By Guest Blogger Lauren Calamari, PT, DPT

The early days of rehab after ACL surgery are not glamorous. However, they are vitally important for setting up long-term success. Regaining knee range of motion is one of the first post-operative goals. While knee flexion (bending) is important, regaining knee extension (straightening) early on is a key factor for successful recovery. In fact, research shows us that failing to do so can put you at risk for negative long-term outcomes1,2,3. It is important to note that not all surgeries are the same, and many people have additional injuries that are also addressed during surgery. This can change the overall post-operative precautions, including range of motion, so always consult with your surgeon and/or physical therapist about what is best for your knee.

Achieving terminal knee extension (getting all the way to your knees end range of straightening motion) is important for several reasons. It is necessary to have a normal gait (walking) pattern once you can begin walking. It can also help to reduce post-operative swelling. Reducing swelling and attaining full extension allows your quadriceps (thigh) muscles to activate properly. In fact, swelling can “shut down” or inhibit the muscles surrounding your knee. This is called quad inhibition. In turn, quad inhibition will make it harder to diminish lingering swelling. You can see how this can become a vicious cycle! The bottom line is, regaining terminal knee extension as quickly as possible will help lessen these early challenges. Early quad activation will allow you to strengthen your quads adequately as you advance through your rehab process. Sufficient quad strength is essential for a safe return to your prior activity, no matter what that is. Strong quads give your knee stability and can help prevent secondary knee pain as you progress.

You can see why emphasizing knee extension early on is so important! Unfortunately, the first days and weeks following surgery can be exhausting and overwhelming, which can make accomplishing this goal tough. People often feel compelled to rest with their knee slightly bent or sit with a pillow under their knee. While this is more comfortable, it will make knee extension more difficult. During this time, it is easier to focus on a few simple tasks vs. a long list of exercises. So, here are a few simple extension exercises to focus on, which most people can perform right away:

  • Heel Prop: Sit with your leg out in front of you and prop your heel on an elevated surface (this could be pillows, the arm of the couch, or the coffee table). Make sure only your heel is on the propped surface and there is space underneath your knee for it to fully straighten – the more elevated your leg is, the better (elevation also helps decrease swelling). Try to relax and let gravity push your knee down.


Try to tolerate this a couple minutes at a time. Over time, work up to 10 minutes of propping, 5 times per day. 

  • (Assisted) Heel Pop: Not to be confused with the heel prop. This will help with end range extension and quad activation. Sit with your leg out in front of you on a firm, flat surface. Loop a non-stretchy strap (dog leash, towel, fitted sheet will work) around the bottom of your foot. Gently pull on the strap to lift your heel off the ground while trying to squeeze your quad and push your knee down. 


You might have to work up to these. Try 10+ squeezes at a time, holding each squeeze/heel pop for at least 5 seconds. Once able, do this several times per day following the heel prop.

  • Quad Set: Sit on a flat, firm surface with your leg out in front of you. Squeeze your quad while trying to push the back of your knee down toward the surface. This addresses quad activation, which can be very challenging at first. Sometimes it helps to practice on your other leg!

Try 20+ squeezes at a time, holding each squeeze for at least 3 seconds. It is good to do this right after you finish the heel prop & heel pop.

Performing these exercises is an excellent way to work toward achieving full knee extension after ACL surgery. I encourage everyone to work with a trusted, experienced physical therapist throughout their recovery process, and always consult their surgeon before performing any independent exercise. However, doing these on your own as part of a home exercise program will be an important part of the early rehab process, and will ultimately set you up for long-term success!

Disclaimer: Please consult your physician or health professional before engaging in any physical activity and stop if you experience pain or discomfort.

About Lauren Calamari, PT, DPT

Lauren graduated from the Medical University of South Carolina with her Doctor of Physical Therapy. She earned her undergraduate degree in Exercise and Sport Science from the University of North Carolina at Chapel Hill. She has experience treating middle school, high school, and college athletes, as well as active adults of all ages. Lauren currently works in an outpatient physical therapy clinic specializing in sports-specific treatment in Baltimore, MD. Her other professional interests include writing, education, coaching, and management.

