Cincinnati SportsMedicine and Orthopaedic Center

Anterior Cruciate Ligament Reconstruction: Delayed Rehabilitation Protocol*

This rehabilitation protocol was developed for patients who have anterior cruciate ligament
(ACL) reconstruction and one of the following:
 Concomitant meniscal repair, complex or in avascular region
 Concomitant ligament reconstruction
 Concomitant patellofemoral realignment procedure
 Significant articular cartilage lesion
 ACL revision reconstruction
 Marked physiological laxity (expect high ACL forces postoperatively)

The protocol is divided into 7 phases according to postoperative weeks (for instance, Phase I =
Postoperative Weeks 1-2). Each phase has several categories including:
 General observation of the patient's condition (weight bearing, pain, hemarthrosis,
muscle control)
 Evaluation of specific variables with goals identified for each
 Treatment and exercise program, according to frequency and duration
 Rehabilitation goals which must be achieved to enter into the next phase

The overall goals of the reconstruction and rehabilitation are to:

 Control joint pain, swelling, hemarthrosis (minimal or none)
 Regain normal knee flexion and extension
 Regain a normal gait pattern and neuromuscular stability for ambulation
 Regain normal quadriceps, hamstring lower extremity muscle strength
 Regain normal proprioception, balance, and coordination for desired activities
 Achieve optimal functional outcome based on orthopaedic and patient goals

The supervised rehabilitation program is supplemented with a home self-management program

which the patient performs on a daily basis. The therapist must evaluate the patient thoroughly to
implement the enclosed protocol and should see the patient in the clinic for therapeutic
procedures and modality treatments which are required for rehabilitation. The majority of this
protocol can be accomplished at home provided patient cooperation and follow through are
present. The approximate number of rehabilitation visits required for each phase are provided.
Additional supervision may be required if a complication develops.

Important postoperative signs to monitor include:

 Swelling of the knee joint or soft tissues
 Abnormal pain response
 Abnormal gait pattern with or without assistive device
 Insufficient flexion or extension motions, limited patellar mobility
 Weakness (strength/control) of the lower extremity, especially the quads/hamstrings
 Insufficient lower extremity flexibility
 Abnormal AP displacement (joint arthrometer testing > 3 mm) early postoperatively
*copyright 1997
The patient is placed into one of four sports activity and occupational activity
categories based on the following scales. It is expected that patients who follow this
protocol desire to return to sports activity levels I or II, or very heavy/heavy occupations.

1. Cincinnati Knee Rating System Sports Activity Scale

(check one)
 Level I - jumping, hard pivoting, cutting sports (basketball, volleyball, football, gymnastics, soccer)
 Level II - running, twisting, turning (tennis, racquetball, handball, ice/field hockey, skiing,
wrestling)
 Level III - light recreational sports (bicycling, swimming - no running, twisting, jumping)
 Level IV - no sports, activities of daily living only

2. Cincinnati Knee Rating System Occupational Rating Scale

Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Factor 6 Factor 7

sitting standing/ walking on Squatting climbing lifting/ pounds
walking uneven carrying carried
ground
0  8-10 0 0 0 0 0 0 0 0 0 0 0 0-5
hrs/day hrs/day hrs/day times/day times/day times/day lbs
1  6-7 2 1 2 1 1  1-5 2  1 flight 1  1-5 1  6-10
hrs/day hrs/day hrs/day times/day 2 times/day times/day lbs
2  4-5 4  2-3 4  2-3 2  6-10 4  3 flights 2  6-10 2  11-20
hrs/day hrs/day hrs/day times/day 2 times/day times/day lbs
3  2-3 6  4-5 6  4-5 3  11-15 6  10 flights/ 3  11-15 3  21-25
hrs/day hrs/day hrs/day times/day ladders times/day lbs
4 1 8  6-7 8  6-7 4  16-20 8  ladders 4  16-20 4  26-30
hrs/day hrs/day hrs/day times/day with weight times/day lbs
2-3 days/week
5 0 10  8-10 10  8-10 5 > 20 8  ladders 5 > 20 5 > 20
hrs/day hrs/day hrs/day times/day daily with times/day lbs
weight

