Dr. Mitchell W. Larsen MD
Director of Education
Central Utah Sports Medicine
1055 N 500 W Bld C Ste 121
Provo, UT 84604
(801)373-7350

LATERAL RELEASE PROTOCOL

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REHABILITATION PROGRESSION:

The following is a general guideline for progression of the rehabilitation program following lateral release. Progression through each phase should take into consideration patient status (e.g. healing, function) and physician advisement. Please consult the attending physician if there is uncertainty regarding the advancement of a patient to the next phase of rehabilitation.

PHASE I

Begins immediately following surgery and lasts approximately 2 weeks.

Goals:

• Protect healing soft tissue structures

• Improve knee flexion and extension range of motion

• Increase lower extremity strength including quadriceps muscle re-education

• Education of patient regarding limitations and the rehabilitation process

• Educate patient on rehabilitation progression

Weightbearing Status

• Weightbearing as tolerated with 2 crutches

Therapeutic Exercises:

• Quad sets and isometric adduction with biofeedback for VMO

• Heel slides

• Ankle Pumps

• Non-weight bearing gastroc/soleus hamstring stretches

• SLR in flexion with turnout, adduction, and extension. Begin hip abduction at approximately 3 weeks

• Functional Electrical Stimulation may be used for trace to poor quad contraction

• Begin aquatic therapy at 2 weeks with emphasis on normalization of gait

• Stationary bike for ROM when patient has sufficient knee flex

PHASE II

Begins approximately 2 weeks post-op and extends to approximately 4 weeks post-op. Criteria for advancement to Phase II:

• Good quad set

• Approximately 90° active knee flexion

• Full active knee extension

• No signs of active inflammation

Goals:

• Increase flexion ROM

• Increase lower extremity strength and flexibility

• Restore normal gait

• Improve balance and proprioception

Weight Bearing Status:

May begin ambulation WBAT without crutches if the following criteria are met:

• No extension lag with SLR

• Full active knee extension

• Knee flexion of 90-100°

• Non-antalgic gait pattern (may ambulate with one crutch or a cane to normalize gait before ambulating without assistive device).

Therapeutic Exercise:

• Wall slides from 0-45° knee flexion, progressing to mini-squats

• 4-way hip flexion, extension, and adduction

• closed kinetic chain terminal knee extension with resistive tubing or weight machine

• Calf raises

• Balance and proprioceptive activities (including single leg stance, KAT and BAPS)

• Treadmill walking with emphasis on normalization of gait pattern

• ITB and hip flexor stretching

PHASE III

Begins approximately 4 weeks post-op and extends through approximately 8 weeks post-op. Criteria for advancement to Phase III:

• Normal gait

• Good to normal quadriceps strength

• Good dynamic control with no evidence of patellar lateral tracking or instability

• Clearance by physician to begin more concentrated closed kinetic chain progression

Goals:

• Restore any residual loss of range of motion

• Continue improvement of quadriceps strength

• Improve functional strength and proprioception

Therapeutic Exercises:

• Quadriceps stretching when full knee flexion has been achieved

• Hamstring curl

• Leg press from 0-45-degrees knee flexion

• Closed kinetic chain progression

• Abduction on 4-way hip

• Stair master

• Nordic Trac

• Jogging in pool with wet vest or belt

PHASE IV:

Begins approximately 8 weeks post-op and extends until patient has returned to work or desired activity. Criteria for advancement to Phase IV:

• Release by physician to resume full or partial activity

• No patellofemoral or soft tissue complaints

• No evidence of patellar instability

• Necessary joint range of motion, muscle strength and endurance, and proprioception to safely return to work or athletic participation

Goals:

• Continue improvements in quadriceps strength

• Inprove functional strength and proprioception

• Return to appropriate activity level

Therapeutic Exercise:

Functional progression which may include but is not limited to:

• Slide board

• Walk/jog progression

• Forward and backward running, cutting, figure 8, and carioca

• Plyometrics

• Sport-specific drills

Work Hardening program as prescribed by physician