By Andrew Kwan

As a working artist and graphic designer, I spend most days at my computer and drawing table. While it’s not as hazardous a job as say—working on an oil rig or playing football in the NFL, being a professional artist has its own risks and effects on the human body.

For much of 2020 and 2021, I struggled with intense and debilitating injuries to my wrist and back that no amount of ice and rest seemed to fix. Once I gained a better understanding of my own body mechanics and bad habits during work hours, the road to recovery was simple!

The act of using my arm, hand and wrist to draw, paint, type and use a mouse opens me up to injury do to overuse. At the same time, if I’m sitting all day while working, I am also putting stress on my lower spine and the soft tissues around my lower back and pelvis. This will also create opportunity for injury caused by underuse and inactivity. These are also common risks to office workers. Since there are so many people who fall into these types of work habits, it can be easy to dismiss aches and pains we develop as normal, trivial or nothing to worry about.

By overusing and underusing parts of our bodies without regular care and maintenance, muscles become tight and stiff. The tighter they become, the more likely they are to sustain injuries causing painful spasms and cramps or chronic conditions like Carpel Tunnel Syndrome, Tendonitis or Tendinosis.

While we all know that our bodies develop issues as we grow older and as time goes on, the frequency of workers pulling long hours and overtime increases the risk of developing chronic, long-lasting problems a lot earlier in life. Taking frequent breaks and giving your body rest from what seems like mundane, low-energy activity at the work table is incredibly important.

When beginning these exercises after an injury, we have to be mindful of giving ourselves enough time to properly rest and ease into becoming active again. During the rest phase of our recovery, our bodies are mending themselves, but the decrease of regular activity will also cause loss of strength. If we rest for a couple weeks and find that our pain has subsided, diving into regular, everyday activity or an intense training regiment immediately, will open you up to re-injuring yourself. So, be sure to start slow and ramp up your activity levels at a comfortable pace!

Creating a regular fitness routine to re-strengthen the areas at risk and keep them loose and flexible makes a big difference. To get started on making a positive change to your work habits, try out some of these easy stretches and exercises that are convenient and effective to fit into a busy schedule, that you can do anywhere and anytime!


  • Dumbbell Wrist Curl
  • Dumbbell Reverse Curl
  • Wrist Flexion/Extension
  • Wrist Radial/Ulnar Deviation
  • Finger Extension with Thumb Abduction with Rubber Band


  • Internal Rotation Stretch with Stick
  • Shoulder External Rotation with Dowel
  • Unilateral Pectoralis Stretch
  • Shoulder Shrugs
  • Neck Angle Up/Down

Lower Back/Pelvis

  • Bridging
  • Child’s Pose
  • Side Bend
  • Lumbar Alternating Leg Quadruped
  • Lower Trunk Rotation
  • Hip Flexor Stretch

About Andrew Kwan

Andrew Sebastian Kwan is a Canadian illustrator and writer. He graduated from Max the Mutt College of Animation and Design in Toronto, Canada with a Diploma for Illustration in Sequential Art. Andrew wrote and illustrated his first creator owned comic book series, GEL, in 2017 and illustrated the graphic novel, THE GRAVEYARD WARS, with Ablaze Publishing in 2020. Andrew also enjoys creating alternative movie posters and his design for Get Out was featured in the New York Times.


The exercises listed above can be found in our exercise prescription service for health professionals, PT-Connect, and in our mobile app for patients, PT-Helper Pro, on both iOS and Android.

Reminder: Please consult your physician or health professional before engaging in any physical activity and stop if you experience pain or discomfort.

Having undergone two ACL surgeries myself, I have an affinity towards seeing new exercises to help patients recover from ACL injuries. One of my favorite physical therapists that I follow on Instagram is Dr. Wesley Wang PT, DPT whose bio includes Sports & ACL Physical Therapy. Many of the exercises shown on Dr. Wang’s Instagram posts are athletes in the recovery process performing mid-stage or late-stage exercises. Compared to my own rehab experience, these athletes are performing advanced exercises leading towards return to play. For competitive athletes looking towards returning to play, working with a sports-based physical therapist may provide them with specific exercises to give them the strength and confidence to return to play and avoid re-injury.

