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
- How do you deal with the emotional toll of things?
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
- Setting the stage
- A primer
- Pain remediation
- Waking up
- Drugs
- “What should I take?”
- “Get ahead of the pain!”
- Compression
- ACE bandage technique
- Icing
- Walking
- Range of motion
- Immobilization
- Flexion versus extesion
- Extension (more specific)
- Quad inhibition
- Flexion (more specific)
- The Patella
- Extension (more specific)
- Other
- Sleeping
- Proprioception
- Strength
- Conditioning
- Nutrition
- Rehab program
- Day 1
- Days 2-10
- Days 11-14
- Week 3
- Week 4
- Appendix
- Some other questions
- “Can I do upper body exercises?”
- “The mental part of this is really tough. Do you have any other recommendations on how to deal with it?”
- “Where do I go from here?”
- “Should I be working my other leg?”
- Ibuprofen after activity
- NSAIDs and injury
- Icing and injury
- Some other questions
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: 
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Kylie
February 27, 2016
Hey! So I just got my ACL reconstruction surgery on February 16, which makes it 11 days since. I started rehab since two days after the surgery. My PT says that my extension is great, I can fully straighten my leg with no problem. I’ve been so worried and obsessed with trying to bend my knee. this past Thursday, I was able to to bend it 65 degrees which was such a huge accomplishment for me. However these past days, I’ve been having difficulty bending it because it’s very sore than usual. Do you think I shouldn’t push myself to keep bending my knee if the pain is worse than usual? I’ve always been having the worst time trying to lift my leg up. My PT says that it’s important to lift my leg up with my leg straight. However, through the process, my knee is experiencing the most excruciating pain ever and my quads aren’t as strong enough to lift it up. Is it normal to feel pain when lifting my leg up? Should I focus more on strengthening my quads before lifting my leg? Is it bad I can’t lift my leg up 11 days after surgery?
My name is Kylie, and I am 16 years old and I tore my ACL in a soccer game. It’s been 11 days since the surgery and I have been able to bend my knee 65 degrees and fully extend my leg with no problem. Recently, I have been experiencing pain in my knee when bending it, however it’s much more excruciating than usual. Plus, I’ve been having difficulty bending it to the height I normally can when doing heel slides. Other concerns I have is my inability to lift my leg. My quad isn’t quite strong yet but my knee is unbearably painful. I just wanted to know: Should I stop pushing myself if the pain is worse than usual when bending? Is it normal for my knee to not bend as much as I usually do? Is it bad if if I can’t lift my leg up 11 days after my surgery. Plus, is it normal to feel pain when attempting to lift my leg up? It would mean a lot to me if you replied back. Thank you so much.
reddyb
March 1, 2016
Hey Kylie,
I combined your two comments into one.
At only a couple weeks out, flexion and straight leg raises can take some time. The most important thing is full extension right now, and a gentle return to walking.
You don’t want to be forcing the leg. Keep in mind during something like range of motion, the leg needs to relax in order to get that. If you’re in pain, you’re going to be tense and fighting that range of motion. Forcing it, while common in therapy, is not helpful. Long, gentle, slow, stretches are the better way to go. Where it might take you minutes to relax into a given range of motion. Flexion will come with time. After a couple weeks you’re hoping for *passive* range of motion of 90 degrees, gently working passively past that over time. It doesn’t need to be regained immediately though, and often can’t be, due to fluid in the knee that needs time to work it’s way out.
If straight leg raises are painful, one can do the quad activation without fully lifting the leg yet. (In other words, do what you can of it, while avoiding pain.) This exercise gets obsessed over right after surgery, but it’s really not that big of a deal. At a couple weeks, things like leg pressing and squatting can be implemented for quadriceps strengthening. The straight leg raise works really works more the hell out of the hip flexors anyways.
-> A friendlier way to do this is have the leg hung over a table, with the knee on the edge, foot dangling. Passively straighten your leg with your other leg, then try to hold the leg straight there. This opposed to trying to lift the leg off a table. Sorry I don’t have a video of this right now. I might be able to put this up on the site this week.
