I just got ACL reconstruction, what will my rehab look like?

After getting your ACL reconstruction surgery, rehab is a long 9-12 month process. Rehab is split up into early, mid and late stage rehab. Each stage of rehab looks slightly different with different goals that we want you to achieve before progressing you onto the next stage. Below are some of the criteria within each stage of rehab which you will work on!

 

therapist undergoing physical therapy with female patient 23 2148836558

Early Stage

Range of motion
After surgery you will have lost some of the range of motion in your knee, you will find it difficult to fully bend and fully straighten the knee. Swelling and pain will limit this range of motion. Getting your full range of motion back is crucial to getting you to walk correctly, progress onto running and to progress your strength exercises.

Quads, Quads, Quads!
You will notice that you have lost some muscle mass in your quad muscle after your ACL surgery. Not only is it important to regain this muscle mass back, it is also important to regain strength as it is vital for walking, single-leg stance, squatting and running. Throughout rehab it is important to get them quads firing with lots of quad dominant exercises. Research shows that people compensate by avoiding bending through the operated knee and taking the load through the glutes, this can happen for up to 5 months post surgery (Sigward et al., 2018) We will tailor exercises for you in order to avoid this compensation and get you to load your quads correctly.

Normalising gait.
Before you run you must walk! Once you are walking without crutches post surgery it is important that you are walking with a normal gait pattern. Unfortunately some people can pick up bad habits and walk with some compensations. Common gait abnormalities seen following ACL reconstruction surgery are: walking with bent knee/’fixed flexion’, overusing the calf, avoiding terminal extension, reduced push off, and reduced weight-bearing time on the affected side. To avoid these bad habits we will work on gait-specific training from the get-go! We want to see controlled extension in mid-to-late stance, allowing adequate push off, and have good quad control throughout the gait cycle.

training wellness healthy weight walking motion 1428 762

Mid Stage

Return to running
We generally start thinking about returning to running around the 8 week mark with the aim of returning to running by 12 weeks. Before returning to running we would ensure that you have minimal pain, full range of motion in the knee, adequate strength and no swelling in the knee joint (Ramburd et al., 2018). We will perform low level plyometric drills and running drills before getting you to complete your first run. There are a variety of clinical tests we perform to ensure that you are ready to return to running!

Continue strengthening
ACL rehab past the 3-month mark will look like a progressive strength and conditioning program. Getting strong– particularly in the quadriceps, hamstrings, glutes, and calves. You will be lifting heavier loads and for less reps. Improving your strength will reduce your risk of re-injury and help ensure that when you return to sport your performance is not affected.

Proprioception work
Your balance and proprioception (your bodys awareness of where it is in space) will be reduced after surgery. We will do lots of single leg balance work and single leg exercises to improve the neuromuscular control of your knee and help reduce the feelings of instability. 

 

Hamstring strength
If you have had a hamstring graft it is important to regain the strength of the hamstring. Hamstring strength is also an important marker for returning to running.

Lateral hip strength
Research suggests rehab which includes hip strengthening exercises appears to improve sagittal plane dynamic balance at three months after ACL reconstruction (Garrison et al., 2014). Additionally, lateral hip strengthening can be an important part of reducing the risk of patellofemoral pain when returning to activities. We will make exercises as functional and relevant to running as possible, including exercises like lateral band walks and zig zags.

Calf work
The calf is often forgotten about in ACL rehab. However, it is important to regain strength here as the gastrocnemius muscle crosses the knee joint and helps the hamstring flex the knee (bend the knee).

young woman sportswear practicing exercise physiotherapy session 23 2149115612

Late Stage

Jumping, landing and agility work
Jumping, correct landing technique, change of direction and agility work is crucial for when you return to sport and have to make decisions quickly in your sport. We will start to incorporate plyometrics, change of direction drills and agility drills to ensure that you are ready for the fast pace demands of your sport when you return.

Return to training
Returning to non-contact training is an important milestone. However, this can be tough psychologically as many fear reinjury. At this stage in rehab we begin to incorporate sport specific exercises to help you rebuild your confidence in your knee.

Return to sport
When you have finally hit all your criteria for strength, balance, running and hopping and you are ready to return to sport it is important to keep up rehab. You will still benefit from continuing a strength program even after being cleared to return to sport. This may include some extra quad/hamstring work, plyometric work or hopping/landing techniques depending on areas which you are weak on.

Conclusion
ACL rehab is a long process, commitment to rehab is difficult and life does get in the way! For this reason not all people return to sport after surgery, but most do. Research shows that 80% of ACL reconstruction patients return to some form of sport, 65% return to the same sporting level and only 55% return to sport at a competitive level within 1-2 years post ACLR (Adern et al., 2014).

 

Conclusion

ACL rehab is a long process, commitment to rehab is difficult and life does get in the way! For this reason not all people return to sport after surgery, but most do. Research shows that 80% of ACL reconstruction patients return to some form of sport, 65% return to the same sporting level and only 55% return to sport at a competitive level within 1-2 years post ACLR (Adern et al., 2014).

References:

  1. Sigward SM, Chan MM, Lin PE, Almansouri SY, Pratt KA (2018). Compensatory strategies that reduce knee extensor demand during a bilateral squat change from 3 to 5 months following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 48(9): 713- 718

     

    Garrison JC, Bothwell J, Cohen K, Conway J (2014). Effects of hip strengthening on early outcomes following anterior cruciate ligament reconstruction. Int J Sports Phys Ther. 9(2):157-167

     

    Rambaud A, Ardern CL, Theroux P, Regnaux JP, Edouard P (2018). Criteria for return to running after anterior cruciate ligament Reconstruction: A scoping review. by Rambaud A et al (2018)Br J Sports Med 52(22):1437-1444.

     

    Ardern, C.L., Taylor, N.F., Feller, J.A. and Webster, K.E., 2014. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. British journal of sports medicine, 48(21), pp.1543-1552.“`

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