One of the things I realize is that many patients don’t know what to expect after ACL surgery. My last ACL surgery was an out-patient procedure. Within 2 days after the surgery, a Continuous Passive Motion (CPM) machine was delivered to my house to start the process of gently flexing and extending my knee. A week after surgery was my first visit to out-patient physical therapy where my therapist evaluated my knee and provided me with the first of many exercises. Early exercises included Quad Set and Active Assisted Knee Flexion. Among the things I found most surprising post-surgery was how quickly my quadricep muscle mass diminished. Of course, this is why physical therapy is important and why it’s necessary to follow through with your home exercises. In total, it was about 6 months before I was close to being back to pre-surgery leg strength.

Each person will have their own unique recovery experience. Patience, hard work and consistently doing your home exercises will help lead to great outcomes.

PT-Helper has added three new exercises in our exercise library based upon Dr. Wang’s Instagram post.

Step Up Plyometric: Stand in front of a step or short box. Raise one foot above the height of the step. In one continuous motion, drop your foot onto the step then push down with your front foot raising your body up above step while driving your rear leg up in front of you. Push off the step with your forward foot such that your foot rises off the step. Return back down with one leg on the step and the other leg off the step. Raise your front foot of the step and repeat.

Heel Elevated Goblet Squat: Stand straight with your feet slightly wider than shoulder width apart, on top of an incline board. Hold a dumbbell or kettlebell with both hands close to your chest, elbows tight against your body. Tighten your core then bend your knees pushing your butt back while keeping your back straight. Straighten your knees to rise to a standing position. Repeat.

Step Shuffle: Stand to the side of a step with one foot on the step and the other foot to the side of the step. Hop from one side of the step to the other side, alternating which foot remains on top of the step. Repeat.

In addition to the exercises listed above, we have many more exercises in our Knee & Hip category available to help you achieve your recovery or fitness goals.

Reminder: Please consult your physician or health professional before engaging in any physical activity and stop if you experience pain or discomfort.

It’s not uncommon when I tell friends that I have a physical therapy app (to help patients do their exercises) that these friends inquire if I could recommend exercises for them. Recently, I was asked if I could recommend exercises for a friend who injured his Achilles Tendon while playing racquetball. He had recovered from his injury and wanted to start running again but discovered that his push-off strength was imbalanced. Not being a physical therapist, I don’t prescribe exercises but was able to point him towards Dr. Leada Malek’s recent Instagram post where she demonstrates several Achilles Tendon exercises. My friend was able to find these exercises in PT-Helper Pro and create his own unique exercise program to build up his calf strength.

Some exercises recommended by Dr. Malek are:

Eccentric Heel Raise – 2 Up 1 Down: Stand facing a wall with your feet shoulder width apart. Place your hands on the wall for support. Raise both heels simultaneously. Transfer your weight to one leg and raise the other leg while keeping your heel raised. Hold. Slowly lower your heel back to the ground. Lower your raised foot. Repeat.

Weighted Seated Heel Raise: Sit on a chair and place a weight on top of your thigh of your affected leg. Raise your heel off the floor. Hold. Lower your heel back to the ground. Repeat.


Weighted Seated Heel Raise with Riser Block: Sit on a chair and put a riser block under your affected forefoot so that your heel is below the level of the block. Place a weight on top of your thigh of your affected leg. Raise your heel above the level of the block. Hold. Lower your heel so that it is below the level of the block. Repeat.

Squat with Heel Raise: Stand with proper form with your feet shoulder width apart. Bend your knees while lowering your hips to go into a squat position. Holding the squat position, raise both heels off the floor. Hold. Lower both heels back to the ground while staying in the squat position. Repeat.

Reverse Lunge to Triple Extension: From a standing position with feet hip width apart, take a large step backward with one leg as you bend both knees to go into a lunge position. Your front knee should remain above your ankle (for the leg that didn’t move). Do not allow your knee to move past your toes on your stationary foot. Push off with your rear foot as your rise up and bring your rear leg up in front of you. Simultaneously raise your heel of your front foot. Return to the lunge position. Repeat.

In addition to the exercises listed above, we have many more exercises available to help you achieve your recovery or fitness goals.

Reminder: Please consult your physician or health professional before engaging in any physical activity and stop if you experience pain or discomfort.

