Rehabilitation for ACL repair is crucial post-surgery to improve the recovery process, prevent the risk of re-rupture and to increase range and strength of the affected knee.
Rehab can be a period of ups and downs and is not always smooth sailing. Some days will feel better than others and this is perfectly normal. Here are some of my top tips to get you through that initial recovery period after surgery to ensure your recovery goes as smoothly as possible.
Control your pain
High levels of pain will prevent you from completing necessary exercise. Consulting your doctor and having adequate pain relief on board and timing pain medication with exercises approximately 30 minutes before can improve pain levels and therefore make exercises less painful.
Surgery is actually a trauma to the body and therefore as part of the inflammatory response swelling will occur post repair. Swelling after an ACL repair is often quite large, and it can take weeks to reduce. Swelling resulting in reduced range of motion and result in pain. Simple measure such as elevation of the limb and compression bandage can assist with this. Ice can be used to assist with pain.
Restoring range of motion
Achieving a straight knee (full knee extension) is very important post-operative. Full knee extension is required during walking (gait) to ensure correct biomechanics, otherwise a limp will develop. A simple exercise such as having the leg out straight with the heel propped on a pillow to gently force the knee straight is a great way to get started. Ensure you get the knee bending (knee flexion) too. Often difficulty bending the knee post-operative is less common, however sufficient knee flexion is required for normal gait for leg clearance. In the acute stages after ACL surgery the knee is often stiff. If patients want to get back to sport, then full knee ROM is a must. Some people are apprehensive about damaging their reconstruction. Not improving range at the joint can lead to inadequate rehabilitation and stiffness. The reconstruction is stronger than you think and won’t be damaged by extension or bending in the early weeks.
Activate the muscles
The quadriceps are a primary muscle group which help straighten the knee. After surgery wasting of the quads is a common impairment and quads exercises such as pushing a straight knee into a towel and a straight leg raise should be commenced the day after surgery. Hamstring strength is also important to incorporate post-surgery, however if the replacement graft was from the hamstring (most common graft), hamstring strengthening is often delayed until 6 weeks. Follow your physical therapist’s recommendations about which exercises are appropriate
Walking is a great way to start. Walking activates all the muscles of the lower limb including the quadriceps, hamstrings and calf, therefore helps improve strength and neuromuscular function. After surgery you will be given crutches to assist with weightbearing however you should aim to be off these within 1-2 weeks post-op as reliance on crutches will slow your rehab and recovery. Stationary bike is also a great way to improve knee range and lower limb strength.
Look for signs of infection
Don’t forget to look for signs of infection (i.e. redness and warmth around the area) or deep vein thrombosis (DVT) which is a blood clot within the calf. DVT will present with pain in the calf, warmth or swelling to the area. These are 2 complications that may occur post-surgery.
Do you need help recovering from your ACL reconstruction?
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Written by William Lewis (Physiotherapist)