_______ points x 2 =______ total points

Occupation Rating Total Points

 Disabled 0
 Very light 1-20
 Light 21-40
 Moderate 41-60
 Heavy 61-80
 Very heavy > 80
Physical Therapy Visit Timeline*
Phase Weeks Postoperative Minimum # Visits Maximum # Visits
1 1-2 2 4
2 3-4 2 4
3 5-6 1 2
4 7-8 1 2
5 9-12 1 2
6 13-26 2 3
7 27-52 2 4
Total 11 21

*Physician Notification
The physician will be notified if the patient (1) fails to meet the expected goals for
each phase of the protocol, (2) has a persistent joint effusion, (3) develops a chronic pain
syndrome, (4) develops abnormal AP displacement on arthrometer testing (> 3 mm
difference), (5) complains of giving-way, (6) has difficulty with ambulation, or (7) has a
limitation of knee motion or patellar mobility.
These problems could result in a modification of this protocol and necessitate further
visits to the physical therapist.

Discharge Criteria (If goals for sports and occupation place patient into different
categories, use category with highest functional demand criteria. For symptoms, use
Symptom Rating Form found on next page.)

Sports Activity Level I or Heavy/Very Heavy Occupational Rating*

No pain, swelling, giving-way with level 10 on Symptom Rating Form
KT-2000 < 3 mm (I-N, 134 N, total A/P)
Biodex strength testing: quadriceps & hamstrings strength > 85% of opposite limb
Function testing: 2 hop tests, limb symmetry > 85%
Sports Activity Level II or Moderate Occupational Rating*
No pain, swelling, giving-way with level 8 on Symptom Rating Form
KT-2000 < 3 mm (I-N, 134 N, total A/P)
Biodex strength testing: quadriceps & hamstrings strength > 80% of opposite limb
Function testing: 2 hop tests, limb symmetry > 85%
Sports Activity Level III or Light Occupational Rating
No pain, swelling, giving-way with level 6 on Symptom Rating Form
KT-2000 3-5 mm (I-N, 134 N, total A/P)
Biodex strength testing: quadriceps & hamstrings strength > 70% of opposite limb
Function testing: 2 hop tests, limb symmetry > 75%
Sports Activity Level IV (ADL) or Very light Occupational Rating
No pain, swelling, giving-way with level 4 on Symptom Rating Form
KT-2000 3-5 mm (I-N, 134 N, total A/P)
Biodex strength testing: quadriceps & hamstrings strength < 70% of opposite limb
Function testing: 2 hop tests, limb symmetry < 75%

*patients desiring to return to sports or strenuous work activities may require 4-6 more physical therapy visits during
postoperative weeks 25-52 for advanced neuromuscular, strength, and activity-specific training to prevent reinjury.
Cincinnati Knee Rating System Symptom Rating Form
Scale Description
10 Normal knee, able to do strenuous work/sports with jumping, hard pivoting
8 Able to do moderate work/sports with running, turning and twisting; symptoms with strenuous work/sports
6 Able to do light work/sports with no running, twisting or jumping; symptoms with moderate work/sports
4 Able to do activities of daily living alone; symptoms with light work/sports
2 Moderate symptoms (frequent, limiting) with activities of daily living
0 Severe symptoms (constant, not relieved) with activities of daily living

1. PAIN (circle one)

10 8 6 4 2 0

2. SWELLING (circle one)

10 8 6 4 2 0

3. PARTIAL GIVING-WAY (circle one) (partial knee collapse, no fall to the ground)

10 8 6 4 2 0

4. FULL GIVING-WAY (circle one) (knee collapse occurs with actual falling to the ground)

10 8 6 4 2 0

Return to Activities Warning

Return to strenuous activities after major knee ligament surgery carries the definite risk
of a repeat injury or the potential of compounding the original injury. These risks cannot
always be scientifically assessed. Patients are warned to return to athletic activities
carefully and to avoid any activity in which pain, swelling, or a feeling of instability is
present.