By guest blogger Dr. Madison Oak, DPT

Vestibular Rehabilitation Therapy is a very niche practice within physical therapy focused on treating the inner ear. In elementary school, we learn that the ear is for hearing, but what we often forget is that it is also an essential part of balance, stability, and equilibrium. There are many conditions that can present with symptoms of dizziness that stem from the inner ear. These include:: Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s Disease & Secondary Endolymphatic Hydrops, and Vestibular Migraine. Each of these, and more, occur when your vestibular system is dysfunctioning and cause dizziness, vertigo, and lightheadedness. Let’s jump into the hows and why’s of vestibular dysfunction!

Inner Ear Anatomy and Pathology:

The inner ear is located deep within your skull; you can see in the picture below the outer, middle, and inner ear. The outer ear is the part you can see outside your head and proceeds to the space the doctor looks in when you have an earache. The middle ear begins at your tympanic membrane (ear drum) and extends through to your eustachian tube, which connects your ear to the back of your throat. The inner ear is placed deep in your skull, in the direction toward your brain.

Within the inner ear, you have two sections, the cochlea and the vestibular system. Your cochlea is the hearing organ, the curly- shaped part that almost looks like a snail. The vestibular system is the other circular structure, made up of the otolith organs and 3 semicircular canals. Together these two control your balance, stability, and equilibrium; when one part of this system experiences dysfunction, you can experience imbalance, lightheadedness, anxiety, and vertigo.

Common Vestibular Diagnoses:

There are many vestibular diagnoses, some being more common than others, that we think of when it comes time for a differential diagnoses. The most common vestibular diagnoses are Benign Paroxysmal Positional Vertigo and Vestibular Migraine, but there are many others. Knowing the key differences between each kind of dysfunction is vital for diagnosis and treatment.

Benign Paroxysmal Positional Vertigo:

Benign Paroxysmal Positional Vertigo, abbreviated BPPV, is the most common cause of true spinning vertigo (1). BPPV is defined by episodic vertigo lasting 10-30 seconds and is evoked by specific head positions. BPPV occurs when tiny calcium-carbonate crystals, called otoconia, become dislodged from the otolith organs where they’re held in your inner ear, and end up in your semicircular canals. [In order to picture this, go back to this lesson on ear anatomy!] This causes the perception of room spinning or wall sliding. Benign Paroxysmal Positional Vertigo is a long name that really spells out what it is.

  • Benign: non-harmful, dangerous
  • Paroxysmal: sudden, short-term
  • Positional: occurring in specific positions
  • Vertigo: true spinning dizziness

When you turn your head into certain positions, typically laying down at night to go to sleep, rolling over in bed, or looking up into a cabinet, the otoconia move inappropriately within the semicircular canals where they do not belong and cause repetitive, uncontrolled eye movements, called nystagmus. The nystagmus is what causes the room to look as though it’s spinning, your PT will look at the nystagmus and determine which canal and type of BPPV you have. BPPV can be classified into two types: canalithiasis, where the otoconia are trapped in the semicircular canal, and cupulolithiasis, where the otoconia are trapped in the ampullary cupula. This is pictured below:

Once diagnosed, BPPV should be treated by a physical therapist; it can usually be cured in 1-2 sessions. The first will be diagnosing and treating the canal where the otoconia are located, and the second is to recheck the affected canal and other canals where otoconia are located. The treatment for BPPV is a Canalith Repositioning Treatment (CRT), and shoudl only be performed with a qualified healthcare professional. Call your physical therapist or primary care provider to find out if they are able to help you find the care you need.

Secondary Endolymphatic Hydrops & Meniere’s Disease:

Ménière’s Disease and Secondary Endolymphatic Hydrops are chronic, frustrating, and incurable inner ear diseases thought to be caused by a buildup of endolymph in the membranous labyrinth of your cochlea and vestibular system (2). This buildup of endolymph causes swelling on the membranous divide between the endolymph and perilymph, the Reissner’s membrane. This imbalance in your vestibular system causes symptoms of vertigo, spinning, dizziness, hearing loss, and tinnitus. The potassium-rich endolymph flows into the perilymph, causing your symptoms to occur until the membrane heals, and/or the fluid balance is restored (2). Ménière’s Disease is also called Primary Endolymphatic Hydrops. Primary and Secondary differ as Primary Endolymphatic Hydrops (Ménière’s Disease) is believed to cause a full rupture of the Reissner’s membrane, creating intermittent and/or sustained hearing loss, and Secondary does not.

