Designing a Post Surgical ACL Rehab Program
What is an ACL Injury?
In designing a post surgical ACL rehab program, it is important to understand about ACL injuries and how they occur. An ACL injury is the tearing of the anterior cruciate ligament (ACL) inside the knee. An ACL injury is usually involved with sports that have sudden stops or changes in direction. This includes such sports as volleyball, basketball, tennis, etc. If one or more of your favorite sports are similar, you can preventative measures and follow a properly designed training program to help minimize the chances of getting an ACL injury.
After an injury to the knee, it is best to consult with a physician immediately because that nasty “pop” sound was most likely the ACL tearing. A proper diagnosis will be determined after the physician performs various stability tests, and/or takes an X-Ray or an MRI. Once the diagnosis of a torn ACL has been determined, the physician and patient will decide if surgery is appropriate. Unfortunately, a torn ACL cannot simply be sutured back to the bone; instead, it is necessary to completely replace the damaged ligament with a tendon from another area of the body or external source.
Read about the ACL Ligament or the components of the Knee Joint. Did you know that there are differences between the sexes with knee injuries?
I just had Surgery. What can expect now, what will my ACL Rehab be like; and when will I be able to participate in my sport again?
There is not one universal timetable for recovery that can be applied to everyone recovering from ACL surgery. Some of the factors that determine an ACL rehab schedule are: age, the severity of the ACL injury, the surgical procedure that was used, the individual’s personal work ethic during ACL rehab, and the overall health of the person going through ACL rehab.
As a general guideline, after a traditional ACL repair surgery an ACL rehab program can take from 6 to 9 months to achieve and restore full strength and function. A simple milestone for an ACL rehab program would be that the patient should be able to start a light running program within about 4 months after the ACL surgery. A general guideline to establish when an individual can return to their sport is that the recovering knee must have a minimum of 90% of the strength of the healthy knee.
Aside from a post ACL rehab program, what can I do myself to help my recovery?
Before I go into the details of a post surgical ACL rehab program, I want to share a few simple things that you can do during your ACL rehab to help speed your recovery.
1) Proper nutrition: Eating properly is an important part of everyday living, and can be even more important post ACL surgery and during your ACL rehab program. Eating a proper diet after surgery can help your body heal faster. Some of the foods that are important after ACL surgery are: lean proteins (such as red meat, chicken, or fish), fresh dairy products, and fresh citrus fruits. You should also include foods that are nutrient rich such as spinach and other green leafy plants. And as much as I hate to say it, you should limit your caffeine and alcohol intake. It is also a good idea to cut back on the sodas (even if you are not recovering from ACL surgery).
2) Proper amount of sleep: Yes, sleep is an important part of an ACL rehab program. Sleep is a big part of my training program when I am healthy, and it is even more important when you are recovering from an illness or surgery. Sleep is the time that your body repairs damaged tissues and promotes the healing process. To help your body recover, get at least eight hours of sleep a night.
3) Follow your doctor’s orders for taking prescribed medications: I am not one for taking any more pills than I have to, but when it comes to following my doctor’s orders I will follow through. After ACL surgery, and during your ACL rehab you most likely will be on some sort of pain medication(s). You will need to talk with your doctor about any current medications that you are taking, and discuss if there are any other supplements or vitamins that you should be taking.
4) Changes in your recovery: During your ACL rehab program, if there are any changes in your recovery such as your pain suddenly increases, you develop a fever, or there are signs of infection; call your physician immediately.
Rehabilitation Procedures
Now that you have an understanding what ACL surgery is, what to expect post surgery, and what you can do for yourself; I will now discuss what your post-surgery ACL rehab program may look like. Under current guidelines for post surgical ACL rehab programs, physiotherapy can begin as soon as 3-4 days after surgery; and can last for 6 months. The final goal of your ACL rehab program is to regain full range of motion and have strength equal to the opposite knee.
The Timeline of Your ACL Rehab Program
ACL Rehab: Day 1-2
During this phase of your ACL rehab you will most likely be weight bearing wearing a Zimmer splint. The Zimmer splint will be worn during sleep. However, the goal right after surgery is not to be walking around, it is to reduce the pain and swelling. The principle of R.I.C.E. comes into play. R.I.C.E. stands for Rest, Ice, Compression, and Elevation. Hence, the first day or two will consist of bed rest, wearing the Zimmer splint for compression, having your leg elevated, and iced.
ACL Rehab: Days 3-14 (Week 1–2)
What to expect
This early after surgery the rehab program will start. The ambulation goals during this phase are to start to increase the amount of weight placed on the leg that had surgery (while wearing the Zimmer splint) and by day 14 be full weight bearing on the leg. During days 3-14 you should minimized that amount of walking to help reduce swelling. When sleeping the Zimmer splint must be worn and when resting it is advised to elevate your leg so that your knee is above your heart.
