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When to start Physical Therapy after ACL surgery

When to start Physical Therapy after ACL surgery

Anterior Cruciate Ligament (ACL) injuries are unfortunately common, especially among athletes participating in sports that involve sudden stops, changes in direction, or jumping. 

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.

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What is an ACL Surgery?

ACL 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.

You’ll work with your physical therapist to create a comprehensive rehab plan enabling individuals to regain their function and return to their normal activities.

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.

Physical Therapy ACL When to start Physical Therapy after ACL surgery:

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.

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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 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 on 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 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 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: ACL surgery

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:

  • 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.
  • 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 lead to new knee injuries and may compromise long-term joint health.

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.

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