ACL rehab
POST ACL RECONSTRUCTION – WHAT TO EXPECT DURING YOUR REHAB
What is the ACL?
The Anterior Cruciate Ligament (ACL) is a dense ligamentous structure connecting the femur to the tibia and limits forward movement of the tibia and rotation between the two bones. ACL injuries are most common in sports where a sudden deceleration or pivoting movement is required such as netball, football, and skiing. An injured ACL can range from a grade 1 sprain, where the ligament is stretched but no tear has occurred to the ACL being ruptured completely.
Australia has the highest reported rates of ACL injury in the world! Between 2000 – 2015 almost 200 000 primary ACL reconstructions were performed in Australia.
Diagnosis:
When someone has experienced an ACL rupture, they will often describe a ‘pop’ or loud ‘cracking’ sound followed by extreme pain in the first few minutes and immense swelling within the next hour. The injured person may also report that they feel unstable when weight bearing on their knee and unable to straighten their knee to full range.
A physiotherapist can diagnosis an ACL rupture based on what you have told them, a physical assessment of the knee’s structures, range of motion and strength in addition to a form of imaging, most commonly an MRI.
An MRI provides a clear and defined image of the anatomical structures within the knee and has a 95% accuracy of diagnosing an ACL injury
Rehabilitation following an ACL injury:
Whether someone with an ACL injury chooses a surgical approach vs a conservative approach for treatment, the rehabilitation is very similar.
The goal of an ACL rehabilitation program is to:
1. Reduce pain levels.
2. Reduce swelling and inflammation.
3. Regain strength.
4. Regain range of motion in the knee.
5. Regain proprioception (awareness of the position of the knee in space)
Injuries of the ACL rarely occur in isolation. Your physiotherapist will take into consideration any additional injuries sustained and tailor your rehabilitation program to your needs. Your physiotherapist will also consider if you had a patella or hamstring graft and implement exercises and treatment of those areas accordingly
What to expect from your rehabilitation program following an ACL reconstruction:
Prehabilitation (prior to surgery)
This will include strength training for the affected leg, range of motion exercises, balance and proprioceptive exercises and gentle walking, bike riding and swimming.
Phase 1. 0-2 weeks post-surgery
The goal of phase one is to return to full weight bearing, decrease swelling and increase range of motion through gentle exercises. Gentle strengthening exercises for the quadriceps, hip muscles, and calf muscles. No sport related activities.
Phase 2. 2-12 weeks post-surgery
During this phase, the goal is to eliminate all swelling, continue to improve the knee’s range of motion, perform a full squat, continue to improve balance, and walk as normal. This would involve more demanding exercises such as squats, lunges and leg press. Step ups and bridges and a progression of the exercises in phase one. During phase two the injured person can begin walking and using an exercise bike. Due to the length of time spent in phase two, there will be regular progressions for the exercises to ensure steady progress of the knee’s function.
Phase 3. 3-6 months post-surgery.
The goal of this phase is to regain full range of motion, strength, and power. Return to jogging running and agility-based exercises and begin restricted sport specific drills. This involves increasing the difficulty of the exercises in phase two and beginning straight line jogging, swimming, road cycling, and multidirectional running. For instance, running forwards, backwards, sideways and hopping, jumping and kicking.
Phase 4. 6-12 months post-surgery.
The goal of phase four is to return to sport. This involves completing high-level strengthening exercises related to the sport the injured person wishes to return to and a progressive return to unrestricted training and competitive match playing. Will I need to wear a brace when I return to sport? No, wearing a brace when returning to sport is not necessary unless it helps build your confidence in your knee. Many reliable studies have found no benefit of a postoperative brace when returning to sport and therefore do not recommend the use of one.
It is important to note that every individual’s journey post ACL reconstruction is different and the time for returning to competitive sport will vary amongst individuals.