Rehabilitation for PCL Injuries
The following guidelines for rehabilitation of a posterior cruciate ligament injury is for information purposes only. We recommend seeking professional advice before undertaking any rehabilitation programme.
When might surgery be required?
- Surgery for a ruptured posterior cruciate ligament is often required when other structures in the knee are also damaged for example the anterior cruciate ligament or lateral ligaments.
- Also, if there is rotational laxity, or the athletes lower leg twists more than normal in relation to the upper leg.
Rehabilitation of a posterior cruciate ligament injury can be split into 4 phases:
Phase 1: Immediately following injury
Aims - To control swelling, maintain the ability to straighten and bend the leg and to begin strengthening exercises for the leg muscles when possible.
Duration - 2 weeks.
- Rest from aggravating activities.
- Use crutches if necessary.
- Complete rest for the first 48 hours, after that let pain be the guide to the speed of progression of rehabilitation.
- Apply cold therapy and compression as soon as possible following injury and for 15 minutes every 2 hours for the next 24 to 48 hours.
- The frequency of application can be gradually reduced over the next few days to no less than 3 times a day and always after mobility or strengthening exercises.
- Stretching exercises for the lower leg and upper body. Calf stretches, hamstring stretch, ankle mobility, pain free knee mobility exercises. If it hurts, do not do it.
- Strengthening exercises (pain free) - static quads, static hamstring holds, calf raises (both legs).
- After week 1, the athlete may be able to maintain aerobic fitness with stationary cycling. By the end of week 2, the athlete should aim to be walking normally without aids.
Phase 2: After week 2
Aims - To completely eliminate swelling, regain full mobility and build on strengthening exercises. By the end of this phase the athlete may be able to do 'proper' cycling or light swimming.
Duration - 2 weeks.
- Apply cold therapy and compression 3 times a day until swelling is eliminated.
- Once this is achieved, apply cold after every training session.
- Mobility exercises - continue to work on these if full mobility has not been achieved.
- Otherwise progress onto more usual stretching exercises as long as they do not cause pain in the knee.
- Strengthening exercises - continue with phase 1 exercises and also begin to include standing static quads (instead of sitting), half squats (both legs), hip raises, hip exercises against resistance, step ups and single leg calf raises.
Phase 3: After week 4
Aims - To regain full strength and begin to return to sports specific training.
Duration - 2 weeks.
- Apply cold therapy and compression following training sessions for 15 to 20 minutes to help prevent swelling returning.
- Stretching exercises for calf muscles, hamstrings, quadriceps, adductors and abductors.
- Progress strength exercises from phase 2 by increasing resistance and moving from double leg exercises to single leg exercises. Plyometric exercises (hopping and bounding may be possible during this stage).
- Begin a gradual return to running. Once the athlete can run for 20 to 30 minutes without any problems then speedwork can be gradually introduced. Start at 50% of maximum speed and increase each session to 90% of maximum speed.
- Include backwards and sideways running drills as well as quick changes of direction.
Phase 4: After week 6
Aims - To return to sports specific training and competition.
Duration 2 weeks.
- Cold therapy and compression should not be required during this stage. If there is still swelling on the knee it may be necessary to go back a stage or two.
- Full sports specific flexibility training should be done through regular stretching before and after training sessions, on a daily basis.
- Sports massage techniques to the surrounding muscles will help recovery after training and keep muscles in better condition.
- Sprinting speed should now be near to normal and the athlete able to change direction at speed and perform other sports specific tasks without pain or unease. Normal sports specific training should now be resumed.
- When the athlete is confident they should be returned to sport in a limited capacity for example a footballer may play only 20 minutes of a game.This will gradually introduce them to the demands of competition both physically and psychologically.