Rehab After ACL Knee Surgery

Have you recently had or are currently contemplating ACL surgery?  Rehabilitation following Anterior Cruciate Ligament (ACL) reconstruction is an essential part of a full recovery. You will likely be given a protocol by your surgeon that will guide the treatment plan and progression. The rehabilitation protocol spans over a 6 month period and is divided into several timelines. Each timeline has goals and exercise suggestions for several domains:

  • Pain and Swelling
  • Range of motion and flexibility
  • Strength and endurance
  • Cardiovascular fitness

Pre-operative Rehabilitation (Prehab): Prehab should be done prior to surgery. After an ACL injury, deficits occur in strength and proprioception with the primary problem being instability. An unstable knee is one in which you experience episodes of the knee ‘giving way’ and buckling. These episodes can lead to further joint damage and ultimately, long term degenerative changes. Research has demonstrated that physiotherapy provided pre-operatively is effective in increasing strength and balance which may limit the number the episodes of ‘giving way’ and decrease the incidence of re-injury in the ACL-deficient knee.

The main goals of your prehab program include:

  • Full range of motion equal to the opposite knee
  • Minimal joint swelling
  • Sufficient strength and neuromuscular control in the knee as well as the joints above and below (hip and ankle)

Post-operative Rehabilitation (Rehab):  

  1. Pain and Swelling – Your knee will be painful and swollen after surgery. Physiotherapy will help to decrease pain and swelling with various electrotherapeutic machines (eg. ultrasound, IFC) that will also work to promote healing.
  2. Range of Motion and Flexibility – After ACL reconstruction, it is important to restore full range of motion in the knee (bending and straightening). Quadriceps re-training has been found to improve range of motion in the early stages, and a stretching program is also incorporated to maintain lower extremity flexibility.
  3. Strength and Endurance – A series of open and closed chain exercises will be provided along with different exercise parameters (the number of reps and sets) to increase muscular strength and endurance in the knee following ACL reconstruction. It is still very important to maintain strength in the joints above and below the knee (hip and ankle) as well.
  4. Cardiovascular Fitness – It is important to maintain heart health during the rehabilitation phases of your knee to prevent deconditioning. I can provide exercises that increase your heart rate and may also recommend other forms of exercise, such as the elliptical, bicycle, treadmill or stair master.

The focus of early rehabilitation is on regaining range of motion, normalizing gait and activation of the quadriceps muscle. To ensure the best possible outcome, the client should be followed for the entire 6 months of the protocol. The emphasis of rehabilitation should be focused at the 4-6 month mark. In these later stages, higher level rehabilitation will occur including proprioception and balance training, plyometric training, agility drills, muscle patterning drills, and functional testing. The performance of these skills determines the client’s readiness for return to sport/activity.

Don’t let ACL surgery stop you from getting back to your normal routine and favorite sports and exercise.  Taking the proper steps will ensure a speedy and effective recovery.  If you need assistance, I’m here to help!

Leanna Taggio, Physiotherapist


Preventing ACL injuries in kids sports!

It’s quite possible that you’ve heard about ACL (anterior cruciate ligament) injuries before.  Perhaps you know someone who’s had one or maybe one of your favorite pro athlete’s sustained an injury to it recently.

ACL injuries are quite common in a wide range of sports.  Football, soccer, basketball, martial arts, hockey, tennis are some of the most common.  More specifically, sports that involve sudden changes in direction, quick decelerations, and awkward landings after a jump typically result in ACL injuries.

With the rising participation rates of competitive youth sports, there has also been a corresponding rise in ACL injuries amongst children and teens as well, especially those involved in the sports mentioned above.  In Canada and the US, there are over 250,000 ACL injuries per year and over 50% of those injuries occur in youth between 15-20 years of age!  What are the best prevention measures we can take to help our kids avoid this serious injury?

In the past 10 years, a significant amount of research has shown that ACL injuries can be prevented with a proper focus on movement technique and developing hip strength.  In particular, if we can teach our kids how to squat, jump and land better, we can make significant inroads with reducing the risk of knee injury.

If you have ever attended your child’s team conditioning session for soccer, hockey, baseball, etc., you would probably notice that everyone does the same workout and that some kids seem to move well while others don’t.  However, since every youth athlete has varied muscle imbalances and movement pattern issues, your child should ideally have their movement and strength analyzed by a medical professional and then a training program is developed specifically targeting his/her weaknesses.

With respect to ACL injury prevention, hip strength is important.  But you can still have a strong athlete whose body does not know how to activate those strong hip muscles which will still result in injury.  So knowing how to activate muscles and then also knowing how to move properly are essential.  These are things that will not likely be covered by your child’s team coaches or staff both due to time and lack of specialized knowledge.

