ACL injuries are common among athletes and often require surgical repair. As a physical therapist and CSCS, it is essential to guide patients through the pre-operative and post-operative phases to ensure a successful recovery. In this article, we will discuss what to do before ACLR, what to expect in the phases after surgery, the red flags to look for after surgery, the Dos and Don’ts of exercise, what neuro tags are, and how they may be limiting confidence during the maturation phase.
Before ACLR, it is crucial to prepare the patient both physically and mentally. This includes preoperative rehabilitation to improve knee range of motion, muscle strength, and proprioception. The stronger the muscles around the knee joint are, the better the outcomes post-surgery. It is also essential to address any psychological concerns the patient may have, such as anxiety or fear of re-injury.
After surgery, the recovery process is divided into three phases: the acute phase, the maturation phase, and the return-to-sport phase. In the acute phase, the goal is to reduce pain and swelling, restore knee range of motion, and regain muscle activation. The maturation phase involves restoring muscle strength, power, and endurance, improving neuromuscular control, and returning to functional activities. In the return-to-sport phase, the focus is on preparing the patient for sport-specific activities, such as running, jumping, and cutting.
There are several red flags to look for after ACLR, including increased pain and swelling, limited range of motion, persistent instability, and decreased muscle strength. If these symptoms occur, it is important to address them promptly to prevent any setbacks in the recovery process.
When it comes to exercise, there are several Dos and Don’ts to keep in mind. It is important to avoid high-impact activities and exercises that place excessive stress on the knee joint, such as running, jumping, and pivoting, in the early stages of recovery. Instead, focus on low-impact exercises, such as cycling and swimming, to maintain cardiovascular fitness. As the recovery progresses, exercise intensity and volume can be gradually increased. It is also essential to incorporate neuromuscular control exercises, such as balance and agility training, to improve joint stability and prevent re-injury.
Neuro tags are subconscious markers that the brain associates with pain or fear of movement. These tags can limit confidence during the maturation phase of recovery, leading to a fear of re-injury and avoidance of certain activities. Physical therapists can address these neuro tags through graded exposure therapy, gradually exposing the patient to activities they may have been avoiding to build confidence and reduce fear.
In conclusion, ACLR requires a comprehensive approach to rehabilitation to ensure a successful recovery. Preoperative rehabilitation, postoperative phases, red flags to look for, Dos and Don’ts of exercise, and addressing neuro tags are all essential components of the rehabilitation process.
Sources:
Ardern, C. L., Webster, K. E., Taylor, N. F., & Feller, J. A. (2011). Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. British Journal of Sports Medicine, 45(7), 596-606.
Filbay, S. R., Grindem, H., & Ackerman, I. N. (2018). Risks, costs, and benefits of exercise and sport participation following ACL reconstruction. Current Reviews in Musculoskeletal Medicine, 11(4), 1-12.
Logerstedt, D. S., Scalzitti, D. A., & Snyder-Mackler, L. (2012). Rehabilitation after ACL injury: theory and practice. Rehabilitation after ACL Injury: Theory and