Primary and Secondary Endolymphatic Hydrops are usually triggered as a response to an underlying condition. These conditions include, but are not limited to, surgeries that affect the inner ear, inner ear infections, allergies, and head trauma (3, 4). The attacks are spaced weeks to months apart, and over time can slowly destroy your vestibular and hearing systems. These symptoms manifest in different ways depending on the individual. Regardless of your symptoms, we need to treat the symptoms and the underlying condition simultaneously to preserve your vestibular system and restore homeostasis in your body. Treatment for these conditions are based in lifestyle modifications and dietary changes. Patient’s can avoid symptoms recurring by monitoring what they eat, drink, and do!

Vestibular Migraine:

Migraine is a genetically induced hypersensitivity to internal or external stimuli within central nervous system neurons (5). When a neuron that is primed to a migraine is triggered by a stimulus either inside or outside of your body, the neuron reacts through a migraine (5). Migraine is generally considered a headache, however not everyone with migraines experience headaches. Some people get migraines in the form of vertigo, called Vestibular Migraine or Migraine Associated Vertigo. It is estimated that about 1% of the population has Vestibular Migraines (6). Because Vestibular Migraine’s diagnostic criteria are new, it often goes undiagnosed or misdiagnosed for a while before an individual receives a diagnosis. Patients are sometimes alternatively diagnosed with Ménière’s Disease or chronic BPPV instead of Vestibular Migraine, Some of the symptom and diagnostic criteria will be helpful to pinpoint exactly what’s going on for you. People who experience Vestibular Migraine fit the following criteria:

  • At least 5 episodes of vestibular symptoms of moderate or severe intensity lasting 5 minutes to 72 hours
  • Current or previous history of migraines with or without aura according to the ICHD classification
  • One or more of the following migraine features with at least 50% of vestibular episodes:
  1. Headache with at least 2 of the following characteristics: One-sided location, pulsating quality, moderate or severe pain intensity; photophobia or phonophobia
  2. Visual aura
  • Not better accounted for by another vestibular or ICHD diagnosis

Once you or a loved one is diagnosed with Vestibular Migraine, there are many treatment options. There is not a quick fix formula for Vestibular Migraine, and finding what works for you may be a process. It is important to remember that you have to treat the migraine first, and the symptoms related to the migraine second. A neurologist or migraine specialist is best suited for your needs as a migraine patient, and a vestibular physical therapist is the best practitioner for the feelings of dizziness, lightheadedness, and nausea. Working with a healthcare team, instead of just one provider, is an excellent choice when it comes to treating Vestibular Migraine.

Anxiety Related Dizziness:

Anxiety related dizziness is an under diagnosed and under treated reason people feel lightheaded, imbalance, and fearful of walking. Anxiety can be an underlying cause of dizziness or related to another diagnosis. Having any form of dizziness can be incredibly anxiety provoking, and the two factors work together to make you feel worse. They react in a cycle, anxiety making you dizzy, and the dizziness making you anxious. Treating anxiety related dizziness is multifactorial. Cognitive behavioral therapy, physical therapy, and psychiatry can work hand-in-hand to make you or your patient’s symptoms retreat and disappear. Treating both the anxiety and the dizziness simultaneously is important to returning to function and feeling like yourself again.


Treating vestibular dysfunction is very similar to other physical therapy treatments. Your PT will take subjective and objective measures to determine what is difficult for you, why you are dizzy, and what your goals are. You will work with your PT to come up with a home exercise program that fits your specific needs, and will potentially work with you to make some lifestyle and dietary changes in order to prevent future vestibular episodes. Whether your symptoms are true vertigo from a mechanical issue like BPPV, or the feeling of nausea and lightheadedness from Vestibular Migraine, your vestibular PT will be able to help you recover faster.