As a parent, what can you do to start assessing your child?  Watch this video:

Two key things we see in this video that the girls are practising with each jump is landing with:

  1. feet straight
  2. knees out

acl injuryWhat very typically happens with both children and adults alike who are unaware of how to properly land and engage their hips and gluteal muscles, is that the feet turn out (think ‘duck feet’) and the knees cave inward.  One or both of these errors occurring during the landing result in a ‘valgus knee fault’.  When your child performs athletic movements like pivots, cutting or landing after a jump in their chosen sport, he is essentially putting excess strain on the supportive structures of the knee joint like the ACL.  Over time, that repetitive fault will take its toll and contribute to a possible ACL injury or tear.

Teach your child to walk with straight feet and keep reminding them whenever they revert back to the ‘duck walk’.  As they develop the muscle memory to maintain the foot forward position, this will translate into their ability to also jump and land with straight feet.  Have them practice the jumping drill as in the video.  Good habits start with mastering the simple things!

Consider consulting with a qualified athletic therapist, physiotherapist or chiropractor to look more deeply into your child’s individual concerns.  Help them enjoy their sport for years to come!

Until next time,

Dr. Keith

Chiropractic ‘Self-Defense’ Tips for Your Knees

Knee pain and knee injuries are extremely common in the general population.  Tears to the anterior cruciate ligament (ACL) are common in turning/twisting sports like skiing, soccer and football.  I have three friends in their early 30’s who all had ACL surgery last year alone!  Menisus tear are also very common and affect jocks, couch potatoes and moms alike.  These can often brew from years of overuse, poor biomechanics in sports or just silent deterioration of connective tissue.  And let’s not forget our good friend, osteoarthritis.  I’ve had some patients present with this even in their late 20’s….so it’s never too early or late to develop arthritic knee joints.

The knee has two basic movements: flexion and extension.  However the joint also allows for a bit of internal and external rotation that is insufficient enough to protect it from some of the torquing forces that get placed upon it in life and sporting activities.  Our knee muscles function to propel our bodies forward in movement and also help cushion the impact of movement.  The best way for you to help keep your knees healthy is to maintain the balance and strength of those supporting muscles.

Here are some quick chiropractic tips on how to prevent knee injuries and maintain good knee health:

  1. Avoid prolonged squatting, for example while gardening or doing housechores.  Extreme flexion of the knee places alot of stress on the cartilage and connective tissues in the knee joint.
  2. Ladies, avoid heels that are over one inch as much as possible.  The change in angle alters your centre of mass and subsequently puts more stress on the front of the knee joint and tendon.  The occasional wedding or dinner party will warrant something high but keep them in the closet day-to-day.  Your knees, hips and back will thank you for it down the road!
  3. Don’t prop you feet up on a table or ottoman without some kind of support under your knees.  Just like extreme flexion is bad for your knees, hyperextension of the knee in this ‘relaxed’ position is also not advisable.
  4. Don’t sit with one leg tucked underneath you or sit on the floor with your legs to the side.  There is too much rotation torque applied to your knees in these positions.  It was fine when you were a kid but now that you are older and less flexible, those joints can’t handle it!
  5. Runners will kill me for saying this but I’ll say it anyway!  I don’t advise running as your main form of exercise or fitness because it is simply too much pounding on your knees and rest of your body.  There are a lot of other way to stay fit or lose weight that don’t create such a toll on your body.  At the very least, try not to run more than every other day, run on softer surfaces and cross-train on your off days.  Competitive runners…keep doing what you’re doing because I know you won’t listen to me anyway!
  6. Wear properly fitting athletic shoes for whatever sport you participate in.  This also means that you shouldn’t wear running shoes to play soccer or basketball in, nor should your wear basketball shoes to run in.  Shoes are designed for specific purposes and are best used in the appropriate court, field or pavement.
  7. Lose some weight if necessary.  In climbing stairs, an extra 50 lbs of weight translates into over 150 lbs of extra pressure on your knees!
  8. Invest in a foam roller to perform self-myofascial release in key muscles such as your quads, hamstrings, ITB and calves.  By releasing excessive soft tissue tension around the knee joint, there will be less pressure on the joint when doing any activity.

When looking at knee pain, the common conditions you may hear thrown around at the office, in the gym or at home include:

  • ACL/MCL/mensicus tears,
  •  Jumper’s Knee, Runner’s Knee, Patellofemoral Pain,
  • IT band syndrome,
  • quad/hamstring pull,
  • knee arthritis

Whichever one of these you may or may not have, you should always see a qualified health professional to have it assessed properly.  Most of the time rehab therapies, manual treatments and properly addressing muscle imbalances will help you get back to normal in short order while surgery and injections should only be viewed as last resorts.

What is the best medicine?…PREVENTION!

Dr. Keith