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):
- 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.
- 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.
- 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.
- 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