It seems like we’re always hearing on the news about how one famous athlete or another is out for the rest of the season because of a knee injury. Knee injuries such as straining or tearing of the anterior cruciate ligament (ACL) can be very painful and debilitating, and can take months to years to recover from depending on the extent of the damage and the patient’s recovery rate. Surgery is often required to repair a torn ACL, but recovery afterward is a long journey involving multiple treatment approaches, including resting, medication, knee brace use, physical therapy, and even mental practice to build confidence and eliminate fear when returning to normal activities.
The ACL, a tough band of tissue connecting the end of your femur to your tibia, is one of four ligaments in your knee joint. It provides much of the restraining force involved in flexing your lower leg, providing support and stability as your muscles move. The most common ACL injury is a complete tear, which, in addition to pain and swelling, results in the knee losing strength and “giving out.” Surgery is done to stitch the ligament back together, but extensive therapy and recovery is required afterward to regain normal strength and flexibility in the knee. However, there are a few things you can do to get the most out of post-surgery therapy and speed your recovery time by as much as possible.
The first stage is resting.
For a couple of weeks after surgery, the focus is on healing the surgical site and getting swelling and pain under control. Usually you will be given a pain medication by your doctor to help with this, and icing the area can help as well. Spend some time with your leg propped up on a couple of pillows at least four times a day to further reduce swelling. Mainly, it is important to allow your knee to rest. However, you will need to do some basic leg exercises each day to keep blood flowing in the leg and prevent blood clots. Some quad sets and keeping your knee fully straight will also help ensure you don’t develop a contracture.
After a couple of weeks, you should be able to start putting some weight on your leg. This is the point at which you would usually start physical therapy at Blue Hills Sports & Spine Rehabilitation. The first few physical therapy sessions will be focused on techniques to help your knee stop hurting completely. Your goals now are to keep moving around; nothing strenuous, but enough to keep your blood flowing and your muscles engaged. It is also very important that you keep stretching your leg to a fully straight position to prevent stiffening and scar tissue formation which would make full recovery much more difficult down the line.
One to two months after surgery, you will start your more in-depth physical therapy to return the function of your leg to normal. At Blue Hills Sports & Spine Rehabilitation, a physical therapist will tailor a rehabilitation program to your specific injury, health status, and abilities. You will begin stretches and exercises to build strength in your muscles, restore stability to your knee joint, and regain flexibility. In the beginning, you will likely start with strengthening your thigh muscles, then will be given progressively more challenging exercises to safely advance knee and muscle recovery. Techniques you may practice include isometric exercises, which work muscles without bending the knee, and neuromuscular training, which will work on your leg’s balance, reaction time, agility, and fine motor control. Initially you will probably see your physical therapist two to three times a week, gradually reducing to once every few weeks as you improve.
Part of your rehabilitation program may involve doing an exercise routine at home. There are a few practices that will be especially helpful during this time.
First, as mentioned earlier, is routinely stretching your leg out straight. Similarly, you’ll want to work on your knee flexor motion as well, by doing deep bending exercises like squats and eventually lunges. Doing exercises that work your quads is good for regaining neuromuscular control in your upper leg. Giving soft tissue mobilization massages to your patella, or kneecap, can help prevent motion loss in your knee; your physical therapist can show you how to do this. And lastly, gradually building weight exercises on your leg will help you build the strength you need to start walking and balancing with your leg again. Once your full range of motion has returned, swelling is gone, and you can put weight on your leg, you’re on your way to getting back to work and sports!