Preparing for ACL surgery

Posted on November 25, 2019

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(Last Updated On: November 25, 2019)

We’ve talked a lot about recovering from an anterior cruciate ligament reconstruction. We haven’t talked a ton about getting ready for it. I certainly wouldn’t say the prehab is as important as the rehab, but the better you go in, the better you come out.

-> This is why all surgeries have worse success rates the older you are. You go in worse as you get older.

My favorite way to prep for ACL surgery is to go through all the early phase recovery before the surgery.

For example, I get readers who have purchased my ACL guide:

The most important phase of ACL rehab

And they’ll ask me what they should do in the month leading up to the surgery. (Most of us schedule the surgery at least a few weeks out.)

-> If you’re doing this, good for you. You’re on the right track. Too many wait until they’re weeks after surgery to start thinking about their recovery. (Partially the surgeon’s fault. They could prep us better too.)

And what I tell them is to do the guide, now (then do it again after surgery). This way you’re very familiar with what you need to do when you wake up. You don’t want to be learning exercises when you need them to recover. Learning a new exercise is fundamentally different than doing an exercise you’re familiar with. A new one is more stressful, brings up more questions, makes you unnecessarily sore, it’s just not as effective as one where you know what you’re doing. Compound this with the pain of ACL recovery, being loopy from medication, just generally being unpleasant, and learning anything isn’t going to be done as effectively.

You could check in with whatever physical therapist you’re going to be using and see if they do anything in particular that you could be working on before surgery as well.

You want to make sure the gym you’re at has the equipment you need, or you may need to get a gym membership if you don’t have one.

Those kinds of things.

But basically I’d go through the guide and probably add more intensity to certain movements, such as the weights. The first month or two post-op is pretty light weight wise, so you could do the exercises, but make them challenging for yourself in the month or two leading up to surgery. Unless you’re super close to the injury event, your leg can probably tolerate it well. This way you have some more muscle than you otherwise would going into surgery. So when the inevitable atrophy hits from surgery, you have more muscle to lose.

With that, I’d make sure to get life sorted for post-op-

  • figuring out time off work
  • who is going to help you
  • getting your driving / transportation sorted
  • you might want to start stocking up on easy meals to have at home
    • cooking on one leg can be tough
  • you might want to start finding some kind of hobby right now if you don’t have one
    • if you’re really active, it can be a shock to the social life to then suddenly not be able to be active post-op
  • if you’re not familiar with crutches you could start practicing with them now
    • for some people going up and down stairs is crazy hard when they’ve never done it before. Or if applicable, you might want to reorient your house so you don’t need to use stairs

Basically, plan for the worst, so hopefully when it’s not the worst, it all feels easier post-op.

There are quotes out there along the lines of,

“Having low expectations is the key to happiness.”

Or, as Peter La Fleur so eloquently stated,

“I found that if you have a goal, you might not reach it. But if you don’t have one, then you are never disappointed. And I’ve gotta tell you, it feels phenomenal.”

The idea being expectations significantly dictate our emotions. By far, the people I’ve seen have a rough time with this surgery had too rosy of expectations. (Again, sometimes the surgeon’s fault for making it seem too easy a process.)

You want to flip that in your preparation. You want to visualize,

“Ok, this is going to suck. I’ll need this. I’ll need that. I won’t be able or want to leave the house for two weeks, I’m going to have this, this and this ready so I can cope with that.”

Then, when you start going through your recovery and hopefully it’s not as bad as you’ve planned, it all feels easier. If you’re an athlete, as many ACL patients are, an analogy might be “make practice hard, so the game is easy.”

As one personal example, I prepped myself to have a ton of pain after surgery. I thought about some of the worst pain I had experienced playing sports, like dislocating my elbow, and was thinking about having to deal with that again.

Then I woke up from surgery, and…the pain never came. I woke up and basically thought everybody I knew who had the surgery was a soft-ass pillow for complaining so much.

-> By wake up I mean in the days after surgery. It’s common in the hours after surgery to think it’s all easy…then the pain really sets in at about 36 hours post-op, when the anesthesia wears off.

What I didn’t do a good job planning for was my surgeon telling me to lock my leg straight for TWO WEEKS! This was never mentioned to me before the surgery, and I just didn’t consider it would happen. It’s not something every surgeon does either. My surgeon flat out told me he’s more conservative than most, so that’s why he does it (again, telling me this after doing the surgery). The other people and surgeons I talked to didn’t do this, more reason it didn’t enter my mind.

That made life terrible. I couldn’t drive for two weeks, as I couldn’t drive with my right leg held completely straight. In fact, I’m tall and had a small car at the time. I couldn’t even sit in the passenger side. I had to sit in the back of the car, sideways, which made my back feel wonderful (not). I couldn’t put socks on. I couldn’t shower.

I was miserable in that context because it was so unexpected.

I really should have spent more time on crutches before the surgery too. I played enough sports with enough injuries beforehand where I knew how to handle myself on them, but what I wasn’t ready for was weeks of them. You know when you get tired how angry and irritable it can make you? After a few days of incessant crutching, my upper body was exhausted to the point of making me perpetually angry with the world. If you’re thinking “I’m in good shape. I’m sure my upper body can handle the crutching,” no. Your upper body, no matter how much you bench press, is not in supporting-your-bodyweight-for-hours-a-day shape. Go try to walk on your hands for ten minutes. Bench press strength, weight-room strength, won’t be too relevant.

-> Of course, you can try to manipulate your post-op life so you’re not having to get up much, but laying on the couch all day requires its own preparation too. Sounds fun…until you’re on day three of it.

Never mind the mental component, laying down all day can start to make other areas hurt too.

One of the big things with prepping for ACL surgery is to not get blindsided.

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