One thing which may be happening to you is when forcing the leg through painful movements, the leg will often swell…which will make movements, particularly flexion ones, even harder. Then you force it even more, it swells even more, and the cycle continues. This is one reason to not go into pain. Some discomfort is ok, but it should not get worse as you do something. This is discussed a lot in the comments of this post: http://b-reddy.org/2013/10/23/the-biggest-mistakes-acl-patients-make/
reddyb
March 7, 2016
http://b-reddy.org/2016/03/07/making-straight-leg-raises-more-knee-friendly-after-surgery/
maria f
April 28, 2016
Hey, so Iʻm not sure if you’ll reply to this since its been so long ago, but yesterday I was exactly 4 weeks out of surgery. I got my ACL reconstructed and i got my medial and lateral meniscus repaired. My doctor told me that i can start weight bearing and walk at home without crutches. But the thing is, I don’t know how to walk without crutches, my leg just doesn’t seem to want to move. So I thought that my physical therapist but he told me that he thinks its too early for me to start weight bearing and to start walking. But when my doctor told me i could start weight bearing so i obliviously took as an ok, i mean i haven’t done full weight because my leg is too weak but I’ve been trying to walk and I’m having the hardest time. So what should i do? I mean i either hear follow your doctors order or phyiscal therapist. Not sure what to do. What are some things i can do to start walking?
reddyb
May 1, 2016
Starting weight bearing and immediately walking without crutches aren’t the same thing. You can start walking *with* crutches. Where your legs do the motion, but you’re still using the crutches as needed. You can use one crutch so you have some insurance in case things are too much. Going from full crutches to none is going to be hard if you’ve been using crutches for all four weeks, which is a long time.
At a month post-op you definitely should be getting into walking by now, unless there is something unique about your surgery. I would be very interested to hear why your physical therapist would oppose something like I just outlined above.
This is discussed pretty thoroughly in the manual too, with an example of a progression.
Worst case have your surgeon and physical therapist talk to one another, or see what your physical therapist’s rationale is. Still fully using crutches at more than a month post-op is a very long time. Too long.
Andrew
January 24, 2017
My big question is what happens in 30 or 40 years down the road, when you are getting old and naturally decaying. How does your knee respond to that with the surgury vs without the surgury? What I was told was that your gonna get arthritis no matter what, but a repaired acl will help reduce abuse to the joint and thus may prevent arthritis from occurring for a little while longer. Any thoughts on this?
reddyb
January 27, 2017
Hey Andrew,
Good thing to be thinking about. Discuss it here: https://b-reddy.org/2011/11/29/reconstructive-acl-surgery-is-it-beneficial/
And a bit here: https://b-reddy.org/2011/12/05/reconstructive-acl-surgery-is-it-worth-it/
Amrit
March 19, 2017
Hi, I am Amrit from India and I have my ACL surgery on 27th Jan 2017 and after 1 month and 20 days my flexion is only 95 degree while extension told by my physiotherapist is good but I always feel stiffness . After seeting 10-15 minute on chair I feel stiffness when I try to extend my knee . Please guide me that I am working fine or need more exercise .
reddyb
March 21, 2017
95 degrees flexion at nearly two months post-op is very limited. Would take a look at this: https://b-reddy.org/2017/03/08/cant-bend-your-knee-heres-what-to-do/
Extension stiffness after sitting for a while is common. You want to change how you sit in that case- https://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
Adriana Villalobos
March 19, 2017
Hi im Adriana, i had acl reconstructive surgery and a bad bucket meniscus tear repair 4 dsys ago. My hamstring tendon was used for the acl graft. My doctor/surgeon said i need to have bed rest for 2 weeks before i start physical therapy for 6 weeks. And im not allowed to put any kind of pressure on my leg all 6 weeks of PT so the meniscus can heal properly. I feel bad that i cant do much. But these days while im laying down all i can do is flex and extend my foot snd move it medially and laterally. I dont a towel with this exercise though. What ate yoir thought?
reddyb
March 21, 2017
Reduction of load is common as some surgeons want to really insure the meniscus repair stays in place. You want to defer to their judgment here, as they’re the one who did the repair.
However, bed rest is extreme. I’d double check that’s really necessary, that you shouldn’t be working on any range of motion or activation work. It’s not an uncommon recommendation after surgery as some surgeons want to let the leg calm down as much as possible, but doing nothing for a couple weeks isn’t usually ideal.
Lora Church
December 10, 2019
Hi there! I am 42 years old and having acl reconstructive surgery using a cadaver on dec 27th. I’m scared!!! Anyone else in the same situation? I can barely walk now.