We did a blog post a little while back about what an ACL injury is, and a bit about how to protect yourself from injury. So now we are going to talk about what happens if you still end up with an ACL injury. If you are athletic, you will most likely require surgery to repair the ACL. Not all ACL injuries get surgically repaired however and you should have a conversation with your physiotherapist or doctor about the benefits and risks of surgery. The surgery varies somewhat depending on the specific case, but involves creating a “new” ACL from other tissues, usually from a part of your hamstring or a tendon around your knee cap, and attaching it in place of the damaged ACL.
Physiotherapy interventions pre-surgery are very beneficial in helping to regain range of motion (ROM), strength, and balance, which are all lost after the injury. It is important to get as much strength in both the injured, and uninjured leg prior to going into surgery as this will speed up your recovery afterwards.
Physiotherapy interventions are crucial post-operatively and are usually initiated between 3-5 days after the operation. Most surgeons will even want you to have an appointment booked with a physiotherapist before you even go in for the surgery to make sure you start within that time frame!Rehabilitation usually lasts between 4-6 months depending on the type of surgery, and if any other damage was done to the knee at the time of injury. You will most likely need crutches after surgery until you have restored some ROM and strength. Another beneficial device is an "ice machine" or cryo-therapy device. These devices work by circulating very cold water around the knee to help with swelling, pain reduction, and muscle spasm. Although not necessary for recovery from the surgery, they can be beneficial in the early stages of therapy, especially for pain relief!
Immediately after surgery, it is important to start working on restoring ROM. Regaining knee extension is important early after injury to reduce pain later in the rehabilitation process, and get back to normal walking (gait). Regaining knee flexion takes a bit more time, but is also very important for activities like going up and down stairs, moving around in bed, and even just walking. Early in rehabilitation, you will be given stretches and exercises to regain ROM and your physiotherapist will use some hands-on techniques such as muscle release and passive movements to improve your ROM.
Strengthening exercises are also initiated early in the rehabilitation process. After surgery, muscles become inhibited due to swelling in the knee and get weak very quickly. Early strengthening exercises are added to improve muscle activation around the knee, especially your quadriceps. Furthermore, strengthening for muscles around the hip, such as your gluteal muscles, is important to help stabilize your trunk and leg, not only on the affected side, but also on your good leg, since your good leg will be doing a lot of extra work at first while you work on improving you affected side.
This exercise helps improve quadriceps activation
Gait retraining is another aspect of ACL rehabilitation. Gait retraining is essentially learning how to walk properly again. Due to the muscle weakness that develop after surgery, and the ROM deficits initially present after surgery, walking can be challenging. Getting back to normal weight bearing and walking as early as able will help restore knee ROM and strength, as well as reduce stress on the uninjured leg. This can involve doing weight shifting exercises onto your affected leg, walking with or without crutches, and just slowly working back into normal walking. An important thing to work on initially is proper heel contact on the affected side. Sometimes it may seem easier to just put your whole foot flat on the ground, especially when you are using crutches, but heel contact can help restore knee extension and helps promote the normal way we walk.
Finally, neuromuscular and proprioceptive training is started almost immediately after surgery. Whoa, whoa, whoa, what is this “proprioception” thing you're talking about?? Well don't worry, it's not too complicated. In short, proprioception is your body’s ability to know where it is in space. If you close your eyes then lift your arm, you can generally tell where it is with respect to your body. This ability is decreased in a post-operative knee, which can affect walking, balance, fall risk, and proper muscle coordination. With proper training these can all be improved.
This is an example of a more advanced proprioceptive exercise.
Finally, one thing to make note of, is that most surgeons will have a rehabilitation protocol that they use after their surgeries as guidelines for the physiotherapy to use, and so that you can see what to expect at different times after the surgery. If you are going in for a surgery I recommend taking a look at these protocols, though some of it you may need the help of a rehab professional to understand.
Although this seems like a daunting and long process, most people recover well after surgery, and can get back to sports within 6-12 months depending on their sport. It does take a lot of work however, and you have to be willing to put in the time and work on yourself to help get you better!
Hope you enjoyed the read! If you have any questions about ACL injuries, feel free to call or book an assessment at 905-240-9355 or email us at firstname.lastname@example.org!
Brody Langlois, Registered Physiotherapist