I get asked this all the time about post surgery rehab from those who have recently had an ACL reconstruction, so let’s talk about it!
Should I Ice It?
An ACL injury is one of the biggest injuries in sport (and life) because of the time frame it takes to return back to sport safely. Initially though it needs to be treated like any other ligament tear! So ideally we continue to move the knee throughout the full range of motion you have and stick to the basics of rest, ice, compression and elevation.
There is often a lot of swelling and the first goal is to manage and minimise that as best we can so it doesn’t compromise day-to-day functioning of the knee. It is crucial to get on top of this as soon as possible and continue regular ice application every two hours for the first day or two. This also helps to manage some of the pain you’ll no doubt be in and take pressure off the surrounding structures.
Can I Walk On It?
It amazes me the number of people I still see that have been placed in a rigid splint or put on crutches for weeks and told not to move it! These methods belong in the era of stoning witches to death… Unless there is an associated fracture of the bone, there is no reason to avoid moving the joint through its full range of motion – all this will do is increase the stiffness of the knee joint, decrease muscle function and result in more pain and a longer recovery.
Remember, not everyone ends up having surgery on their ACL so you can regain day-to-day function without one intact; and if you follow the Olympics you would have heard at least 150 times that athletes compete without one or both of their anterior cruciate ligaments due to not having enough time to get an ACL surgery! Crutches may be used on the day of injury to assist with walking and even for the first week if necessary, however, that is all they should be – an assistance! You should still try to keep a normal walking pattern (heel-to-toe walking pattern), good knee flexion (knee bending), full knee extension (knee straightening) and even normal weight bearing between both legs. The quicker you can master a normal walking pattern and regain that single leg control, the quicker you can progress to the next stage!
Do I Need ACL Surgery?
You do have options when it comes down to whether you need ACL surgery or not! Depending on your age, level of activity, job, goals and other associated injuries, you may choose whether you want to proceed with an ACL reconstruction or opt for conservative management following ACL injury (such as physiotherapy). You really want to get your MRI scan and consult with an orthopaedic surgeon specialising in ACL reconstructions as soon as possible following the injury to start to plan what is best for you.
More than often, an ACL injury is associated with other injuries within the knee (i.e. cartilage damage, other ligament damage, knee joint capsule damage and/or bone bruising) so this will add in to whether you do or don’t need an ACL reconstruction and, if you do, how long you need to wait before you can get it done. In saying this, there are positives and negatives to both approaches so it’s vital get all the unbiased information first about what to do regarding an anterior cruciate ligament rupture!
What Can I Do To Bounce Back Quickly After ACL Surgery?
There’s great evidence to show that doing 10 sessions of HEAVY strength and neuromuscular training over a 5 week period post operatively can result in:
- Improved knee function
- Improved quality of life
- A greater likelihood of returning to pre-injury sport than “usual” pre-operative care (measured at 2 years post-operative)
Before going in for an ACL reconstruction surgery you want to make sure you have:
- Full movement of your knee (i.e. full knee extension and knee flexion)
- Minimal to no swelling
- Normal walking pattern (i.e. even weight bearing and not limping)
- Good balance
- Strong thigh muscles (you’ll be amazed at how quickly it can switch off!)
- Generally STRONG overall
This makes the recovery post operatively a lot smoother and results in much better long term results following ACL surgery!
What Does ACL Rehab Look Like Post Surgery
Before you leave the hospital, you will be seen by a physio who will go through some basic range of movement exercises with you and help you to start using some crutches and putting weight through the leg before you are discharged home.
After all the medications it can sometimes be difficult to remember everything to do, which is why I want to see every client at one week post ACL reconstruction surgery. Every person has a different experience with surgery and this first post-operative consultation is a great opportunity to discuss how you are feeling and provide recommendations to help ease any pain and help you feel more comfortable quicker. It is also a chance for me to look at the wound and ensure that it is healing well and there are no signs of infection.
We will then look at you walking either with or without crutches and with or without a brace (depending on your surgeons recommendations, severity of pain and the amount of range of motion you have) to ensure you are walking properly and start to review your exercise program to ensure you are doing your exercises correctly (have seen some interesting variations of exercises before!) and if we can start to progress your rehabilitation program.
Our first goal in Phase 1 of your rehabilitation program is to:
- Decrease pain and swelling
- Increase bending and straightening range of motion in the knee
- Regain a normal walking pattern without crutches as soon as possible
- Return to normal activities of daily living
- Start to rebuild strength in all the muscles around the knee and leg
This initial 6 weeks following ACL reconstruction is the most important phase. If you get the basics right first then the rest of the rehabilitation will be a lot easier to manage.
Your exercise program will start off with some basic body weight exercises which will then progress to some exercises with resistance bands before moving into either hydrotherapy and/or gym-based programs which is normally around week 4-6. Typically I will see you once per week for the first 6 weeks and then start to progress to once a fortnight and then once a month, when we are confident that your rehabilitation program is on track. The focus of our appointments will be to progress your exercise program – you will find you generally progress quite quickly at the start! There may also be a small amount of manual therapy in the first few weeks, such as massage, to help with any discomfort and help to get back to a normal range of motion as quickly as possible.
Once you are set with your gym program and managing well, progress testing is generally conducted at 3-, 6- and 9-months post-op which includes strength testing using our NordBoard and GroinBar technology before your final return-to- sport testing typically conducted around 12- months post-op.
Keep in mind though, this is a very milestone-based rehab and as mentioned above, everyone has a different experience. Your program will be tailored to you so that you have the best outcome at the end of the journey!
I’m so confident I can help you that I’d love to chat with you personally about your knee, it’s what I’m passionate about! Just enter your details in the field below and a rough time that you’d like me to contact you & I’ll be more than happy to explain how we can have you on the FASTEST ROAD TO RECOVERY!
