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The Ultimate Guide to ACL Rehab Immediately Post-Op

Writer's picture: Aaron TurnbullAaron Turnbull

Introduction

In the world of sports and physical activities, injuries are as inevitable as taxes. One of the most dreaded injuries a person can face is an ACL tear. But don't throw in the towel just yet! ACL rehab, though challenging, is your golden ticket to recovery. So, grab a seat, and let's dive into the nitty-gritty of ACL rehabilitation.


Understanding the ACL: What’s All the Fuss About?

The anterior cruciate ligament (ACL) is a key player in keeping your knee stable. Imagine it as a sturdy rope that keeps your knee bones from playing a game of tug-of-war. When this ligament goes snap, crackle, pop, the stability of your knee takes a nosedive. ACL injuries commonly occur in sports that involve sudden stops and direction changes, like soccer, basketball, and skiing.


ACL Rehab Phase 1: Protection Phase

The first days and weeks after an ACL surgery can be tough. Your knee may be rather swollen, you may be wearing a brace and your new crutches may be getting very old, very quick. Make no mistake, an ACL surgery is a big deal so it's important to let your knee calm down and ride the wave of symptoms that come along with it.



ACL surgery


The protection phase spans the first 1-2 weeks post surgery, where we encourage patients to follow the basic program they will be given from the hospital. We want the knee to settle down, most of the pain to subside and ensure that come week 2 or 3, we are able make meaningful changes and start working.


Not all ACL surgeries are the same. Based off the surgeon’s preferences, the choice of graft (hamstring, patella tendon or quads tendon autograft) and whether other procedures have been performed (e.g. meniscus repair, lateral tenodesis), the first 1-6 weeks may differ person to person. If it is a clean ACL only, most people are weight-bearing as tolerated without crutches by week 2-3, whereas those who have a meniscus repair as well, may have a strict bracing and weight-bearing protocol for the first 4-6 weeks of their ACL rehab.


No matter the surgery, there are ways we progress ACL athletes through this stage by week 2-3 (into the Primary Loading Phase) to maximise healing, but also increasing the stress and therefore development of the muscles around the knee.


Aims of this REhab stage:

  • Reduce swelling and symptoms.

  • Ensure surgical incision hygiene is maintained.

  • Allow the knee to settle, allowing for low load exercises to be introduced without symptom regression.


ACL Rehab During THIS STAGE

  • After surgery, the hospital will provide basic range of motion and activation exercises. We recommend patients stick to those over the first 1-2 weeks.

  • If patients have been prescribed a brace/splint by the surgeon, we recommend adhering to their advice, as this will help ensure optimal surgical outcomes and allow them to move past this stage as soon as it safe to do so.

  • Neuromuscular stimulation is essential (in our opinion) during this stage as we can fire up the quads and hamstrings without annoying the ACL knee. This involves a physiotherapist placing specialised probes on the muscle and performing active movements while the probes "switch on" more muscle tissue than you can do by yourself. Don't worry, you have the controls to determine how intense it goes.

  • Episodic icing and compression can really help modulate swelling during this stage. Swelling inhibits the muscles around your knee's ability to contract, so utilising ice, compression, Game Ready machines etc. is a great adjunct to your ACL recovery.


HOME EXERCISES DURING THIS STAGE

(2-3 x a day)

  • Quad setting: 3 sec holds, pushing down into the towel (video)

  • Straight leg raises: 10 reps (video)

  • Hamstring setting: (video)

  • Heel slides: (video)


ACL Rehab Early Stage Exercises


Frequently Asked Questions

1. How long does ACL rehab take? Typically, ACL rehab can take anywhere from 9 to 12 months, depending on the individual's recovery pace and adherence to the rehab protocol. Going back to sport before 9 months increases your risk of re-rupture by 8.7 times.

2. Can you fully recover from an ACL tear? Only around 50% of individuals return to their previous level of activity/sport post-rehab, so obviously it takes commitment and effort to get a great result.

3. Can ACL rehab be done at home? While some exercises can be done at home during the early stages, professional guidance is recommended to ensure proper form and progression.

4. Is surgery always necessary for an ACL tear? Not always. It depends on the severity of the tear, other pathologies and the individual's activity level.

5. What are the risks of not undergoing ACL surgery? Non-surgical rehab may lead to instability in the knee, increasing the risk of further injury.


Conclusion

The ACL rehab journey is no walk in the park, but with consistency and the right guidance, you can come back a force to be reckoned with. Whether you opt for surgery or take the non-surgical route, remember that consistency, patience, and a sprinkle of optimism are your best allies. So, lace up those sneakers and take one step at a time. You got this!

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