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The ultimate goal post ACL surgery is to get your knee as strong and as conditioned as possible. However, the strength and movement in your knee is just as important pre-surgery as it is post.
Studies have shown that five weeks of intensive pre-operative rehabilitation with the aim of achieving 90% limb symmetry resulted in better knee function two years after surgery (Grindem et al., 2015). For those who are operated on sooner, it has still been shown that completing some pre-op rehab results in a higher likelihood of returning to sport and having better knee function post-op (Mansson et al., 2013).
In many cases there will be a delay of several weeks between the injury and surgical dates. It is important to use this time to start the rehabilitation process. That is why talking to your physiotherapist is an important early step.
The first goals of rehabilitation is to minimize/reduce the swelling, get the knee fully straight and regain good quadriceps activation. It is likely you will be highly motivated to start strength and movement exercises straight away, however it is important to keep the first 1-2 weeks gentle to recover from surgery. During this time you should concentrate on compression, regular icing of the knee and tendon graft site, basic quadriceps activation exercises and range of motion exercises.
You will then progress to basic body weight exercises and balance tasks. Once your knee can bend to 90 degrees you can usually start using a stationary bike and then progress to a gym-based program. After this, your progression towards returning to sport should all be criteria-based as opposed to time-based. This means achieving key functional milestones before progressing to the next level.
Returning to running is only a small component of the overall picture and requires adequate muscle strength and single leg balance prior to being attempted. Your physiotherapist can help guide your recovery and will conduct regular strength testing to assess your readiness to progress to running, hopping, change of direction, returning to training and then ultimately returning to play.
ACL rehabilitation can be a long 12 months of regular gym sessions, running, and jump/landing practice. Everyone will progress differently, have ups and downs and times of very low motivation. Allowing yourself a mental break from training here and there is also important to get you back on track.
It is a team effort. Work with your physio to devise the best plan to work toward achieving your recovery goals.
About the Author – Kobi Phelan is a physio based at Camberwell Sports & Spinal Medicine. She has a Clinical Interest in the management and rehabilitation of knee injuries including ACL injuries.
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