Rehab After ACL Surgery

acl rehab
Physical therapy is a significant part of ACL recovery. DNY59 / Getty Images

Rehabilitation after surgery for an ACL tear is a lengthy process. Return to sports and activities takes months. There are many variations of ACL rehabilitation, and the information provided here is simply an overview. Specific rehabilitation must focus on each individual athlete, and you must adhere to your own protocol. It is also important to note that timelines are a guide -- progression depends on completion of one step, before advancing to the next step. Most sports medicine surgeons agree, that rehabilitation timeline's are not rigid. Individual athletes may very in their progression, and movement from one step of rehabilitation to the next requires an athlete to demonstrate expected progression. A good physical therapist will monitor your progress through the various stages of rehabilitation and only move you from one phase to the next when it is appropriate. Some stages may move more quickly, others may take a little longer. The most important goal is to ensure the best chance of long-term recovery and return to sports activities, not the speed with which you progress through your rehabilitation.

The First Days

The goals of the first days after ACL reconstruction are to minimize swelling and prevent discomfort. This can be accomplished with:

Some surgeons recommend the use of a brace after ACL surgery. This is controversial, and many surgeons choose not to use a brace at this time.

Another controversial subject is the use of a CPM, or motion machine, after surgery. Again, some surgeons will use the CPM despite a lack of evidence that it helps your recovery.

Weeks 1-2

Range of motion exercises can begin immediately after surgery. The initial focus is to regain full extension (the ability to fully straighten) of the knee. In general, flexion (ability to bend) is much easier to regain than extension.

Patients will work with physical therapists to work on gait training (walking), gentle strengthening, and aerobic work. I like to get patients on a stationary bicycle as soon as possible after surgery as this improves strength, motion and aerobic activity.

Weeks 3-6

Work is continued with physical therapy. As motion increases, emphasis is shifted to strengthening. Specifically balance and proprioceptive exercises.

Once normal motion has been achieved, some sport-specific activities can be started. Before beginning these activities, motion must be near normal and the swelling in the knee gone.

Weeks 7-12

Early sports activities can be started and patients can often begin light jogging, cycling outdoors, and pool workouts. Side-to-side, pivoting sports -- such as basketball, soccer and football -- must be avoided.

Toward the end of this phase, some athletes can begin shuttle runs, lateral shuttles and jumping rope

Months 4-7

Continued progression with sports specific activities. This phase of rehabilitation is often the most difficult, because patients may have a knee that "feels" normal, but is not ready for the stresses of some sport activities.

Emphasis of rehabilitation should be on sport simulating activities. These will include figure-of-eight drills and plyometrics, and over time will include sport drills. For example, a tennis player may start light hitting, a soccer player some controlled dribbling, etc.

Return to Sports

Deciding when to return to unrestricted sports activities depends on a number of factors:

  • Functional Progression
    • The decision to return to sports must be based on each individual's progression through their therapy.
  • Graft Type
    • Some surgeons may delay return to sports if the graft used to reconstruct the ACL came from a donor. Because these grafts are sterilized and frozen, there is a belief that they take longer to heal well inside the patient.
  • Surgeon Preference
    • Your surgeon will guide your rehabilitation, and the ultimate decision about return to sports.

Bracing After ACL Surgery

There is also controversy about the use of braces during sports after ACL reconstruction. Studies have shown no benefit in preventing re-injury to the ACL. However, some athletes feel more comfortable in a brace, and there is no harm in wearing a sports brace. My typical recommendation is to use a brace when first returning to sports activities to give the athlete confidence in their recently injured knee. Over time, the bracing can be discontinued.

A Word From Verywell

Recovery following ACL surgery is a lengthy process that requires prolonged rehabilitation. Initial efforts are to decrease swelling and improve mobility following surgery. Over time, strengthening and balance become more important, and ultimately sport specific activities are performed to get athletes back on the field. Progressing from one step of rehabilitation to the next depends on successful completion of the goals of each phase. Athletes and physical therapist need to be flexible to allow adequate time to meet the appropriate milestones at each phase of rehabilitation.

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