(1) Fife, T. D. (2017). Dizziness in the Outpatient Care Setting. CONTINUUM: Lifelong Learning in Neurology, 23(2), 359-395. doi:10.1212/con.0000000000000450.

(2) VEDA. (2020, June 24). Ménière’s Disease. Retrieved September 01, 2020, from

(3) VEDA. (2020, August 07). Secondary Endolymphatic Hydrops (SEH). Retrieved September 01, 2020, from

(4) BC Balance and Dizziness. (n.d.). Secondary Endolymphatic Hydrops. Retrieved September 01, 2020, from

(5)  Rothrock, J., MD. (2020). What is Migraine? Retrieved September 02, 2020, from

(6) Tepper, D. (2015, November 12). Migraine Associated Vertigo. Retrieved September 02, 2020, from

About Dr. Madison Oak, DPT

Dr. Madison Oak is a Vestibular Physical Therapist based in Manhattan, New York who specializes in treating dizziness and vertigo of all kinds. She graduated with a clinical Doctorate in Physical Therapy from the University of Wisconsin and has been treating patients with dizziness ever since.

Dr. Madison Oak understands that dizziness comes in many forms, from vertigo to lightheadedness, and knows that finding the source of your dizziness is the best way to treat it. Finding the root of your problem, and treating the whole person, instead of just the symptoms, is very important to her. That’s why she started; to provide easy to read, accessible, resources to patients who are dizzy and struggling to find diagnosis, prognosis, and treatment. She strives to help her patients reach functional goals to return to a dizzy-free way of life. 

By guest blogger Mandy Shintani Reg. OT (BC ) & Gerontologist

Nordic Walking is currently one of the fastest growing forms of fitness globally, but its benefits extend far beyond metabolic benefits. Currently, there are 280+ published studies on PubMed which highlight the benefits of Nordic walking aka Urban Poling/pole walking for rehabilitation. Benefits span across a wide spectrum of chronic conditions including Parkinson’s, Multiple Sclerosis, spinal and orthopedic conditions including pre/post hip & knee surgery.

In a recent 2019 Harvard Health publication, Dr. Baggish, director of the Cardiovascular Performance Program at Harvard-affiliated Massachusetts General Hospital, sites “When you walk without poles, you activate muscles below the waist. When you add Nordic poles, you activate all of the muscles of the upper body as well; you’re engaging 80% to 90% of your muscles, as opposed to 50%, providing a substantial calorie-burning benefit.”. Baggish also explains, “You’re much more stable when you use poles, because you have more ground contact points and you’re not relying on two feet alone.”

In Canada and other parts of the world including the UK, Ireland and Australia, the rehabilitative benefits of using specially designed poles are widely accepted and are prescribed as an effective alternative to canes, crutches and walkers.

A current pilot program being conducted at the Royal National Orthopedic hospital in London, UK evaluated Activator Poles and found improvement in healthy adults’ posture was statistically significant in comparison to elbow crutches and walking sticks (canes). Rickenbach et al (current).

While the concept of walking poles for rehabilitation is new in the USA, many American therapists are recognizing the benefits. Iowa based PT, Jon Schultz was recently featured on WHO TV channel 13 and stated: “The great thing about the poles is it gets them out of their mind and they start using their body how it was designed”.

For more information about the research and the Activator Poles developed by a therapist for rehabilitation, visit or stop by the Urban Poling booth #640 at the upcoming APTA CSM. Seated and standing exercises with Activator Poles can be found in PT-Connect home exercise prescription software.

About Mandy Shintani Reg. OT (BC ) & Gerontologist

Mandy is an occupational therapist, gerontologist and the founder of Urban Poling. Her mission is to inspire all Canadians toward active living and wellness through innovative pole designs and education.  As an avid proponent of life long fitness, she has experienced herself how Urban Poling fuels a healthy and fun lifestyle that includes, using poles with other exhilarating activities such as snowshoeing, hiking and adventure travel, which she is passionate about.  As a therapist, her design of our patented ACTIVATOR Poles was rooted in her desire to create a tool that would revolutionize mobility and rehabilitation programs.  She is an international presenter and is considered to be one of the leading experts on this activity.  She was a finalist at the YWCA Women of Distinction Awards in the category of Innovation and Entrepreneurship.