Rehab: Post ACL Reconstructive Surgery
Tearing the anterior cruciate ligament (ACL) is a devastating injury for athletes. This injury will undoubtedly end the season for the injured player. It is a tough pill to swallow even for the most hardened athletes.
The ACL is the ligament on the outside of your knee. It is active when you are planting and cutting which is vital in athletics. If you tear that ligament you will need surgery to replace the ligament with a brand new one. After reconstructive surgery to repair the ligament, it is a very long road to full recovery.
This injury is becoming more and more common in athletics, including professional sports. Most notably, Chicago Bulls superstar Derrick Rose tore his left ACL last April. His ACL rehab is being documented by Adidas as a marketing campaign and has been dubbed the name #thereturn.
I am currently going through ACL rehab for my left knee. I tore my ACL playing soccer this summer. My studs were in the turf when another player tackled through my leg which caused the tear. I waited three weeks before I had surgery to allow swelling and pain to go down. I am now in my 6th week of rehab post surgery. My knee physically feels and looks better after each week.
My rehab program was created by my surgeon, Dr. Doug Evans, MD from Loyola Hospital. My rehab is guided and monitored by Bryan Yonka, Assistant Athletic Trainer for Loyola University of Chicago Athletics. I also seek guidance and advice from my friend Kyle Anderson, a Certified Athletic Trainer at Ohio Orthopedic Center of Excellence.
The following information and timeline for rehab is based from my personal experience and from the information given to me by the above three professionals.
Rehabilitation time for everyone is different, full recovery is anywhere between 6-12 months. Each individual has to follow their own specific rehab instructions from their surgeon. However, there is a general time line that can help guide you.
It is important to note that though ACL rehab is mapped out in a time line, you cannot move to the next step until you have completed the previous one.
“The length of rehab depends on you. The harder you work the quicker you can move from step too step,” said Kyle Anderson, Athletic Trainer.
Important things to know before surgery:
- You will not be able to move your effected leg up to 24 hours after surgery because of the two numbing shots you will receive.
- The leg you get surgery on will be significantly smaller than your other leg. You lose most muscle mass in the leg during surgery.
- You will be in a full leg brace after surgery for all walking for 4-6 weeks.
- Crutches will be used for walking for 2-6 weeks depending on preference.
First 3 Days after Surgery:
The first few days after surgery are a daze. You will be heavily medicated and still affected by anesthesia from surgery. Be very careful the first few days because the new knee is very sensitive. The following are important things to do in these three days:
- Keep the recovering leg elevated as much as possible.
- Keep surgery bandages on for 2 days to protect the scars.
- Ice frequently.
- Pump foot of injured leg to keep blood flow circulating.
- Take 1 aspirin a day to prevent blood clots from forming.
After the first few days you can start to do light rehab exercises.
- Start to use the passive motion machine. Start at 20 degrees. move up 10 degrees a day if comfortable until you reach 90 degrees. Do not go past 90 degrees.
- Continue icing to decrease surgery swelling.
- Start leg raises. 3 sets of 10.
- Begin flexing your quad. 3 sets of 10.
You should feel a lot better than you did the previous week. You will start to be more dependant with various activities. You should be more comfortable moving around by this point.
- Continue leg raises but with 6 second holds at the top of the lift.
- Continue quad flexes also with 6 second holds.
- Start using a stationary bike if available to work on range of motion. (You might not be able to complete a full rotation on the pedals but it still helps with mobility)
- Ice only if there is swelling or pain.
- Start to consider weaning off crutches for short distances if comfortable.
By this time you should expect to have your brace off and not need crutches. Range of motion now becomes very important. Now that your straight leg brace is off you can now start working on getting your leg back to full motion. Without full range of motion you cannot start doing other forms of aerobic exercise.
- Hamstring and calf stretching frequently.
- calf raises
- Swimming with only small flutter kicks. No restrictions on upper body.
- Continue leg strengthening exercises.
- Start walking on a treadmill at various slower speeds to get form back.
You should have complete range of motion by this point in rehab.
- Start forward and backward jogging if cleared by surgeon or trainer.
- Outdoor biking is now permitted.
- Seated rows in the weight room and other seated or laying down exercises such as bench press.
- Start agility exercises.
- Leg press only to 90 degrees.
- Leg curls with no hyperextension.
- Running only on treadmill.
This is a very tough time in the recovery. This is the period of time where most people if they do re-tear their ACL. You will feel like your knee is completely back to normal and want to start pushing it. However, your knee is not quite ready to handle the stresses of normal athletic competition.
You can start working on sport specific exercises. For example, soccer players start working on tight space dribbling and ball control. Tennis players work on hitting. Basketball players work on shooting, passing and dribbling.
Hopefully you will be able to return to sports at this point. Your surgeon will have the final say on whether you can return or not.
Once you are cleared to play again you might have to wear a sports specific brace for support, which will be determined by you and your surgeon.
- written by enock on January 17th, 2013
- posted in Writing for the Web