When to start ACL rehab after ACL surgery (part 1)
A common question we get is “how soon I should start rehab after ACL surgery?”.
This is quite dependent on the extent of the ACL surgery, including what tissue was repaired and other factors. Most surgeon’s protocols suggest beginning Physical Therapy for ACL repair 1-2 weeks after surgery. The reason they want you to wait is to respect healing and protect the ACL graft.
However, they often still give a sheet of exercises to do at home on your own. People often have a hard time understanding these exercise along with how hard to push or how many to do.
Because of this uncertainty we strongly recommend begining Physical Therapy for ACL repair 3-5 days after ACL surgery. The early stage of an ACL program sets a foundation moving forward. Doing too much or too little early on will slow the ACL recovery process. Working with a Physical Therapist who specializes in ACL rehab will make sure you are setting yourself up for success.
Day 1 of ACL rehab should be based on this framework
Respecting ACL Healing
“Quieting” down the knee by managing ACL pain
Starting basic knee range of motion work
Respecting ACL Healing
It is crucial to respect the healing in the early phases of ACL rehab. You have just recently gone through a major surgery, and we must consider what tissues were just freshly repaired. Following ACL reconstruction this will mean protecting the graft, and at times a repaired knee meniscus. It is crucial that you follow your surgeon’s post-op protocol. Surgeons have the deepest understanding of what tissue was repaired. Your Physical Therapist will ensure that you are following ACL guidelines, while still creating an early foundation early.
Early on, your graft or your “new ACL” undergoes some significant remodeling and settling. This new ACL is still very immature and cannot handle significant loads. With an ACL reconstruction without a meniscus repair, there are no weight bearing or range of motion precautions. Your Physical Therapist will help you get back walking and getting around the house while factoring in your ACL healing.
When someone uses their own tendon, this tendon they’ve used must remodel for it to tolerate load. An individual might be able to stress the joint a bit if there was no meniscus repair.
If another structure was repaired in addition to the ACL, then extra protection is required. The meniscus, for example, is a load-bearing structure, so it helps distribute force throughout the knee. With a meniscus repair, weight bearing and motion restrictions are necessary.
Optimal ACL healing environment
We need to promote an “optimal environment” to ensure that your knee and your body are ready to progress. Experienced physical therapy assures the ACL repair is not being pushed too much too soon. Many people push their knee too soon because they are eager to be functioning normally “as soon as possible”. This can result in setbacks such as increased swelling pain which increases the healing timeline. Physical therapy will find the appropriate amount of load that your ACL repair can handle so we don’t irritate the tissues further.
Check out part 2 of this ACL rehab series.
Written by the ACL specialists at MoveMend Rehab and Performance