ACL Recovery - What Does The Early Stage Rehab Entail?

ACL recovery can last anywhere from 9 months onwards, but what does the early stage rehabilitation involve straight after your ACL surgery?

ACL surgery is a big deal for athletes. They are often a traumatic injury which leads to a lengthy period out on the sidelines. Whilst the recovery is physically tough to return back to pre injury levels, it's also mentally tough not being able to play sport. This blog will break down the early physiotherapy rehabilitation and the goals of the early phase of ACL rehabilitation as discussed by Buckthorpe et al 2023 - Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction .

Pain and Swelling

After an ACL reconstruction there is a lot of swelling in the joint, and this swelling causes problems. When there is swelling in the knee joint it affects the ability of the quadriceps muscle to fire properly (hence why post op it feels like your quad falls asleep.)

In the early phases we have to make sure that we reduce the swelling but also not make swelling worse. The best ways to reduce swelling post op are;

• Elevation
• Movement
• Compression
• Ice (to help pain)
• Managing step count in the early phases

Reducing swelling early is important for reducing pain, increasing range of movement and getting the quad firing again.

Range of Movement

When waking up after an ACL reconstruction the knee will be very stiff. It will not want to bend or straighten due to pain and swelling. It is essential that we restore extension early on as this will help with strengthening the quadriceps and walking mechanics. It is important to follow the surgeon's post op protocol and your physiotherapist will guide you through increasing range of movement.

Muscle Activation

All of the muscles are important in the early stages but the main priority we have is the quadriceps. The quad is the powerhouse of the knee and some studies show that quad strength can reduce by 40-60% 4-6 weeks post operation. Early isometric exercises such as squeezing the knee down into a pillow can help to get the quadriceps firing again post op. It is also important to note that the surgeon's graft choice can have a big factor in muscle weakness. Quads tendon grafts will impact the quad and the hamstring graft will impact the patella.

Movement Patterns

There is also a big emphasis on throwing the crutches away by patients. But is getting off crutches early always a good thing? The criteria we need to get off crutches are;

• Full knee extension
• Swelling under control
• Able to straight leg raise
• Good technique on a body weight squat

(Each protocol may say different things so follow the guidance from your physio)

Psychological Considerations

The main issues psychologically following an ACL injury are;

a) Patients understanding their injury and what it means for them

b) Not being able to live normal life in the early phases of recovery

c) Building an alliance with their physio

It's a long old rehab and having a physiotherapist that understands, is knowledgeable and you can get along with is VITAL. I'm slightly bias, but our ACL specialist Cian (who also tore his ACL) ticks all of those boxes. I will attach a link to our ACL service page and you can read Cians story.

Maintaining Fitness

Whilst it is not a major priority, maintaining fitness levels is important for an athlete to consider, especially if the aim is to return back to high level sport. Your physiotherapist will be able to guide you through this.

Whilst every protocol is slightly different, the basics remain the same.

• Reduce pain and swelling
• Restore knee range of movement
• Get the quad firing
• Restore basic walking mechanics
• Come to terms with the injury

If you need help recovering from your ACL injury from ACL specialist physios, book a consultation and let's get you back to the sport you love.