An injury to any part of the body can result in pain and loss of function, but an injury to the ACL (Anterior Cruciate Ligament) of the knee can often lead to abnormality of gait, sensations of instability, constant swelling and the inability to participate in sports and recreation. This article will explain exactly what to focus on and what to be cautious of during the rehab process.
It is instinctual to see the inability to bend your knee and want to try to bend it as soon as possible, but in physical therapy, we realize that early flexion can stress the graft too soon. It takes time for the new graft to truly become your own. Once swelling goes down flexion will come naturally. Regaining full extension is more important for reasons related to gait, posture and function.
After an injury, the body has an amazing way of making small, sub-conscious compensations to your gait that is hard to be aware of as it happens over time. Unfortunately, these compensations can involve different posturing, improper weight shifting and the development of a completely pathological walking technique. Be conscious that your body may do this and do your best to walk as you would have before the injury. Make it natural. By getting your normal gait back sooner will offset other complications that can manifest.
Most people do everything they can to regain strength, range of motion (ROM), flexibility while reducing pain and swelling, but patients and athletes often forget about proprioception. Proprioception is defined as position sense and is a close cousin to balance. Knowing where your limb is in space without the dominance or reliance on your eyes is vital to a full recovery.
Most people focus on the thigh muscles or quads after an injury to the ACL. It is paramount to focus on not just the quads but the hamstrings, adductors, abductors and the calves. Take into account the leg as a whole, functional unit and you will always be on target. Exercises like leg press, lunge and wall squats are ideal.
Many people are so focused on rehabilitating their knee they forget about the entire cardiovascular system. Working out aerobically is considered flushing out your system. It is a must throughout the rehab process. We use a progression from the recumbent bike, upright bike, erg, elliptical, to treadmill.
Some people feel confident enough to go a walk outside of their house without their immobilizer brace on. This is not advised. The outdoors are considered an open environment and anything can happen. The brace is necessary to not only control the amount of flexion but also protect the healing graft from the outside world. Remember, you just had surgery, be cautious and follow your physicians rules!
Everyone heals differently and at varying rates. Take into account age, diet, lifestyle, profession, present health, medications and a smoking history. These all affect rates of healing and there are so many more. There is a general time for physiologic healing to occur in the human body but after an ACL injury, don’t expect to get back running or to return to sport until at least 6-8 months unless on an accelerated protocol.
When rehabbing from an ACL tear it is important to first reduce pain and swelling, then restore ROM and flexibility. Finally, regain strength and proprioception. Many people go right to strength training and go too heavy for that matter. This is not advised. Initially, focus on higher repetitions to enhance greater blood flow and later on in the rehab process you can focus on strength.
Many people try to get back to activity too soon. Rehabbing from an ACL tear can take 6-12 months. Yes, that is a long time, but your ACL is the guide wire of the knee and the most important knee ligament. Don’t rush it! Getting back to your sport or activity too soon will increase your chance of reinjury and mental defeat you.
If you can perform ADL’s (Activities of Daily Living) without pain it does not mean your PT is complete. As an owner of 5 physical therapy clinics in NYC, i have seen many patients simply stop coming to PT after they are out of pain and become self sufficient. It is crucial to finish your PT to the end. This is due to the fact that there are milestones that need to be reached, and if not completed properly most people wind up going back to physical therapy at some point again.
Rehabbing from an ACL tear is no easy task. It is imperative that you work closely with your physician and physical therapist in order to make a full recovery. Keeping in mind some of the major goals listed above and being cautious in the initial stages is vital. Remember, you only have two knees. Take your time with therapy, ask questions and do your home exercise plan recommended by your physical therapist to ensure you won’t have a problem in the future.
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