References
Noyes FR, Barber-Westin SD: Anterior cruciate ligament revision reconstruction: Results using a quadriceps tendon-patellar bone
autograft. Am J Sports Med 34, 2006.
Noyes FR and Barber-Westin SD: Revision anterior cruciate ligament surgery with use of bone-patellar tendon-bone autogenous
grafts. J Bone Joint Surg. 83-A: 1131-1143, 2001.
Heckmann TP, Noyes FR, and Barber-Westin SD: Autogenic and allogeneic anterior cruciate ligament rehabilitation. In Knee
Ligament Rehabilitation, Ellenbecker TS (ed), Churchill Livingstone, New York, NY, pp. 132-150, 2000
Noyes FR, Berrios-Torres S, Barber-Westin SD, and Heckmann TP: Prevention of permanent arthrofibrosis after anterior cruciate
ligament reconstruction alone or combined with associated procedures: A prospective study in 443 knees. Knee Surgery, Sports
Traumatology, Arthroscopy 8: 196-206, 2000.
Barber-Westin SD, Noyes FR, and McCloskey JW: Rigorous statistical reliability, validity, and responsiveness testing of the
Cincinnati Knee Rating System in 350 subjects with uninjured, injured, or anterior cruciate ligament-reconstructed knees. Am J.
Sports Med. 27: 402-416, 1999.
Barber-Westin SD, Noyes FR, Heckmann TP, and Shaffer BL: The effect of exercise and rehabilitation on anterior-posterior knee
displacements following anterior cruciate ligament autograft reconstruction. Am. J. Sports Med. 27: 84-93, 1999.
Rubman MH, Noyes FR, and Barber-Westin SD: Arthroscopic repair of meniscal tears that extend into the avascular zone. A review
of 198 single and complex tears. Am. J. Sports Med. 26: 87-95, 1998.
Noyes FR and Barber-Westin SD: Anterior cruciate ligament reconstruction with autogenous patellar tendon graft in patients with
articular cartilage damage. Am. J. Sports Med. 25: 626-634, 1997.
Noyes FR and Barber-Westin SD: A comparison of results in acute and chronic anterior cruciate ligament ruptures of arthroscopic-
assisted autogenous patellar tendon reconstruction. Am J Sports Med 25: 460-471, 1997.
Noyes FR and Barber-Westin SD: Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early
protected postoperative motion to decrease arthrofibrosis. Am. J. Sports Med. 25: 769-778, 1997.
Noyes FR, Barber SD, and Mangine RE: Abnormal lower limb symmetry determined by function hop tests after anterior cruciate
ligament rupture. Am J Sports Med 19: 513-518, 1991.
 Cincinnati SportsMedicine and Orthopaedic Center
Rehabilitation Protocol Summary for
Delayed ACL Reconstruction

Postoperative Weeks Postoperative Months

1-2 3-4 5-6 7-8 9-12 4 5 6 7-12
Brace: postoperative & functional X X X X X X X
Range of motion minimum goals:
0°-90° X
0°-120° X
0°-135° X
Weight bearing:
Toe touch X
1/4 - 1/2 body weight X
3/4 - Full X
Patella mobilization X X X
Modalities:
Electrical muscle stimulation (EMS) X X X X
Pain/edema management (cryotherapy) X X X X X X X X X
Stretching:
Hamstring, gastroc-soleus, iliotibial X X X X X X X X X
band, quadriceps
Strengthening:
Quad isometrics, quad-ham isometrics X X X X X
co-contraction, straight leg raises,
active knee extension
Closed-chain: gait retraining, toe raises, X X X X X X
wall sits, mini-squats
Knee flexion hamstring curls (90°) X X X X X X X
Knee extension quads (90°-30°) X X X X X X X
Hip abduction-adduction, multi-hip X X X X X X X
Leg press (70°-10°) X X X X X X X
Balance/proprioceptive training:
Weight-shifting, mini-trampoline, X X X X X X X
BAPS, KAT, plyometrics
Conditioning:
UBE X X X
Bike (stationary) X X X X X X X
Aquatic program X X X X X X
Ellipical machine X X X X X X
Swimming (kicking) X X X X X
Walking X X X X X
Stair climbing machine X X X X X
Ski machine X X X X X
Running: straight X X
Cutting: lateral carioca, figure 8’s X
Full sports X
BAPS = Biomechanical Ankle Platform System (Camp, Jackson, MI), KAT = Kinesthetic Awareness
Trainer (Breg, Inc., Vista, CA), UBE = upper body ergometer.
 Cincinnati SportsMedicine and Orthopaedic Center Rehab Protocol: ACL – Delayed
Phase 1. Weeks 1-2 (Visits: 2-4)

General  Toe-touch weight bearing to 25% body weight when:

