ACL Rehab: 5 Tips Heading into ACL Reconstruction Surgery
#ACLStrong
Know the General Timeline for Recovery.
Before I lay out any timeline, it is important to note that everyone’s body recovers differently. Do not get too caught up in strict dates and rather trust your therapist to progress you when appropriate and hold you back when necessary.
That being said, most athletes are accustomed to following some sort of training schedule (preseason, in season, championship season, off season, etc.) and knowing the goals of each of those seasons is important for maximizing benefits as well as for mentally preparing yourself.
In ACL rehab, these phases are typically referred to as early phase (6-8 weeks), middle phase (6-12 weeks), and late phase (12 weeks-return to sport) with return to sport occurring typically between 9 months and 1year++ (research supports increasing time to return to sport in order to decrease re-tear risk).
These time frames are dependent on numerous factors including patient readiness, surgeon, graft type, concomitant involvement of other tissues, pain/swelling, and strength, just to name a few. That is why it is important not to get too hung up on specific dates. Your therapist will progress you as appropriate.
Early Phase
The early phases of ACL rehab may be linked most closely to the preseason, affectionately known by some athletes as ‘hell week(s).’The early phase of rehab lasts somewhere between 6-8 weeks. During this time, the body is healing from the surgery and the new ACL is grafting itself into the bone.
Middle Phase
The middle phases of ACL rehab may be closely associated with the grind of the off season which typically (depending on the sport) includes a lot of strengthening. During this phase, the emphasis is on maintaining mobility gains while building strength (particularly of the quads, though other muscles should not be neglected).
Late Phase
The late phases of rehab may be associated with in season training. During this phase, athletes are working on fine details related to their specific sport. This means continuing to maintain and build on strength while also adding in speed, acceleration/deceleration, cutting, jumping, and sport specific movements. As appropriate, athletes can return to practice. Note: with all of these, it is never 0 to 100. Adding back in activities should always be a progression to ensure patient tolerance and readiness.
Return to Sport Phase
The return to sport phases of rehab may be most closely related to championship season. The athlete is FINALLY getting back to full play. This is the time in rehab that is the most fun because the athlete is getting back to what they love to do and is able to see all of their hard work pay off. Our goal is always to return the athlete to sport as a better and stronger athlete than before they had surgery.
2.Know Your Therapist
Between the initial injury and your actual surgery date, it is recommended that athletes undergo prehab in order to prepare mentally and physically for surgery and improve outcomes. During prehab, therapists and patients work together to decrease effusion, achieve full knee range of motion, and strengthen quads (and lower extremity) in order to prepare the athlete for surgery. During this time, therapists can also educate patients on the rehab timelines, early stage goals, and general expectations.
While it is important to be in the best possible physical shape heading into surgery and to have adequate knowledge about the process, I think the real value of this time is building a relationship with your therapist.
The early stages of ACL rehab are honestly just not fun. If you already have a good relationship with your therapist, you can trust that the reason they are pushing you is because they want you to have a successful outcome- NOT because PT is really just 'pain and torture.' I promise you- PT's do NOT want to cause you pain. They simply want you to get back to doing what you love.
Shower set-up: used a shower chair and propped my leg up on a laundry basket. Wrapped my leg in saran wrap to keep the incisions dry
3. Gather Key Items That Will be Helpful for Recovery
Crutches for post op.
Ice machine. And lots of extra ice or ice packs since you will be icing every hour.
Stretch out strap to help you move your leg and for exercises early on.
Handles to put next to the toilet or in the shower if you don’t have anything already in place to grab a hold of.
Shower chair and something to prop your leg up on (I used an upside down laundry basket with towels on top).
Dry shampoo for when showering is too much.
Compression sleeves or bandages.
Stool softener especially if you plan to take pain meds for a little bit
Loose fitting clothes that you can easily slide on over the brace
Snacks that you know you can eat even if you feel nauseous. I recommend lots of high protein snacks but it's also helpful to have food available that you know you can eat to give you some energy, especially if you don't feel like eating anything. For me, that was pretzels, clubhouse crackers, and lots of Gatorade.
Backpack. Pack a backpack of things you will like to have nearby you after surgery (i.e. laptop, journal, books, chargers, etc.)
Continuing my PT at home! Quad sets and straight leg raises for days :)
4. Practice Getting Around Your Home
If possible, it is a good idea to practice moving around your home, especially stairs, car transfers, getting into and out of bed, shower set-up before surgery, etc. My parents told me they thought this was one of the most helpful things because then it wasn’t something we had to try to figure out while I was already in pain (or REALLY have to go to the bathroom).
10/10 recommend running to your local hardware store to buy this! Perfect to wrap before showers.
5. Mentally Prepare Yourself
One way to do this is to enjoy doing some of your favorite activities, as able, before surgery. This may be walking, swimming, going to the beach, taking a longer car ride, etc. In the early stages of recovery, you won’t be able to do many of your normal activities. I found that enjoying them immediately before surgery helped me to better rest after surgery because I had at least had an opportunity to do some of the things I love to do recently. And since I was doing them right before, knowing that I wouldn’t be able to do some things for a while, I was able to mentally wrap my head around the fact that I was going to need to rest after surgery.
Secondly, many therapists and fellow patients will tell you that recovering from an ACL tear is not just physical, it is also mental. Following a serious injury and a long rehab process, it can be hard to mentally feel ready to return to sport. Even if you are itching to get back on the field/court from the moment you tore your ACL, the fear of re-injury can prevent many athletes from feeling completely confident when they return to play. While this may seem like a problem for the distant future, I mention it now because the earlier we start to address the mental side of ACL rehab, the sooner we can get you feeling confident and ready to return to sport.
One of my favorite quotes states “in the heat of the battle, one does not rise to the occasion but rather falls to their level of training” (Unknown Navy Seal). In other words, when it comes time to return to sport, we don’t expect athletes to suddenly be ready. Rather we expect them to be able to trust the work they put in to get them to the point where they are ready to play. Therefore, addressing the mental side of ACL rehab can begin before you even head into surgery. It simply begins with a commitment to trust the process and put in the necessary work (or REST) in order to safely and confidently return to sport.
Additional Advice for the Ladies:
Neither of these are necessary for a successful recovery but they may be helpful tips to make the first week or two a little more enjoyable. First, I recommend planning your surgery date to be sometime right after you finish your period. Especially right after surgery, going to the bathroom is hard enough- make it the slightest bit easier on yourself! I remember not even wanting to have to get up to go to the bathroom at all, so if you can give yourself more of an option, do it! Obviously this is something that will depend on surgeon availability and is not a good enough reason to delay surgery… but if it’s a difference of a few days, it may be worth it. Secondly, I recommend getting or giving yourself a pedicure before surgery! You won't be able to comfortably bend your knee for a couple of weeks so if you can do this just before you head into surgery, you will be a whole lot happier. If you don’t like painting your toenails, a good trim would be helpful as well.
Your Doctor of Physical Therapy and fellow ACL Patient,
Tara Rogers, PT, DPT