A common athletic injury that you’ve probably heard about might have to do with tearing the ACL. The ACL, or anterior cruciate ligament, joins the upper leg bone (femur) with the lower leg bone (tibia) and functions as the primary rotational stabilizer for the knee. When you’re moving forward, such as when you’re running, the ACL isn’t really involved. It only comes into play when you’re cutting around or changing directions to stabilize the knee joint area. An ACL injury commonly happens when you rotate too quickly or with too much force in that joint area, which causes your ACL to overstretch and tear. Depending on how badly torn the ligament is, you may be a candidate for surgery to repair the damage. Post-surgery, you will likely feel immobile. You may wonder how you’ll ever get back on your feet again. Although the timeline for ACL surgery recovery varies depending on your specific injury, you should expect 4-6 months of one-on-one treatment with your physical therapist.
0 Weeks: Treatment Before You Even Have Surgery
Pre-rehabilitation physical therapy, or “prehab”, is a form of physical therapy that begins before you have scheduled surgery. Prehab focuses on increasing strength and flexibility of the muscles in your surgery area. Although the surgery will fix the tear, it will also cause the muscles in the knee area to become weak and stiff. You’ll want to strengthen all the muscles that will aid in keeping you balanced post-surgery. Undergoing prehab before surgery has been proven to improve knee function faster after surgery. One study in 2013 found that patients participating in prehab returned to sports almost 2 months faster. Prehab treatment might involve building up quadricep and core strength pre-surgery so you’ll see greater knee stability and faster recovery post-surgery. It could also involve teaching you how to use assistive devices (i.e. crutches) and tackling tricky movement barriers, such as stairs, so you know how to move around after surgery.
0-4 Weeks: Baby Steps
Many of the same goals you would want to achieve in prehab also apply here in the initial phases of physical therapy treatment. Some of these processes may vary depending on your doctor’s protocols. Main priorities will be to reduce inflammation, regain range of motion of the knee (i.e. bending and straightening the knee), and begin to slowly withstand bearing weight on your injured knee so you can start to walk. Making sure you have the proper flexibility includes immediate manual therapy, or hands-on techniques, that your physical therapist will perform on the surface of the knee joint and the muscles surrounding it. A common complication post-surgery is stiffness and loss of range of motion because of excess scar tissue formation. Your physical therapist will manually breakdown any scar tissue restrictions that may be developing in your knee. Manual therapy can also help decrease swelling around your knee. You’ll slowly wean off of your dependence on crutches as your knee tolerates. Important exercises in this phase of rehab (i.e. straight leg raises, half squats, partial lunges, etc.) will be targeted toward quadricep strength. By strengthening the muscles at the front of your thigh, walking will become that much easier and the knee will feel more stable.
4-10 Weeks: Getting Back To Walking
At this point, the goal is to start getting your natural walking pattern back. You want to be able to control your walking movements again, which means you may have to begin some balance training. Both the fact that your knee is injured and that you haven’t been using your injured knee very much likely will have thrown your body’s sense of balance off. Guiding you back into proper walking form involves a combination of continued manual therapy and personal exercise-based treatment. It’s key to start building up balance on your weaker leg by doing some one-legged activities. There will also be a focus on building up strength and full flexibility in the muscles around your hips as well as the muscles around your knee. With improved strength in your hips and quads, you’ll be putting less pressure on your healing ACL. You’ll be working your way from exercises such as single-leg squats to step-up and step-down techniques (using a step) as well as resistance training with a band.
12-16 Weeks: Starting Some Light Running
By about 3 months, any swelling you’ve had will likely be gone. You also should have full range of motion in your knee, which means being able to extend and bend without restriction (135-145 degrees for bend, 0 degrees for extend). If you still have muscle stiffness, your physical therapist will apply more manual therapy to any specific muscles that are restricting your ability to fully extend or bend your knee. Depending on your unique recovery progress, your knee joint may still need to be manually mobilized in a certain way. Any basic aspects of leg movement should be back under control, such as naturally walking or being able to move around casually. Your personal ACL treatment program will continue building strength in your core and lower body muscles. You might be doing some endurance training on a stationary bike, elliptical, or treadmill. At this point, you will want to do some more advanced balance training on balance boards or bosu balls to ensure that your healing leg is stabilizing well. Your physical therapist will want to customize your treatment to make sure that you’re treating any balance issues that were caused by your ACL injury. At some point in this phase, you might begin lightly running, jumping, or getting back into any physical activities you used to do.
4 Months+: Getting Back In The Game
There’s a range of what patients with a healing ACL injury might begin to do around 4 months. Everyone has different preferred physical activities and you’ll begin to get back into your favorite activities at this point. If you played basketball, you might begin some shooting drills. If you’re a runner, you might begin getting back into some longer jogging. It all depends on what your activity takes to get back into. You don’t want to halt any progress you made by overly exerting your knee, but certain sports-based drills will be okay to practice. Your treatment program post-injury should focus on not only reducing pain, but building up your body’s strength and flexibility in a way that prevents a future ACL tear. Beyond that, you’ll be given the tools you need to have better endurance, balance, and coordination with your healing knee as you recover from ACL surgery. You may feel totally thrown off balance and mobility-wise after your ACL injury, but one-on-one treatment is meant to steadily get you back to 100%.