Observation - Pain controlled - 0° Knee extension
- Hemarthrosis controlled
- Voluntary quadriceps contraction achieved
Evaluation Goals
 Pain Controlled
 Hemarthrosis Mild
 Patellar mobility Good
 ROM minimum 10°-80°
 Quadriceps contraction & patella migration Good
 Soft tissue contracture None
Frequency Duration
3-4 x/day Range of motion
10 minutes ROM (passive)
Meniscus repair (complex), MCL, revision, EA = 0°-90°
Patellar realignment = 0°-75°
Posterolateral procedure = 0°-90°
(unless exam shows hyperelastic tissue type,
then hold 15°-70° for 2 weeks postop)
Patella mobilization
Ankle pumps (plantar flexion with resistance band)
Hamstring, gastroc-soleus stretches 5 reps x 30 secs

3 x/day Strengthening
15 minutes Straight leg raises (flexion) 3 sets x 10 reps
Active quadriceps isometrics (based on ROM limits) 1 set x 10 reps
Knee extension (active-assisted) 3 sets x 10 reps

As required Modalities
Electrical muscle stimulation 20 minutes
Cryotherapy 20 minutes
Goals  ROM (see above, depends on procedure)
 Adequate quadriceps contraction
 Control inflammation, effusion
EA, iliotibial band extra-articular procedure
Cincinnati SportsMedicine and Orthopaedic Center Rehab Protocol: ACL – Delayed
Phase 2. Weeks 3-4 (Visits: 2-4)

General  50% weight bearing when:

Observation - Pain controlled - Hemarthrosis controlled
- Voluntary quadriceps contraction achieved
Evaluation Goals
 Pain Controlled
 Effusion Mild
 Patellar mobility Good
 ROM minimum 0°-90°
 Quadriceps contraction & patella migration Good
 Soft tissue contracture None
 Joint arthrometer (3 weeks, 20 lbs) < 3 mm
Frequency Duration
3-4 x/day Range of motion
10 minutes ROM (passive, 0°-90°)
Patella mobilization
Ankle pumps (plantar flexion with resistance band)
Hamstring, gastroc-soleus stretches 5 reps x 30 secs

2-3 x/day Strengthening

20 minutes Straight leg raises (flexion, extension, adduction) 3 sets x 10 reps
Isometric training:
Multi-angle (0°, 60°) 1 set x 10 reps
Active quadriceps (full extension)
Quad/ham co-contraction with EMS
Toe raises/heel raises 3 sets x 10 reps
Knee extension (90°-45°, no resistance) 3 sets x 10 reps
Knee flexion (active, 0°- 90°) 3 sets x 10 reps
Multi-hip machine (flexion, extension, abduction, adduction) 3 sets x 10 reps
Leg press (70°-10°) 3 sets x 10 reps
Closed-chain 3 sets x 20 reps
- Mini-squats (0°-45°, 50% weight bearing) to fatigue
- Wall sits
- Wall sits with EMS

2 x/day Aerobic conditioning

10 minutes UBE

As required Modalities
Electrical muscle stimulation 20 minutes
Cryotherapy 20 minutes
Goals  ROM 0°-110°  Control inflammation, effusion
 Adeqate quadriceps contraction  50% weight bearing
 Cincinnati SportsMedicine and Orthopaedic Center Rehab Protocol: ACL – Delayed
Phase 3. Weeks 5-6 (Visits: 1-2)

General  Full weight bearing when:

Observation - Pain controlled without narcotics - Effusion controlled
- ROM 0°-100° - Muscle control throughout ROM
- Dynamic control varus/valgus
Evaluation Goals
 Pain Mild
 Effusion Minimal
 Patellar mobility Good
 ROM 0°-120°
 Muscle control 3/5
 Inflammatory response None
 Joint arthrometer (6 weeks, 30 lb.s) < 3 mm
Frequency Duration
3 x/day Range of motion
10 minutes ROM (passive, 0°-120°)
Patella mobilization
Ankle pumps (plantar flexion with resistance band)
Hamstring, gastroc-soleus stretches 5 reps x 30 secs

2-3 x/day Strengthening

20 minutes Straight leg raises (ankle weight, < 10% of body weight) 3 sets x 10 reps
Isometric training: multi-angle (90°, 60°, 30°) 2 sets x 10 reps
Heel raise/toe raise 3 sets x 10 reps
Hamstring curls (active, 0°-90°) 3 sets x 10 reps
Knee extension (90°-45°, with resistance) 3 sets x 10 reps
Closed-chain
- Wall sits 5 reps
- Mini-squats 3 sets x 20 reps
- Lunge (no resistance)
Multi-hip machine (flexion, extension, abduction, adduction) 3 sets x 10 reps
Leg press (70°-10°) 3 sets x 10 reps

