When to Start Physical Therapy After ACL Surgery
Anterior Cruciate Ligament (ACL) injuries are unfortunately common, accounting for more than 50% of all knee injuries. Athletes participating in sports that involve sudden stops, changes in direction, or jumping are at a much higher risk of suffering these particular injuries.
Soccer, basketball, and winter sports like skiing are common reasons you may attend physical therapy for an ACL injury. When an ACL tear occurs, surgery is often the recommended course of action to restore stability to the knee.
As important as the surgery itself may be, this is only the beginning of the road to recovery, which typically takes nine months to a year for most people.
You will need a well-structured rehabilitation plan that only a properly trained physical therapist can implement to get you back to the activities you love. The following is your guideline when to start physical therapy after ACL surgery.
What is an ACL Injury, and What Does Surgery Involve?
The anterior cruciate ligament is one of the key ligaments that stabilizes the knee joint. It runs diagonally through the middle of the knee, connecting the thigh-bone to the shin-bone and helping to control knee flexion, the movement of the knee cap, and rotational movements.
ACL injuries typically occur when the ligament is overstretched or torn, often due to sudden stops, changes in direction, or awkward landings—common in sports like soccer, basketball, and skiing.
These injuries can cause significant instability, pain, and limited movement in the knee, particularly affecting knee extension and leading to issues like anterior knee pain.
ACL surgery is an especially common form of surgery, with approximately 400,000 ACL reconstructive surgeries performed in the US annually.
The surgery involves reconstructing the torn ligament using either autografts (tissue from the patient's own body) or allografts (donor tissue). This procedure aims to restore stability to the knee joint and injured leg.
After surgery, you'll work with your physical therapist to create a comprehensive rehab plan. This plan will focus on gradually regaining strength, improving knee extension, and addressing any lingering pain, ensuring you can return to your normal activities and regain full function.
Knowing When to Start Physical Therapy After ACL Surgery is Crucial
Physical Therapy plays a pivotal role in the rehabilitation process after ACL reconstruction surgery. It helps to restore strength, flexibility, and range of motion. It also addresses any compensations that may have developed.
Engaging in physical therapy exercises helps prevent muscle weakness, promotes the healing process, and enhances overall function.
You will collaborate with your physical therapist to make decisions based on the surgeon's preferences, type of graft, your goals, comorbidities, and your prior fitness level.
The following are general guidelines that many surgeons send with you after surgery.
When to Start Physical Therapy:
The timing for initiating physical therapy after ACL surgery is a critical aspect of the recovery process.
While the specific timeline can vary based on factors like the type of surgery performed and the individual's overall health, physical therapy typically starts within a few days to a week after the surgery.
Your ACL Recovery Timeline: What to Expect in the First 6 Months:
First Week:
- Immediate Motion: Gentle range of motion exercises to prevent stiffness. These can include heel slides using a strap for assistance to pain tolerance, quad sets for quad muscle activation, and straight leg raises.
- Pain Management: Addressing any knee pain or swelling through controlled movements, proper rest, and ice as needed. Controlling the cardinal signs of inflammation is key, including watching for excessive redness, heat, swelling, or resting knee pain. Some of these are normal in the early stages.
- Weight-Bearing: Gradual introduction of weight-bearing exercises and learning to walk with proper form to minimize compensation from the uninjured leg. You will likely use an assistive device such as B crutches and knee brace early on. You will slowly wean away from these aides.
Weeks 2-6:
- Progressive Exercises: Gradually increasing the intensity of exercises to improve strength and flexibility. This may include mini squats, stationary bike riding beginning with low resistance, and if available, pool walking. Progressive resistance using a leg press may also begin once the inflammatory phase is subsiding.
- Balance and Coordination: Working on spatial awareness and balance to improve stability is important. Tandem and then advancing to single leg balance on stable and unstable surfaces will begin here.
Weeks 6-12:
- Advanced Strengthening: This stage is based around incorporating more challenging exercises to enhance muscle strength. This may include increasing squat depth, single leg squats, and weighted step-ups. The goal is to normalize the strength between the legs, and minimize any difference in quad girth and muscle weakness.
- Cardiovascular Conditioning: Low-impact exercises to improve overall cardiovascular health.
- Jogging: Jogging in a straight line may begin near the end of this phase or the beginning of the next, beginning first with interval jogging and avoiding side to side movements.