ACL Rehab Program and Exercises
Goals
The goals of the ACL rehab exercises during this phase are to: Obtain full extension and hyperextension, reduce the swelling and allow the wound to heal, to maintain active quad control, and to obtain 90 degrees of flexion.
ACL Rehab Exercises and Activities
1) Passive Knee Extensions.
2) Gastronemius stretches with a towel.
3) Static Quadriceps sets while sitting up with legs outstretched in front of you. Place a towel under your heal.
4) Isometrics
5) Wall slides: to increase flexion. Ice may be used on knee during the exercise.
6) Passive flexion sitting over the edge of a bed or exercise table.
7) Hip adductor and abductor exercises as tolerated.
8 ) Heal raises.
9) Simple proprioceptive exercises.
ACL Rehab: Weeks 2–6
What to expect
During this phase of the ACL rehab program the pain will start to significantly decrease. It is extremely important during this phase to protect your knee against over activity. I know from personal experience that the hardest part about training is NOT training. The ambulation goals during this phase are to be full weight bearing on your knee using the Zimmer splint, to discontinue use of the Zimmer splint at home, but still wear it everywhere else, and progress out of the Zimmer splint into a functional ACL brace.
ACL Rehab Program and Exercises
Goals
The goals during this phase of the ACL rehab are to focus on: regaining your range of motion, reduce the swelling, and to increase muscle tone. Exercises will focus on regain balance, possibly perform exercises in a pool or exercise bike, and strengthening exercises will increase.
ACL Rehab Exercises and Activities
1) Quadriceps: straight leg raises in the supine position.
2) Squats: Start double legged and progress to single legged.
3) Hamstring exercises.
4) Exercises stepping up and down 4’ progressing to 6” stairs.
5) Stair climbing machine (progressing very slowly).
6) Stationary bike.
7) Swimming. Used only if incisions are fully healed and if you are comfortable with performing water workouts.
8 ) Progressive proprioceptive exercises.
ACL Rehab: Weeks 6-9
What to expect
During this phase of the ACL rehab you should be able to progress to full weight bearing on the leg that had ACL surgery without the splint. However, you should continue to use the functional ACL splint when active. Your clinic visits will decrease and you will be expected to continue a home exercise program that will be designed specifically to help you to continue to increase and improve your range of motion. You will not be thrown to the wolfs and expected to do these exercises without guidance. Your physician can print out a list of all recommended ACL rehab exercises, plus they will be available to help answer any questions that you may have. Also, your Specialist in Exercise Therapy will be there to help.
ACL Rehab Program and Exercises
Goals
The main goals during this phase of the ACL rehab program will be to gain your full range of motion, and to increase your functional activates. These exercises will now take place both at the clinic and at home.
ACL Rehab Exercises and Activities
1) Continue the exercises from weeks 2-6 with an emphasis on balance and functional movement.
2) Lunges.
3) Squats on a BOSU.
4) Exercises stepping up and down steps using different step patterns.
5) Power walking.
6) Cycling outdoors without toe-clips and on flat terrain.
7) Possibly jogging in waist deep water.
ACL Rehab: Weeks 9-12
What to expect
In this phase of the ACL Rehab you will be able progress to full weight bearing during exercises and activities. The progression from power walking will increase into jogging on a level surface.
ACL Rehab Program and Exercises
Goals
The main goal is to increase your functional activities and increase your endurance.
ACL Rehab Exercises and Activities
1) Jogging on a treadmill.
2) Jogging outside on level terrain
3) Cycling on all terrains.
4) Skipping on both legs.
5) Box jumps.
6) Agility exercises such as a ball toss balancing on one leg.
7) Hopping on one foot.
ACL Rehab: Weeks 12-14
What to expect
You should expect to be full weight bearing by this point in your rehab program.
ACL Rehab Program and Exercises
Goals
Achieve full range of motion, increase your strength and endurance, and to increase your total function in your leg.
ACL Rehab Exercises and Activities
1) Begin using exercise machinery such as a Nautilus program.
2) Leg Press, leg Curls, and Squats.
3) No leg extensions beyond 45 degrees.
4) Running straight ahead at half speed.
5) Running up stairs and then walking down.
6) Proprioception and strength exercises.
7) Hopping drills
ACL Rehab: Weeks 14+
What to expect
A return to light sport activities. This can happen only if the following occur:
1) You have regained full range of motion.
2) You have gained a 90 percent strength ratio to your “good” leg.
3) You have a successful negative Lachman test.
4) And finally, you have your physician’s approval.
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