Goals | Protection | Exercises | Sets and repetitions | Frequency | Criteria for progression |
Acute phase (2 to 4 weeks)* |
- Reduce pain.
- Improve hip and knee mobility as necessary.
- Prevent muscle atrophy.
| - Exercise at pain level 3/10¶ or less.
| - Isometric quadriceps contractions with 30 to 60 degrees knee flexion (use pillow under knee).
| 2 to 3 sets × 5 reps; 45- to 60-second hold per rep at 7/10¶ effort; 2-minute rest between sets. | 2 to 3 times per day. | - Able to walk down stairs with pain no greater than 3/10.¶
|
- Seated heel slides from knee extended to knee flexed.
| 2 sets × 10 reps; knee flexion should not exceed 90 degrees or cause pain greater than 3/10. | 1 to 2 times per day. |
- Standing hip abduction and adduction.
| 2 sets × 10 reps. | 1 to 2 times per day. |
Subacute phase (4 to 8 weeks)* – Early stage |
- Improve knee and hip mobility and strength.
| - Perform exercises with no more than 3/10 pain.¶
| - Hamstring stretch supine – Perform with knee in full extension and hip at 90 degrees flexion.
| 2 sets × 5 reps; 45-second hold per rep. | Subacute phase training performed 1 to 2 times per day; 2 times preferred. | - Able to walk down stairs and walk at fast pace on level surface with pain no greater than 3/10.
|
- Short-arc quadriceps extension.
| 3 sets × 10 reps; knee flexion no more than 45 degrees. |
- Clamshell (hip external rotation).
| 3 sets × 10 reps. |
Subacute phase – Progressive stage |
- Improve knee and hip mobility and strength.
| - Perform exercises with no more than 3/10 pain.¶
| - Quarter squats (knee flexion ≤45 degrees) – Dumbbell or goblet squats may be used.
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ | Subacute phase training performed 1 to 2 times per day; 2 times preferred. | - Able to perform all exercises with pain no greater than 3/10.
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- Standing exercises with resistance bands:
| 3 sets × 10 reps for each exercise/movement listed. |
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- Hip extension to 45 degrees.
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Functional phase* |
- Improve knee and hip mobility and strength.
- Improve balance.
| | - Half squats (knee flexion ≤75 degrees).
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ | Functional phase training performed once per day. | - Able to perform all exercises with pain no greater than 3/10.
|
- Walking lunge.
| 3 sets × 10 reps/leg; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ |
- Balance exercises:
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| 3 sets × 30 seconds each; build to 60 seconds. |
- Single-leg half squats on affected leg.
| 3 sets × 5 reps.Δ |
- Side step-ups on affected leg.
| 3 sets × 5 reps; use approximately 10 cm step. |
| 1 set; build to 60 seconds – When can hold stance for 60 seconds wearing shoes, perform without shoes, then progress to standing on rolled towel or comparable unstable surface. |
- Stair climbing.
| Begin by walking up and down 5 stairs. Increase the number of stairs by 2 each day, provided pain is no greater than 3/10.¶ Goal is 20 stairs. Complete 1 set daily. |
Sport-specific phase |
- Prepare for return to full sport.
| - Completes exercises with pain no greater than 3/10.
| Exercises vary by type of sport. | - Approximately equal strength of hamstring and quadriceps in each lower extremity.
- Approximately symmetric strength of lower extremities.
- Able to perform full-speed, sport-specific movements without difficulty or pain.
- Able to complete 15 minutes continuous dynamic exercise.
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- Generally includes ballistic movements (eg, skipping, jumping) and sport-specific movements (eg, cutting); gradually increase movement intensity.
| | Sport-specific training performed once per day. |
- Squat (progress to 90 degrees knee flexion).
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ | 2 to 3 times per week on nonconsecutive days. |