ACL REHAB PEARLS
WHAT EVERY ATHLETE NEEDS TO KNOW THE FIRST TWO WEEKS AFTER ACL SURGERY
If you've recently undergone ACL reconstruction surgery, the first two weeks post-operation will be some of the most challenging—but also the most crucial—in your recovery. During this period, your primary goals will be to regain full knee extension, achieve at least 90 degrees of flexion, regaining patellar mobility, reducing swelling, and strengthening your quadriceps by achieving an independent straight leg raise. Here’s what you can expect and what you need to focus on for an optimal recovery.
Managing Swelling and Pain
Swelling is expected after surgery, but too much can slow your progress. To control it, you should consistently apply ice, compression, and elevation throughout the day. Keeping your knee elevated above heart level and using compression sleeves can significantly reduce swelling and improve your mobility. Pain management is also essential—take medications as prescribed. Activation of your quadriceps is also helpful to flush out swelling so doing your exercises is crucial for this as well. The use of other techniques such as NMES and TENS may be utilized to help with knee swelling while in the clinic.
Restoring Full Knee Extension and 90 degrees of Flexion
Regaining full knee extension (being able to straighten your knee completely) as soon as possible is one of the most important objectives in the first two weeks. Your PT will guide you through specific stretching and mobility exercises to help achieve this goal. Simultaneously, you should work toward regaining at least 90 degrees of knee flexion (bending your knee), which is crucial for proper gait and functional movement.
Quad Activation and Strengthening
Achieving an independent straight leg raise is a key goal within the first two weeks, as it indicates improving quadriceps strength and control.
After ACL surgery, your quadriceps muscles tend to shut down due to pain and swelling as well as the use of a femoral nerve block during surgery. However, getting your quad to fire again is essential for recovery. Neuromuscular electrical stimulation (NMES) can be used to assist in activating the quad muscle, ensuring it engages properly while you perform your exercises. Your PT will guide you in using NMES along with specific exercises like quad sets, straight leg raises, isometrics off the table, and leg extensions to help restore your ability to contract your quadriceps muscle.
Gait and Crutches
Proper crutch use and walking mechanics are vital during this stage. Your PT will teach you how to use crutches correctly, ensuring you avoid unnecessary strain on your knee. If your surgeon allows partial or full weight-bearing, learning the correct walking technique will help prevent compensatory movements that could cause future issues. We will make sure that they are set up to your proper height and arm length for comfort. You will be locked in your brace with your knee extended so proper gait mechanics are crucial and making sure you are comfortable walking with a heel to toe pattern, emphasizing squeezing your quad with every step. You will also learn how to safely navigate stairs, which can be challenging post-surgery.
Exercise Routine: Consistency is KEY
Your rehab should be your top priority, and consistency is key. To maximize your recovery, you must perform your prescribed exercises five times a day—breakfast, lunch, dinner, and two snacks :) Make sure you are icing prior to doing your exercises to help facilitate better activation of your quadriceps muscle and help with pain. These exercises will include:
Calf/Hamstring stretching for knee extension
Heel prop/prone hang for knee extension
Patellar mobilizations
Heel slides for knee flexion
Quad sets with NMES
Straight leg raises (with strap for assistance initially)
Ankle pumps to prevent blood clots
ICE/elevation
Listening to Your Physical Therapist
Your PT is your greatest ally during this recovery phase. Follow their instructions closely and communicate any concerns or difficulties you encounter. Pushing yourself too hard or neglecting your rehab can slow down your progress or lead to complications.
Final Thoughts
The first two weeks after ACL reconstruction surgery will test your patience and commitment, but they are the foundation of a successful recovery. By focusing on full knee extension, achieving 90 degrees of flexion, reducing swelling, activating your quad, and diligently following your rehab routine, you are setting yourself up for long-term success. Stay dedicated, trust the process, and lean on your PT for guidance. Your hard work now will pay off in the months to come!
