Appropriate physical therapy is essential to a full recovery from ACL reconstruction. Loss of motion is the most common complication of this surgery and the most common reason some patients develop arthritis. However, loss of motion is usually preventable with the use of the proper therapies at the proper time. A typical therapeutic program can be broken down into three phases: control of inflammation and swelling, range of motion exercises and quadricep control, and strengthening.
Your doctor will probably recommend a few simple extension exercises immediately following ACL reconstruction surgery. However, your primary focus in the first few days will be to control swelling and inflammation. You should keep the knee elevated and iced as often as possible, take all medication as prescribed, and learn to handle your crutches safely. Your doctor may have you wear a brace for the first week after surgery but many do not.
To protect against loss of motion, your therapist will focus first on extension of the knee and then flexion. The goal is usually to reach 100% extension and 90 degrees of flexion in the first few weeks. Exercises for extension may include Prone Leg Hang or simply sitting on the floor or on an exercise table with a rolled towel under your ankles. Gravity will gently do the work. Flexion exercises start with lying on your stomach, bending your knee and bringing your foot as close to your glute as possible.
It is also important in this phase to restore quadriceps control. The quadriceps may begin to atrophy after a traumatic knee injury and it must be restored to full function to ensure full use of the knee. You may be instructed to perform exercises such as quadricep sets and seated leg raises to strengthen the quad. Your therapist may also use neuromuscular electric stimulation or NMES to help invigorate these muscles.
During this period, it is also important to ensure that the patella or knee cap remains mobile. Your therapist will manipulate the patella through a full range of motion and may teach you some similar exercises to perform at home.
While all patients progress differently, by around week four you should no longer need icing, crutches or NMES. You should have established range of motion in your knee. Your therapist’s focus will shift to strength training and endurance. You will perform strength training exercises such as step ups and modified lunges. You will begin regular use of a cardio machine such as a treadmill or elliptical. Riding a stationary bike or swimming are also both great ways to restore strength and maintain range of motion.
Successful recovery from ACL surgery is not quick and it requires that you closely follow instructions from your doctor and your physical therapists. Adhere to your doctor’s plan and give yourself six months before returning to strenuous use of the knee such as sports.
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