Should you immobilize your leg after tearing your ACL?

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One of the most common ACL questions I get is how much range of motion you should have at various points after surgery. I get this at the most acute stage. When people are within 14 days post-op and realize, “Holy shit, my leg looks like a bowling ball, I can’t move it, and I’m seriously contemplating letting someone stab me in my eye to help distract me from how much my knee hurts.”

A common fault in an ACL patient’s immediate post-up therapy is they aren’t doing any. Their knee is so stiff 10 days after surgery because they haven’t moved it for 10 days. I’ve written ad nauseam you don’t start your therapy a week or two after surgery, you start your therapy the day of surgery.

Something else to consider is what people do, not after surgery, but after the initial ACL tear. It may seem different, but the two situations  -immediately after ACL tear and immediately after ACL surgery- are quite similar. Your leg is in pain, there’s a ton of swelling, you can’t move much, etc. Just like tearing the ACL is an injury, surgery is its own form of injury.

Considering how similar these situations are, something I haven’t written much about is you actually don’t start your physical therapy after surgery, you start your therapy the day you tear your ACL. The better you are going into surgery -strength, range of motion, etc.- the better you are coming out. This is why even elite athletes have a waiting period after the initial tear.  They don’t blow out their knee then immediately get operated on.

At this point, I’m sure you can tell whether it’s injury or surgery, I’m much more in favor of moving the leg than I am immobilizing it. I want to see if I can make a stronger argument though.

I want to preface this by saying I’m not picking on the commenter, but those who gave him the advice. In Reconstructive ACL surgery: What graft should you use? Rudy left a comment:

Hi Brian,

First of all I would like to thank you for all the help you have been so far as I read all of your material regarding ACL surgery.

I am a 31 year old male who lives in New Jersey and tore my ACL completely, partially tore my MCL and no meniscus damage (Thank God!!) on my left knee playing soccer on Thanksgiving morning (11/28/13).

I am a huge sports fan and love playing soccer, tennis, basketball, jogging, etc. I do not play professionally, just as a hobby and to keep me in form.

I can’t even begin to explain to you what I have been through so far (I am scheduled to have surgery on 01/30/14). I was scheduled for surgery on 01/07/14 with a surgeon that I was not too happy about, he gave me a knee brace that immobilized my knee and told me to not move my leg too much so the MCL can heal quicker. As dumb (and desperate?) I was feeling and did what he told me, and starting to feel pain in my left calf.

I went to see him 2 weeks later as he gave me that appointment and told him about my pain and sent me to do an ultrasound and said my leg was too stiff and need to go to therapy (12/27/13 one month after my injury).

They found a blood clot DVT (Deep Vein Thrombosis) below the knee and prescribed Xarelto for this treatment.

And that’s the end of this post.

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