The most important phase of ACL rehab (info)

Posted on April 2, 2014

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For a long time I’ve debated putting out an ACL resource. Because the rehab is so long, usually at least 6 months, I wrestled with attempting to make something covering that much time. So much can happen in 6+ months, everyone’s timeline is going to be different, goals are individual.

Over the last few years, after going through my own anterior cruciate ligament reconstruction, working with others, and talking to many others (a great deal from this website), I noticed a reappearing theme: People can’t get out of the first month.

They wake up from surgery and have absolutely no idea what to do from there.

“When can I walk?”

“How long should I be using crutches?”

“When can I bend my leg again?”

“Is there a risk of screwing up the graft?”

“How can I better deal with the pain?”

“When should I start physical therapy?”

The last question, when does one start physical therapy, was a primary impetus for me deciding to put something together.

After an ACL reconstruction, physical therapy does not start in one month, it does not start in two weeks; physical therapy, and your recovery from this significant injury, starts the minute you wake up from surgery.

I’ve encountered too many people starting their therapy 2-4 weeks post-op. Initially, my sympathy for those starting therapy this late, enduring the host of issues that come with such an approach, wasn’t much. People don’t research this operation thoroughly enough. However, over time I’ve noticed another theme: People aren’t taken care of physical therapy wise.

While everyone should do some perusing, not everyone can be expected to do extensive research on a topic as complicated as ACL surgery. This is why we have doctors and therapists. To do this for us, and take care of us. Yet, I’ve lost count of how many people have emailed me or left a comment saying,

“My doctor said I’ll start therapy at 4 weeks.”

“My insurance only covers once a week sessions.”

“My doctor said to do nothing for a couple of weeks.”

“I can’t get in to see my therapist.”

“My insurance only covers 10 sessions, total.”

The last quote, from a recent email, was the other impetus for me putting something together. Long story short -only having 10 session- is horseshit. You don’t put a power drill through someone’s body then say, “Alright, you’re on your own. Good luck!” That’s not fair. The rehab is just as, if not more, important than the surgery. If one aspect is taken care of, so should the other. Unfortunately, this isn’t true.

Hell, I had about as good of insurance as one could have when I had my surgery. The operation was fully covered, as many physical therapy sessions as I wanted to pay $10 copays for, you couldn’t ask for more coverage wise. I walked into my first appointment only for the therapist to go,

“Hey, I’m so and so, just wanted to let you know this will be my last day, but we can still do some work together.”

Me “I’m sorry, but is there any point to that?”

Next session,

Therapist “Hey, how’s it going? I’m so and so. I’ll be working with you today.”

Me “Are you the new hire?”

Therapist “Well, no. I’m a temp. I’ll only be here until they find a full replacement.”

Me “How long will that take?”

Therapist “Tough to say. A month maximum. But I could be gone tomorrow too.”

Next session,

Another new therapist “Hey, I’m so and so. I’m the new full time therapist.”

Me “Great. About time.”

Therapist “So, what procedure did you have done?”

Me “Uh, don’t you already have that information? Isn’t the doctor’s office across the hall?”

Therapist “I’m sorry, I don’t have it. But you can just tell me.”

I never went to that office again. In three sessions I had three different therapists. By the time they found a full time hire I was already four weeks post-op. There is no excuse for that. Luckily, I knew what to do that first month. Hopefully, this manual will give you the same ability.

Here are some of the things covered:

  • Dealing with the pain
    • When does pain peak after surgery? How you can align your pain killers with this timeline.
    • Did you know just being more prepared for what the surgery entails, what the rehab process is like, having a plan, all this can help decrease the pain as well? (Here if interested.)
  • When can you walk again? How do you progress into walking?
  • The biggest mistake ACL patients make
  • When can you bend your knee? How much can you bend it? When can you increase your range of motion? What type of bending can you do?
  • What direction should you start your rehab with? Side to side motion? Forward? Backward? How do you progress this?
  • Why it’s common to feel like your knee isn’t a part of you after surgery. Almost like your body is “here,” but your knee is “there.”
  • Videos and pictures for just about everything. Most of which include a voiceover from me going over proper form.
  • The mental aspect
    • How do you deal with the emotional toll of things?
      • Getting into the rehab immediately is a huge part of this, but I also cover an unconventional approach too

As I mentioned, this manual is for the first month of ACL rehab. “Why only the first month?”

  • This is the most important phase. It sets you up not only for having a continued, successful rehab, but to have a healthy knee for rest of your life.
  • It is the phase I most often see people screw up. Whether it’s the individual, their doctor, their therapist, this phase is the most important, yet the most ignored.
    • It’s the phase people are most often left to their own devices. They have no therapist yet, they don’t know what to do, and they’re full of questions. This manual helps bridge that gap. So, by the time you start a formal rehab program with a therapist, you’re a month ahead of most.
  • After the first month individual differences start to matter more. What graft you have, whether you’re an athlete, how fast you can progress, etc. The first month though, there really aren’t going to be many differences.

Many things, like how much you can extend or bend your knee, ability to walk, handling the swelling, aren’t going to vary much, if at all. For example, while it doesn’t matter if you’re running by 3 or 4 months, it matters when you regain full knee extension. While it doesn’t matter if you’re playing basketball again at 9 or 10 months, it matters if you try to bend your knee too soon.

  • Getting back to competitive sports, in the grand scheme of life, isn’t the biggest concern after such a major operation. This manual sets you up for a successful road to sports, but getting back to having a healthy, functional knee is the biggest concern. I want to make sure people get this right. I’m more concerned with you being able to walk well the rest of your life than I am you playing rec sports.

Here is the outline:

Table of Contents

  1. Setting the stage
  2. A primer
  3. Pain remediation
    1. Waking up
    2. Drugs
      1. “What should I take?”
      2. “Get ahead of the pain!”
    3. Compression
      1. ACE bandage technique
    4. Icing
  4. Walking
  5. Range of motion
    1. Immobilization
    2. Flexion versus extesion
      1. Extension (more specific)
        1. Quad inhibition
      2. Flexion (more specific)
        1. The Patella
    3. Other
  6. Sleeping
  7. Proprioception
  8. Strength
  9. Conditioning
  10. Nutrition
  11. Rehab program
    1. Day 1
    2. Days 2-10
    3. Days 11-14
    4. Week 3
    5. Week 4
  12. Appendix
    1. Some other questions
      1. “Can I do upper body exercises?”
      2. “The mental part of this is really tough. Do you have any other recommendations on how to deal with it?”
      3. “Where do I go from here?”
      4. “Should I be working my other leg?”
    2. Ibuprofen after activity
    3. NSAIDs and injury
    4. Icing and injury

Lastly, going back to my own experience, I tried visiting a therapist the first month to get another pair of eyes. Having a pair of trained eyes at your disposal is invaluable. It’s impossible to be unbiased assessing yourself. Nor do you, or can you, always look for the right things.

So, in addition to the manual, if you buy the product and want me to check your form on something, such as one of the exercises, email me videos or pictures and I’ll be happy to take a look for you: b-reddy@hotmail.com

I don’t normally do this for my manuals, but I want to help out the best I can, as this is a topic deeply personal to me. I know how tough the ACL recovery process can be; having to worry about inadequate rehab shouldn’t be part of it. It’s a hard enough road already.

The manual comes in the form of a password protected link. After the purchase is complete you’ll be redirected to the link, and the password will be in your email.

You can get it for $20 here: Add to Cart

 

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