When to start physical therapy after ACL surgery (part 2)
This is the second part of our series on starting Physical Therapy after ACL surgery. Part 1 of When to start ACL rehab can be found here.
As a review:
Day 1 of ACL rehab should be based on this framework
Respecting ACL Healing (discussed in part 1 of this series)
“Quieting” down the knee by managing ACL pain
Starting basic knee range of motion work
“Quieting” down the knee with physical therapy
Quieting the knee down refers to reducing swelling and pain after ACL surgery. Your knee goes through quite a bit of trauma during surgery. Pain, swelling, and bruising are expected. The physical therapists goal is to find the appropriate amount of load your knee can handle to avoid an increase in swelling and pain.
Techniques to reduce swelling and pain include prescribed medications from your surgeon, continuous icing, elevating the leg and using crutches to help offload the knee. Pain and swelling after ACL surgery cause the knee to become more inhibited and atrophied and can be a nasty cycle if not managed appropriately. The longer it takes to properly manage the knee pain and swelling, the longer it will take to return to activity and sport.
Beginning knee range of motion in physical therapy
The basics in ACL rehab are non-negotiable. Restoring range of motion is crucial, and that begins right after surgery. Waiting for 2+ weeks after ACL surgery will limit your outcome. Many clients have been given range of motion exercises by their surgeon. No post-op ACL clients are completely clear on how hard to push motion. It’s easy to push too hard, or not hard enough. The biggest challenge for physical therapy after ACL repair is when clients wait longer than 3-5 days before beginning ACL rehab.
Normalizing knee extension (straightening of the knee) as soon as possible is the top priority after surgery. Functioning without full knee extension will cause problems in performance later on.
Research has shown the following problems when full knee straightening isn’t achieved.
- Worse overall outcome
- Increased risk of osteoarthritis
- Abnormal walking pattern
- Increased stress on the patellar (knee) tendon
- Limits the ability for the quadricep and other muscle around the knee to work
Getting range of motion back after surgery is tough. Waiting longer to start ACL rehab (even by a day) only makes the process harder and more uncomfortable. Start your ACL rehab within a few days of surgery. Or better yet, start working with an experienced physical therapist BEFORE you even have ACL surgery!
Every ACL surgery and recovery is different. But certain factors are part of the process for everyone. Early on, protecting the grafts, quieting the knee, and beginning to address ROM are crucial. The sooner these are addressed the smoother the physical therapy process will be.
If you are have had surgery, check out some of our favorite early post-op exercises: ACL Injury and Rehab – 3 Exercises Post Surgery
(Check out part 1 of this ACL rehab series here)
Written by the ACL specialists at MoveMend Rehab and Performance