How to Feel Great Early in the Game After ACL Surgery

One of the more devastating injuries in youth sports is the dreaded ACL injury. I’ll leave the reasons as to why this is so common for another day…but if you have recently torn your ACL or had surgery to reconstruct your ACL, this is for you (this is meant as an informational reference only, and is no substitute for a personalized evaluation by your expert PT!!).

There are some complications that can come after ACL reconstruction and many of them can be avoided if a smooth start is achieved. Hopefully, you have taken some time to get your knee prepared as best you can prior to the big day, including gaining some range of motion, walking normally and getting your quad to fire really well. Personally, I notice the patients that feel best are the ones who regain full knee extension (straightening) in the first 2-3 weeks, but there are some other things that help too. My goal is to share how these successful ACL survivors have gotten over the first few hurdles. These are the commonalities I’ve seen with those that do VERY well in the long run:

They get their knee straight.

This is the number one early goal after ACL reconstruction. Not getting your knee extension back after surgery can lead to a number of problems. One study has shown a link between lacking knee extension and increased rate of developing arthritis, another shows increased risk for a Cyclops lesion with loss of extension, and another shows a possibility that lacking knee extension can contribute to losing more quadriceps muscle mass. Regaining knee extension after major knee surgery can be challenging, but if you really work hard in the early stages, you’ll be rewarded with a smooth start to your rehab process.

They have no fear.

It’s completely normal to have some fear going in to your first physical therapy (PT) visit after surgery, if you didn’t you wouldn’t be human! But persistent fear can become a paralyzing problem. One thing I’ve repeatedly heard is that people think they are “stretching their ACL back to normal” after surgery when they go through their exercise program. That’s not the case, the ACL actually isn’t stretched at all by bending the knee, and straightening the knee only strains the ACL in the extreme ranges of hyperextension. People also tend to worry about putting weight on the surgical leg. This doesn’t put any stress on the ACL either, but you’ll want to make sure to have your brace on in the early stages to help protect the knee and the new graft. The point is – don’t worry about hurting the new ACL with exercise – motion is what that knee needs.

They have great a work ethic.

Rehab after ACL is a lot of work and cannot be taken lightly. The work has to be done for the rehab process to go well. Usually, I have people try to complete their early rehab program 3-4 times per day. Take advantage of the time off from school or work, even if it’s just a few days, and get after it. Remember, even if you go to 2-3 PT session per week that leaves 109-110 hours when it’s just you and your knee (if you factor in 8 hours of sleep each night)!

They are goal oriented.

This is also a typical trait of good athletes. During your physical therapy sessions, you should be setting some goals with your PT. They might include using crutches no longer than 7-10 days, bending the knee to 90 degrees by the end of the first week, fully straightening the knee by the end of the second week, or other things of that nature. It always helps to have something to work towards and the process of recovering after ACL injury involves many hurdles to get over.

They have a great support system (including their Physical Therapist).

These people have a great team of people around them including parents, teammates, coaches, friends, or coworkers. They also have a great medical staff involving – at minimum – a surgeon and physical therapist, but also even a dietician, athletic trainer, sports psychologist, or strength coach. You should select your support circle with people that can push you when you need it, listen when you’re frustrated, and encourage you if you’re down. There's no need for wasting energy on "negative Nancy's" who share their terrible stories about their Mom's dog's babysitter's knee surgery and how she doesn't walk normally anymore. That's not you. And your energy is better spent on being positive. You will be stuck with some people but there are some you can choose. Put some time into finding an experienced ACL surgeon and put even more time into finding an experienced Physical Therapist. Remember, this is the person you will spend countless hours with after surgery!

Now that you have some ideas for how to get off to a great start, go get to work! 

Brett