Posterior Cruciate Ligament Rehabilitation Protocol - Conservative Management

PHASE 1: Acute Protection (Weeks 0-2)

Goals: Control inflammation, protect healing tissues, prevent posterior sag, maintain basic quad activation

Brace: Locked at 0° initially, progress ROM as tolerated within brace

Weight-bearing: As tolerated with crutches if needed

Exercises:

Quad sets with rolled towel under knee (prevent posterior sag)

Ankle pumps, calf pumpsGlute sets (prone, supine)

SLR in 4 planes (AVOID hamstring dominance - cue quad activation)

Prone hangs for extension

Seated knee extension 90-45° ONLY (no terminal extension yet - ACL protection)

Patellar mobilizations

Stationary bike (minimal resistance, high seat to limit flexion initially)

What NOT to do:

No hamstring curls (posterior translation)
No deep knee flexion
No impact activities
No resisted knee flexion

PHASE 2: Early Strengthening (Weeks 2-6)

Goals: Progressive loading, quad dominance, maintain ROM without posterior translation, wean brace

Brace weaning: Per surgeon protocol (typically start unlocking around week 3-4)

Exercises:

Progress bike resistance and ROM

Mini squats to 60° (wall slides with swiss ball, heels elevated to reduce posterior translation)

Step-ups (forward only, 4-6 inch height)

Leg press 90-45° (foot position high on plate)

Closed-chain terminal knee extension (TKE) with band

Double-leg calf raises progressing to single

Lateral band walks, monster walks

Single-leg balance progression (floor → foam → BOSU)

Prone hip extension (glute focus, NOT hamstring curl)

Core stability work

Restrictions still apply:

No squatting past 90°
No isolated hamstring work yet

No plyometrics

No running

Sports safe activities:

Upper body ball handling drillsSetting practice (seated or standing)

Court positioning/footwork visualization

Criteria to progress: 
Full ROM, minimal effusion, quad strength 60% of uninvolved side, no posterior sag, functional brace-free ambulation

PHASE 3: Advanced Strengthening (Weeks 6-12)

Goals: Build strength foundation, introduce controlled posterior chain loading, prepare for running

Exercises:

Progress squat depth to 90° with load (goblet squats, landmine squats)
Bulgarian split squats (front leg emphasis)
Single-leg pressStep-downs (eccentric control)
Introduce hamstring work carefully: Nordic curls (eccentric only initially), RDLs, bridges with physioball
Lateral lunges (control depth)
Single-leg RDLsBox squats to 90°
Resisted lateral movements (band work, lateral step-ups)
Double-leg jump landing mechanics (no actual jumping yet - just landing from small step)

Introduce running progression (if cleared):

Start with walking intervals on treadmill
Progress to walk/jog intervals
Straight-line jogging only initially
Monitor for swelling, instability, pain

Sports progressions:

Pepper (passing drills, controlled)
Approach footwork without jumping
Landing mechanics training

Criteria to progress: Quad strength 80% of uninvolved, good squat mechanics to 90°, pain-free ROM, successful completion of running progression, single-leg hop 60% of uninvolved

PHASE 4: Return to Sport Prep (Weeks 12-16+)

Goals: Sport-specific power, plyometric progression, agility, psychological readiness

Plyometric progression:

Double-leg jumps (box jumps starting at low height)

Broad jumpsSingle-leg hops (progress cautiously)

Lateral hopsDepth jumps (controlled landing)

Volleyball approach progressions: 2-step → 3-step → full approach

Blocking jumps (repetitive loading)

Agility:

Cutting drills (45° → 90° → reactive)
Shuffle drills

Carioca

Defensive positioning drills

Sport-specific:

Progress hitting (standing → approach)
Full blocking practice

Defensive dives (last to introduce - high PCL stress)

Scrimmage participation (controlled)

Psychological readiness:

Address fear of re-injury
Confidence in movement
Decision-making under fatigue

Return to sport criteria