3 x/day Balance training

5 minutes Weight shift side/side and forward/back 5 sets x 10 reps
Balance board/2 legged
1-2 x/day Cup walking
5 minutes Single leg stance – stable platform 5 reps

2 x/day Aerobic conditioning

10 minutes UBE
Water walking
Stationary bicycling (patellofemoral precautions)

As required Modalities
Electrical muscle stimulation 20 minutes
Cryotherapy 20 minutes
Goals  ROM 0°-125°  Control inflammation, effusion
 Muscle control  Full weight bearing
 Early recognition complications
(motion loss, RSD, increased AP displacement, patellofemoral)
 Cincinnati SportsMedicine and Orthopaedic Center Rehab Protocol: ACL – Delayed
Phase 4. Weeks 7-8 (Visits: 1-2)

General  Independent ambulation when:

Observation - Pain controlled - Effusion controlled
- ROM 0°-120° - Muscle control throughout ROM
- Dynamic control varus/valgus
Evaluation Goals
 Pain No RSD
 Effusion Minimal
 Patellar mobility Good
 ROM 0°-135°
 Muscle control 4/5
 Inflammatory response None
 Gait Symmetrical
 Joint arthrometer (8 weeks) < 3 mm
Frequency Duration
2 x/day Range of motion
10 minutes Hamstring, gastroc-soleus stretches 5 reps x 30 secs

2 x/day Strengthening
20 minutes Straight leg raises (ankle weight, < 10% body weight) 3 sets x 10 reps
Straight leg raises, rubber tubing 3 sets x 30 reps
Isometric training: multi-angle (90°, 60°, 30°) 3 sets x 20 reps
Heel raise/toe raise 3 sets x 10 reps
Hamstring curls (active, 0°-90°) 3 sets x 10 reps
Knee extension with resistance (90°-45°) 3 sets x 10 reps
Leg press (70°-10°) 3 sets x 10 reps
Closed-chain
- Wall sits 3 sets x 20 reps
- Mini-squats (rubber tubing, 0°-30°) to fatigue x 3
- Lunge
Multi-hip machine (flexion, extension, abduction, adduction) 3 sets x 10 reps
Leg press (70°-10°) 3 sets x 10 reps

3 x/day Balance training

5 minutes Balance board/2 legged
Lateral step-ups: 2-4”

2 x/day Aerobic conditioning (patellofemoral precautions)

10 minutes UBE
Stationary bicycling
Water walking
Stair machine (low resistance, low stroke)
Ski machine (short stride, level, low resistance)
Ellipical machine (low resistance)
As required Modalities
Cryotherapy 20 minutes
Goals  ROM 0°-135°  Full weight bearing, normal gait
 Control inflammation, effusion
 Muscle endurance
 Recognize complications
(motion loss, RSD, increased AP displacement)
 Recognition patellofemoral changes
 Cincinnati SportsMedicine and Orthopaedic Center Rehab Protocol: ACL – Delayed
Phase 5. Weeks 9-12 (Visits: 1-2)

General  Full weight bearing  ROM 0°-135°

Observation  No effusion, painless ROM, joint stability
 Performs ADL, can walk 20 minutes without pain
Evaluation Goals
 Manual muscle test 4/5
Hamstrings, quadriceps, hip abductors/adductors/flexors/extensors
 Swelling None
 Joint arthrometer (12 weeks) 3 mm
 Patellar mobility Good
 Crepitus None/slight
Frequency Duration
2 x/day Range of motion
10 minutes Hamstring, gastroc-soleus, quad, ITB stretches 5 reps x 30 secs

2 x/day Strengthening
20 minutes Straight leg raises, rubber tubing 3 sets x 30 reps
Hamstring curls (active, 0°-90°) 3 sets x 10 reps
Knee extension with resistance (90°-45°) 3 sets x 10 reps
Leg press (70°-10°) 3 sets x 10 reps
Closed-chain 3 sets x 20 reps
- Wall sits to fatigue x 3
- Mini-squats (rubber tubing, 0°-40°)
- Lunge 3 sets x 10 reps
Multi-hip machine (flexion, extension, abduction, adduction) 3 sets x 10 reps