Months 3-6:
- Sports-Specific Training: Tailoring exercises to the individual's sport or activities and introduction of multi plane movement may begin.
- Plyometrics: Gradual introduction of jumping and landing exercises.
- Functional Testing: Assessing the readiness to return to specific activities. Physical therapists will provide sport specific testing and standardized testing. This includes double and single leg jumping to compare legs and establish normative values. This will help the physical therapist to feel confident about returning you to your sport.
Benefits and Risks:
Benefits of early physical therapy:
- Faster Recovery: Physical therapy helps expedite the recovery process by preventing complications and promoting optimal healing.
- Reduced Pain & Reduce Swelling: Controlled movements and exercises aid in managing post-surgical discomfort.
- Improved Range of Motion: Early physical therapy prevents stiffness and helps restore the full range of motion more quickly.
- Enhanced Strength: Progressive exercises strengthen leg muscles, preventing weakness and promoting overall knee stability.
Risks of delayed or inadequate physical therapy:
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- Muscle Weakness: Delaying physical therapy can lead to muscle weakness, prolonging the recovery process.
- Joint Stiffness: Without early mobilization, joints may become stiff, affecting range of motion and ability to achieve full knee extension.
- Compromised Function: Inadequate physical therapy may result in persistent issues with balance, coordination, and overall function.
- Increased Risk of Reinjury: Returning to activities without proper physical therapy increases the risk of reinjury or can even lead to new knee injuries and may compromise long-term joint health.
6 Long-Term Recovery Tips
Recovering from ACL surgery doesn’t end when you regain your initial strength and mobility. Long-term recovery plays a crucial role in ensuring that you avoid reinjury and maintain knee health for years to come.
Here are a few key tips to keep in mind as you progress beyond the early stages of rehabilitation:
1. Continue strengthening and doing flexibility exercises
Even after you’ve completed your formal physical therapy program, it’s important to maintain a routine that focuses on strengthening the muscles around your injured knee—particularly your quadriceps, hamstrings, and hips.
These muscles provide essential support to your knee and can help prevent future injuries. Incorporate flexibility exercises as well to maintain your range of motion, which is vital for knee stability and reducing stiffness.
2. Avoid higher-risk movements until cleared
Before returning to high-impact sports or activities that involve pivoting, cutting, or jumping, make sure you’ve been cleared by your physical therapist or surgeon. Prematurely engaging in these movements can increase the risk of reinjury.
Gradually reintroduce sports-specific exercises that simulate game conditions, but only when your knee is fully ready.
3. Focus on balance
Even months after surgery, your knee may still be at risk for instability, particularly when walking on uneven surfaces or quick changes in direction.
Incorporating balance exercises, such as single-leg stands, balance board work, or stability exercises on soft surfaces, can help you improve your overall coordination.
4. Listen to your body
As you get back to more intense physical activities, it’s crucial to pay attention to your body’s signals. If you experience swelling, persistent knee pain, or any unusual discomfort, take a step back and rest.
Overtraining can set back your progress or cause new injuries. Rest days are just as important as exercise in the recovery process.
5. Maintain a healthy lifestyle
Staying active and eating a well-balanced diet that supports joint and muscle health are vital for long-term recovery.
Incorporating low-impact activities like swimming, cycling, or yoga into your routine can help you stay fit without putting excessive stress on your knee.
Proper hydration and a diet rich in anti-inflammatory foods, like fruits, vegetables, and omega-3 fatty acids, can also aid in ongoing recovery and joint health.
6. Have periodic check-ins with your physical therapist
Even after you’ve completed your initial rehab, it can be helpful to schedule periodic check-ins with your physical therapist.
These visits allow your therapist to assess your progress, ensure your knee function is optimal, and provide guidance on preventing reinjury.
Your therapist can also adjust your exercise program based on any new goals or challenges you encounter as you return to your normal routine.
Summing up:
In conclusion, embarking on the journey of ACL surgery recovery requires a comprehensive approach, with physical therapy at its core.
Starting physical therapy at the right time, adhering to the prescribed exercises, and understanding the benefits and risks are essential components of a successful rehabilitation process.
By actively engaging in physical therapy, individuals can not only recover from ACL surgery but also regain the strength and mobility needed to return to the things they love.
Remember, each recovery is unique, and no professional knows that like a physical therapist does.
Working with a physical therapist is crucial for tailoring a rehabilitation plan that best suits individual needs.