Part 1

So you tore your ACL and just had surgery to reconstruct it. Now what?

This first post is going to focus on the first phase of rehab, typically from about 0-12 weeks post operatively. There are some specifics that might change depending on the type of graft, or other procedures performed during surgery, but this is a basic description for an isolated ACL reconstruction.

Understanding the Journey Ahead

After an ACL surgery, stepping into the world of rehabilitation can feel like embarking on a challenging yet hopeful journey. The key to a successful recovery lies in a structured rehab program, starting with the early post-operative phase. This critical period sets the foundation for the strength and stability you’ll build upon in the later stages of rehab. The typical timeline for an adult or teenager who is no longer growing to return to sporting activity is 9 months, while a teenager who is still growing is closer to 12 months.

Overcoming Arthrogenic Muscle Inhibition

One of the first hurdles in early ACL rehab is tackling arthrogenic muscle inhibition (AMI). AMI is a common phenomenon where the quadriceps muscle temporarily loses its ability to contract effectively. This is not just a physical barrier but a protective mechanism by the body, responding to pain and swelling in the knee. Overcoming AMI is crucial, as it allows for the restoration of muscle control and strength – which is highly tied to how well people are able to jump, run, cut, and perform in sporting activities. Having a weak quadriceps muscle after ACL reconstruction has been tied to early onset arthritis in the knee.

The Role of NMES

Neuromuscular Electrical Stimulation (NMES) is a game-changer in the early stages of ACL rehab. By delivering electrical impulses to the quadriceps, NMES helps “wake up” the muscle, combating the effects of AMI. It’s a tool that not only aids in muscle strengthening but also assists in regaining voluntary muscle control. Incorporating NMES into your rehab can significantly enhance your recovery’s effectiveness and speed. At my practice, we use NMES for at least 6 months after surgery, making sure that we are getting the most possible amount out of your quadriceps.

You’re cutting off my blood flow?

Blood Flow Restriction (BFR) therapy is an exciting way to help muscles get stronger and prevent from losing muscle mass early on in recovery without having to use heavy weights. This means there’s less strain on the ACL graft that is still healing. Here’s how it works: a strap is wrapped around the upper part of the leg. This band slows down the flow of blood coming back to the heart but lets blood keep flowing into the muscle. Because of this, even with light exercises, muscles can grow like they would with tougher workouts by creating a low-oxygen setup that muscles respond well in for growth. This is helpful right after surgery when doing heavy exercises might not be a good idea. Starting to build strength sooner without hurting the healing process can make a big difference in getting better faster and keeping your muscle preserved.

Beginning with the Basics

The initial phase of rehab focuses on regaining knee mobility, reducing swelling, and achieving a full range of motion. Gentle exercises, weight-bearing, and using crutches or a knee brace are part of this stage. It’s about taking small, guided steps to ensure the knee’s stability and functionality are progressively restored. There should be steps and progressions for you to slowly reduce the use or get rid of crutches or a brace for daily activities.

A Word on Patience, Persistence, and Expertise of the Rehabilitation Provider

Early ACL rehabilitation is a time for patience and persistence. It’s essential to follow the guidance of your physical therapist or other rehab provider closely and not rush the process. The goals set in this phase are foundational for the more challenging exercises and activities that will come later in the rehab journey.

Further, not every physical therapist is skilled at ACL rehabilitation. It is always worthwhile to ask about specific criteria to advance to the next stage, their experience level with these rehabs, and progressions into running, jumping, and sports – and how you both know you are ready for those.

Stay tuned for Part 2, where we’ll dive into the mid-stage of ACL rehab, focusing on building strength, endurance, starting to jump and run, and beginning incorporating some agility into training.

Thanks for reading!