, you can activate your iliopsoas by lifting the back of your knee of your seat. Although you need a lot of hip flexion with walking and running, your iliopsoas only has a minor role during these times as a lot of this hip movement is created by momentum. Your iliopsoas however does play an important part in providing stability during walking and running activities. Because it has attachments to your lower back it can stabilise these segments of your spine. However as good as this muscle can be at helping you during running, it can cause a lot of problems once it gets tight because it attaches to your back – it can put a lot of tension on your spine when it is tight. The muscle can get tight due to prolonged sitting (eg desk workers), excessive running/training or due to your lower back posture. This can cause lower back, hip or groin pain during running or walking activities.




Here are a few stretching techniques to improve your iliopsoas muscle length.

Lunge Stretch Psoas Muscle


Lunge Stretch Psoas Muscle

Lunge Stretch: Start in a lunge position, with the hip you are stretching as the back leg. Move your hips and torso as far forward as you can and make sure your back knee doesn’t slide forwards. Keep your torso upright and chest forwards. You can add more of a stretch by incorporating an anterior pelvic tilt – by tucking your buttocks underneath you and moving your pelvic bone towards you.

Thomas Stretch Psoas Muscle
Thomas Stretch Psoas Muscle

Thomas Stretch: Lie on the edge of a bed/table and pull your knee towards you. Let the other leg hang from the edge of the bed and keep it relaxed. You should feel a pulling at the front of your hip or thigh. This stretch is for the hanging leg.

These are the main two positions I use to stretch my hip flexors, and the ones I recommend to my patients. However there are lots of progressions incorporating different muscles and different body parts into the one stretch that you can try if you find that these two are not giving you much of a stretch.

Alternate Stretches Psoas Muscle


Alternate Stretches Psoas Muscle

Here are a few strengthening techniques:

The Psoas muscle being a hip flexor can be trained using resisted hip flexion exercises such as straight leg raises, sit ups or band/cable resisted exercises. However before I go through a few exercises that I use, I would say that Psoas strengthening is often not required for alleviating pain or improving biomechanics because Psoas weakness is uncommon. The problems involving the Psoas muscle in most cases relate to tightness or overactivity.

Strengthening of the Psoas muscle puts a lot of stress on your lower back, so before commencing these exercises speak with your Physio.

Straight Leg Raise Psoas Muscle Strengthening
Straight Leg Raise Psoas Muscle Strengthening

Straight Leg Raise: Lying on your back, lifting one leg up while keeping your knee straight, then slowly lower leg back done. Make sure you don’t arch your lower back during the exercise.

Leg Lifts Psoas Muscle Strengthening


Leg Lifts Psoas Muscle Strengthening

Leg Lifts/Straight leg raise: Lift your feet off the floor and bend your hips to 90°. Keep your knees slightly bent throughout. There are several different variations to this exercise – it can be done as a hold by keeping your feet hovering about 2cm off the ground for as long as possible, or add ankle weights to increase the difficulty. This exercise requires good core stability to perform it safely. If you haven’t got great core strength, or can’t do the exercise without arching you lower back then don’t perform the exercise

Standing Hip Flexion Psoas Muscle Strengthening


Standing Hip Flexion Psoas Muscle Strengthening

Standing Hip Flexion: Start in standing with your one leg slightly behind you and a theraband or pulley around your ankle while the other point fixed behind you. Lift your leg up so that your hip and knee are bent to 90°, then lower back down. Keep your hips level throughout the movement.

Strengthening your Psoas muscle is not always necessary, as it isn’t a muscle that requires large amounts of power during day-to-day activities. However if you are feeling like you are lacking power during kicking or other activities then some of these exercises might be helpful.

If you are experiencing pain or problems at the front of your hip, groin or your lower back then seek the advice of one of our Physiotherapists at Enhance Physiotherapy. They will be able to advise you which type of exercises you need to do to minimise your pain and optimise your performance.

Anterior Cruciate Ligament (ACL) injury rehab

Stef’s Anterior Cruciate Ligament (ACL) Injury Treatment

Stef Yeh is one of our fantastic Physio’s here at Enhance Physiotherapy. She started at the Mandurah clinic earlier this year after moving from Melbourne. She has always been a keen sportsperson and in the past has played soccer at an elite level. Shortly after starting work here in Perth she ruptured her right anterior cruciate ligament (ACL) while playing a social soccer match. Stef has kindly granted us permission to follow her recovery with a series of blogs to give us an insight into the rehab protocol after a major injury. We’ve asked Stef to describe her injury for us:

‘’A few months ago after moving from Melbourne to Perth, I injured my knee following an awkward tackle while playing soccer. During the incident, I felt my knee pop and immediately knew something wasn’t right. After being assessed by my wonderful colleagues I was off for an MRI scan. Results showed that I had a complete rupture of my anterior cruciate ligament (ACL)”

Complete anterior cruciate ligament (ACL) ruptures typically require surgery where a graft is taken of the hamstring tendon or the patella tendon and is this is used to reconstruct the anterior cruciate ligament (ACL) to support the knee. This injury also has a long recovery time, usually in excess of 12 months to return to sport. In order to return to sport the person needs to undergo a long period of rehabilitation to increase the strength in the muscles around the knee to a level where they are strong enough to prevent re-injury.

Post Anterior Cruciate Ligament (ACL) Operation Recovery
Post Anterior Cruciate Ligament (ACL) Operation – Enhance Physiotherapy

Stef had a right anterior cruciate ligament (ACL) reconstruction six weeks ago:

“Immediately after the operation I was able to put weight on my leg with minimal support. I returned home from hospital the next day and spent about two weeks resting and focusing on swelling and pain management. I am now up and moving about and have already gone back to work. Although walking can be slow and frustrating, I have actually had very little pain. However, I have lost a lot of strength in my right leg and I can see an obvious change in the size of my leg muscles compared to my left leg. Currently my rehab goals are focussed on getting full movement in my knee and doing some gentle muscle exercises.”

Although it’ll be a long time before Stef is able to play soccer again, she is already making great progress with her rehabilitation and her strength is improving every week! We will keep you updated on Stef’s progress. A big thanks to Stef and we wish her a good recovery!