3 x/day Balance training

5 minutes Balance board/2 legged
Single leg stance – unstable platform

1-2 x/day Aerobic conditioning (patellofemoral precautions)

15-20 Stationary bicycling
minutes Water walking
Swimming (straight leg kicking)
Walking
Stair machine (low resistance, low stroke)
Ski machine (short stride, level, low resistance)
Ellipical machine (low resistance)

As required Modalities
Cryotherapy 20 minutes
Goals  Increase strength and endurance
 Cincinnati SportsMedicine and Orthopaedic Center Rehab Protocol: ACL – Delayed
Phase 6. Weeks 13-26 (Visits: 2-3)

General  No effusion, painless ROM, joint stability

Observation  Performs ADL, can walk 20 minutes without pain
 ROM 0°-135°
Evaluation Goals
 Isometric test (% difference quads & hams) 30
 Swelling None
 Joint arthrometer < 3 mm
 Patellar mobility Good
 Crepitus None/slight
Frequency Duration
2 x/day Range of motion
10 minutes Hamstring, gastroc-soleus, quad, ITB stretches 5 reps x 30 secs

2 x/day Strengthening
20 minutes Straight leg raises, rubber tubing 3 sets x 30 reps
Hamstring curls (active, 0°-90°) 3 sets x 10 reps
Knee extension with resistance (90°-45°) 3 sets x 10 reps
Leg press (70°-10°) 3 sets x 10 reps
Multi-hip machine (flexion, extension, abduction, adduction) 3 sets x 10 reps
Closed-chain:
Wall sits 5 reps
Mini-squats 3 sets x 20 reps
Lateral step-ups (2-4” block) 3 sets x 10 reps

3 x/day Balance training

5 minutes Balance board/2 legged
Single leg stance – unstable platform
Plyoback – ball toss

3 x/week Aerobic conditioning (patellofemoral precautions)

15-20 Stationary bicycling
minutes Water walking
Swimming (kicking)
Walking
Stair machine (low resistance, low stroke)
Ski machine (short stride, level, low resistance)

3 x/week Running program (6 months, straight, 30% deficit isometric test)

10 minutes Jog 1/4 mile
Walk 1/8 mile
Backward run 20 yards

As required Modalities
Cryotherapy 20 minutes
Goals  Increase strength and endurance
 Cincinnati SportsMedicine and Orthopaedic Center Rehab Protocol: ACL – Delayed
Phase 7. Weeks 27-52 (Visits: 2-3)
General  No effusion, painless ROM, joint stability
Observation  Performs ADL, can walk 20 minutes without pain
Evaluation Goals
 Isokinetic test (isometric + torque 300°/sec, % diff quads & hams) 10-15
 Swelling None
 Joint arthrometer 3 mm
 Patellar mobility Good
 Crepitus None/slight
 Single-leg function tests (9 mos: hop distance, timed hop, 85
% inv/uninv)
Frequency Duration
2 x/day Range of motion
10 minutes Hamstring, gastroc-soleus, quad, ITB stretches 5 reps x 30 secs

1 x/day Strengthening
20-30 Straight leg raises, rubber tubing (high speed) 3 sets x 30 reps
minutes Hamstring curls (active, 0°-90°) 3 sets x 10 reps
Knee extension with resistance (90°-45°) 3 sets x 10 reps
Leg press (70°-10°) 3 sets x 10 reps
Multi-hip machine (flexion, extension, abduction, adduction) 3 sets x 10 reps

3 x/day Balance training

5 minutes Balance board/2 legged
Single leg stance

3 x/week Aerobic conditioning (patellofemoral precautions)

20-30 Stationary bicycling
minutes Water walking
Swimming (kicking)
Walking
Stair machine (low resistance, low stroke)
Ski machine (short stride, level, low resistance)

3 x/week Running program (straight,)

15-20 Jog – interval training (20, 40, 60, 100 yards) 1/4 mile
minutes Walk 1/8 mile
Backward run 20 yards
3 x/week Cutting program – lateral, carioca, figure 8’s 20 yards
(20% deficit isokinetic test)
3 x/week Functional training
Plyometric training: box hops, level, double-leg 15 secs,
Sport specific drills (10-15% deficit isokinetic test) 4-6 sets

As required Modalities
Cryotherapy 20 minutes
Goals  Increase function  Maintain strength, endurance
 Return to previous activity level