Introduction
After tearing your ACL, you may be feeling defeated, nervous about the future, and have a lot of questions about your recovery and what to expect. All these emotions that you are feeling are NORMAL! There is no sugar coating it, ACL tears suck. However, with the right combination of surgeons and physical therapists you will be able to return to and exceed your prior level of function!
Confirm the ACL Tear
After a suspected ACL tear, the first step is to confirm the diagnosis. There are reliable hands-on tests, such as the Lachman’s test, which can assess the integrity of the ACL. These tests can be performed by physical therapists, athletic trainers, orthopedic doctors, and sports medicine doctors. While these tests can be used to help determine if the ACL is torn, they are not 100% accurate. The accuracy can depend on a variety of factors including how proficient the clinician performing the test is, how much of the ACL is torn, and how much swelling is present at the time of assessment. This is why an MRI is the gold standard for determining whether or not the ACL is torn. An orthopedic or sports medicine doctor can help you obtain and MRI by writing a script for you.
ACL Reconstruction
Now, assuming the MRI confirms an ACL tear, the next step would be determining whether or not you will undergo ACL Reconstruction. ACL Reconstruction involves ‘reconstructing’ the ACL ligament using a graft, which is usually a piece of your patellar tendon, quadriceps tendon, or hamstring tendon. Not everyone who tears their ACL will require surgery. This determination should be a collaborative decision between patient, surgeon, and physical therapist. If you do require surgery, choosing which graft you use (patellar, quadriceps, or hamstring) should also be a collaborative decision between patient, surgeon, and physical therapist.
ACL Physical Therapy: Prehab
Before surgery, it is beneficial to participate in a physical therapy regime often referred to as ‘prehab.’ Prehab consists of physical therapy sessions focused on decreasing pain, regaining range of motion, and low-level strengthening exercises to maintain as much muscle strength as possible and to decrease muscular atrophy. Prehab has been found to improve outcomes post ACL Reconstruction.
ACL Physical Therapy: Post ACL Reconstruction
After undergoing ACL Reconstruction, it is time to find a physical therapist. Keep in mind, not all physical therapy is created equal. It is important to find an expert in ACL rehabilitation. Good physical therapy is a huge component to recovering from an ACL tear. Your physical therapist needs to have knowledge of how to rehab an ACL tear properly and have the facility to appropriately challenge you during the latter stages of rehabilitation and return to sport progressions. While it may be most convenient to choose the physical therapist closest in distance to where you reside, this is not recommended. Do your homework and find the physical therapist who best fits your needs as a patient. Choose wisely; your recovery depends on it!
Once you find your physical therapist it is now time to begin your post ACL Reconstruction physical therapy program. While each program may look a little bit different depending on type of graft and surgeon and physical therapist preference, this is the typical progression:
ACL EARLY POSTOPERATIVE STAGE - This stage of rehabilitation will be focused on reducing swelling, restoring knee range of motion, improving weight bearing tolerance on the affected leg, and improving walking/gait mechanics.
ACL MIDDLE POSTOPERATIVE STAGE - This stage of rehabilitation will be focused on restoring muscular strength in the affected leg and beginning plyometric exercises, such as jogging.
ACL LATE POSTOPERATIVE STAGE - This stage of rehabilitation will be focused on preparing the patient to return to their sport/activity and will include continued strength training, jumping, sprinting, agility, and other plyometric exercises. During this stage the patient should be progressed through evidence-based physical and psychological testing to ensure that they are ready to return to their sport/activity.
It is important to note that the rehabilitation process generally takes 9+ months following ACL Reconstruction. Research has found that returning to sport prior to 9 months exponentially increases patients’ risk of re-tear. ACL Rehabilitation should be milestone dependent and not strictly time dependent. Your physical therapist should be routinely testing your range of motion, muscular strength, running mechanics, jumping/landing mechanics, and other agility and sports based movements before progressing you to the next stage of rehabilitation and/or discharge. ACL Rehab is supposed to be challenging! If you are not feeling challenged, it may be time to find a new physical therapist.
Closing Thoughts
Remember, you are stronger than this setback. Many other athletes have went through this exact process and have come out stronger on the other end of rehab. Allow yourself to feel the emotions that come along with the process, however do not let them consume you. Take it one day at a time, stack days, be diligent with your rehabilitation process, and seek the support of your rehabilitation team, family members, and friends when needed.
Looking for ACL Physical Therapy in the Greater Philadelphia region? Ironphysio Sports Physical Therapy and Performance may be the perfect place for you! Proudly serving Southampton, Newtown, Richboro, Warrington, Doylestown, Philadelphia, Jamison, Levittown, Yardley and surrounding areas.
Learn more about ACL Physical Therapy at Ironphysio: https://www.ironphysio.net/acl-physical-therapy
Written by: Dr. Jayson Jeffries, PT, DPT