Rehabilitation Protocol After ACL Reconstruction
ACL progression has multiple phases to work through, and each phase has its own checklist of tasks. Each of these checklists has to be completed before you progress into the next phase, which makes for a tedious (but thorough) process.
On the plus side, even if it’s tedious, it’s at least pretty straightforward, right? Finish off some checklists, and you’ll be back to safe running — plus, we’ll even walk you through it all.
Phase 1: Improving Your Movement
It’s necessary to start your first phase within 3-4 days after your surgery when it comes to rehab after ACL reconstruction.
That sounds very optimistic, maybe, but it’s for good reason.
This first step is all about easing back into normal post-surgery leg movement. Since this is the first of many steps, it is necessary to start soon after reconstruction. If you do not move immediately, the joints and tissues can quickly become rigid. Plus, waiting longer to work your muscles just ensures that you’ll have more ground to make up for during recovery. So, make sure to get started soon after surgery to prevent these extra delays of hard work.
First of all, you will have minimum post-operative swelling, which will subside in some time. In addition, to make it function correctly again, proper care in the first phase will allow for greater movement in your knee and improve the muscle capacity around your knee joint.
As a consequence, you will be able to work your way to other important recovery activities, such as returning your knee to a full range of motion. For restoring proper movement, being able to completely extend and flex your knee (when you straighten or bend your leg) are also super essential aspects.
When you start restoring the activation and control of various leg muscle groups, such as the quadriceps, hamstrings, and gluteal muscles, it is important to provide a complete range of motion. Full extension of the knee is especially necessary for the ability to contract the muscles of the quadriceps, which enables the muscle strength of the quadriceps to be restored and the knee to be stable for proper walking form.
Throughout this first point, you’re also going to begin learning how to walk again, and we don’t just mean getting back on your feet. More importantly, to guarantee that your ACL is not at risk of additional strain or reinjury, you can re-learn proper walking mechanics. Here, it is extremely important that your knee is capable of maximum flexion, as many basic everyday tasks are an important feature. Simple tasks such as walking, putting on your shoes or socks, getting up from a chair, or going up and down the stairs, for instance, all require the knee to bend.
Not too bad, huh? Without rushing the healing process, this whole first step helps you to jump straight into rehabilitative treatment and at least brings you back to the basics of your everyday life.
But it doesn’t end there, of course.
Phase 2: Restoring Your Strength and Control
You should move into the second phase now that you have checked off all the tasks from phase 1 (and double-checked all to make sure you actually did them all).
The second phase typically begins anywhere between 4-6 weeks after surgery, although the time period can vary. Theoretically, it only begins after all the prior work from the first phase has been completed.
This is where you start to strengthen the balance in your surgical leg once you reach Phase 2. The strength target for this stage is, in total, to recover 80-90 percent of strength based on the current strength of your stable leg.
For your development through ballistic (or impact) activities such as running and jumping, restoring the strength and control of your leg is important. Your muscles must be powerful enough to withstand all the loading forces of your operation, which can be up to 3 times your body weight. If you are unable to properly strengthen the muscles around your knees, hips, and ankles, if your ACL graft undergoes additional pressure because it has not yet healed completely, you will be vulnerable to reinjury.
In addition, this second step will also focus on strengthening your proprioception, which is your knowledge of the location and movement of your body in a nutshell. Basically, in order to change your equilibrium and stability depending on where you are in space, your brain and body are in constant contact with each other.
Ultimately, it is important to restore proprioception (specifically in the surgical leg) to return to running, as you essentially leap all the time from one leg to the next. As you run, within hundreds to tens of seconds, your body needs to change its equilibrium to generate the strength required to propel yourself forward.
Many of your ligaments, including the ACL, would have to take on extra stress that is counterproductive to the healing process if you are unable to use your leg muscles to re-stabilize your body.
Via simple tasks such as standing on one knee, you’re training in Phase 2 will strengthen your proprioception, and you will possibly also advance to more complex tasks. An instance involves standing with your eyes closed on an unstable pad or ball while reciting the alphabet backward (which honestly doesn’t even sound super simple without reconstructive surgery).
And that’s the gist of Phase 2 — making sure your leg is solid and healthy enough to prepare for the next training change.
Phase 3: Relearning Proper Force Absorption (ACl Surgery)
The third and final step is now arriving, which normally begins somewhere between 12-16 weeks after your surgery. (But, just as before, before moving to phase 3, you want to be 100 percent sure that you have fulfilled all the correct Phase 2 criteria.)
At this point in your rehab, the ACL graft has finally healed enough to properly handle the forces of ballistic activities, like light jumping or running. And yes, this is actually the step where you can get back to running (gradually)!
The move to this third stage focuses on teaching the muscles during movement how to actively absorb effects. This is why it is so essential that you have tackled all the previous training beforehand, otherwise your still-vulnerable ACL could be overpowered by weak muscles or lack of alignment control.
On top of that, the surgical leg will also begin to improve strength and proprioception. The key aim here is to get it back as your non-injured leg to an equivalent degree of strength and stability. Since ballistic activities continuously put higher loading forces on the body, it is important that your leg is well-prepared to take on the repeated running effects.
You’ll probably start by practicing how to land a small jump on both legs as you begin this process, followed by a progression to repeated jumps on both legs. You’ll go on to a small leap on one leg from there, followed by small repetitive hops on one leg. Remember: running is actually just a series of short jumps from one leg to the other, so these jumping exercises are intended to prepare for the repetition and test your leg muscles.
You’re just about ready to ease back into the running world once you’re able to show sufficient, active control in both hopping and landing!
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