How To Get Through ACL Surgery

Have you heard about the dreaded ACL tear? Maybe a loved one (or yourself) has injured this ligament. Rehab for ACL is no easy feat, but can be successfully completed if done in the right manner. Here at MOMENTUM Physical Therapy, in Okotoks, we LOVE rehabbing ACL injuries. Consider this blog your Coles notes to understanding ACL injury and ACL recovery after surgery.

The Anterior Cruciate Ligament (ACL)

The Anterior Cruciate Ligament (ACL) is the major stabilizing ligament of the knee. The ACL is located deep inside the knee joint. You cannot physically touch the ACL, it is best “felt” by a series of specific tests completed by a physical therapist or seen using a MRI.

OK, but how did I injure my ACL?

The ACL is often torn when the knee is either hyper flexed, hyper extended, or if the knee collapses inward. When an ACL tears, people often hear a snap and then report a feeling of “unstableness” within the knee. In the hours following the ACL tear, the knee will often swell (to the size of a large melon) and the knee will become painful and stiff.

ACL’s are torn either by contact (think knee on knee collisions) or non contact (think trying to pivot or turn too quickly).

ACL injuries can occur in varying levels of severity ranging from minor tears (grade 1 tears) to complete tears (grade 3 tears). Rehabilitation for ACL injuries vary depending on the severity of the injury.

So, I think I’ve injured my ACL… now what?

The first thing to do if you think you have hurt your ACL is to get your knee evaluated by a physical therapist, such as our crew here at MOMENTUM Physical Therapy in Okotoks.

At your first session, your physical therapist will evaluate the ACL to determine the severity of injury. If the ACL has a minor injury (partial tear), physiotherapy will commence that day to heal your knee. If your ACL appears to be completely torn, your physical therapist will begin treatment that day but will likely refer you to a knee specialist to determine your eligibility (and need) for knee surgery.  

Do all ACL Knee Injuries Require Knee Surgery?

No! Not all ACL injuries end up in surgery. Only ACL’s that are completely torn may require surgery. This is why proper diagnosis is so critical in the early days following a knee injury.

So, after surgery will my knee be as good as new?

Well, kinda.

When you have an ACL surgery, the surgeon re-creates your ACL by using another tendon from the body. This tendon takes time to strengthen and become as strong as your original ACL. This “maturation” process takes 12 months to occur and coincides with a structured physio process. Without proper rehab, the knee will not return to full function and you could be left with a knee that feels unstable, weak, painful, or stiff. This is why getting high quality physiotherapy is so critical after ACL surgery.

This was the case with a client of ours named Danica.

Meet Danica.

Danica is a 19 year old athlete from Okotoks who is an avid soccer player. She plays defence on a competitive soccer team and exemplifies the characteristics of a lifelong soccer fanatic.

18 months ago, Danica was involved in a knee on knee collision in soccer that tore her ACL. After a trip to her local MOMENTUM physical therapist in Okotoks, she was diagnosed with an ACL tear and sent to see a knee specialist who set up surgery.

After undergoing successful ACL surgery, Danica came to us at MOMENTUM Physical Therapy to complete her rehab. By dedicating herself to rehabbing her knee, Danica has fully rehabbed her knee and has returned to the soccer pitch. She is ready to resume her career at college next year. Without proper rehab and training, Dancia would not have been able to return to competitive sports.

But guess what. It's just not soccer players who tear their ACL’s. Football players, BMX’ers, martial artists, badminton players, baseball players, and many, many others tear their ACL.

Let's walk through the rehab process following ACL surgery that Danica underwent that allowed her to return to soccer,

Month One - post Acl surgery:

The first month following surgery is, in our opinion, the most important. Failure to excel through the first month will prolong all the following phases of your recovery.

Initially, you will be on crutches. You will have stitches or bandages over the incisions on the front of the knee. The knee will feel hot, stiff, and likely sore.

Your goal for the first 4 weeks here will be to get the knee moving, get the swelling down, activate the thigh muscles, and get off the crutches. We strive to have full knee extension (or the ability to straighten your knee) by the end of week 2.

Treatment throughout this month will involve:

Hands on physio to loosen your leg muscles and get your knee cap moving 
Exercises focusing on activating your leg muscles and getting your knee bending and straightening 
Stretching exercises to regain your knee movement (especially if extension has stiffened up) 
Icing and taping to help reduce your knee swelling and pain

In this phase, expect to have the physical therapist working on your muscles and leg A LOT. They are working to jumpstart the knee and get it moving!

You can expect to be in physio twice a week for this first month. Anything less may prolong your healing process.

Months two & three - post acl surgery

The second and third month of your ACL rehab largely focuses on rebuilding strength and balance.

In order to enter this block of physiotherapy, you will need:

To be off crutches 
Have full knee motion (especially with extension!) 
Be largely be pain and swelling free 
Have good activity of leg muscles

In this phase, you will still be getting lots of hands-on therapy. Your therapist will be continuing to loosen muscles in the leg (as they tighten up periodically) and breaking down any scar tissue that might have formed over the past month. It is common to have some scarring over the incision sites of the surgery, but it is important to receive hands on treatment to break this scar down.

Exercises in this phase will focus on building strength in the legs (hamstrings and quadriceps) as well as through the hips (glutes) and core! You can expect to be doing exercises like squats, lunges, split squats, and deadlifts.

Balance also comes into play in this phase. Getting that knee confident on single leg exercises, bosu balls, and balance boards is so important.

You can expect to be in physio 1 to 2 times per week in this phase (depending on how your knee is feeling and how well your home exercises are going).

Months three through six - post acl surgery

The next block of treatment - between months 3 and 6 - is where the fun really starts to happen!

By now, your knee should be fully moving, really have minimal (to zero) swelling, be pain free, and starting to feel strong (because you just finished like 10000 squats over the last 3 months).*

*Not literally 10000 squats, just a lot.

If your knee is doing well, we start to reintroduce some low impact activities such as running and hiking (~3-4 months) and golf (~5-6 months).

In this block, we push the strength further. Squats and deadlifts get weighted. Movements become more complex (lunging with weights and pulling sleds). We are into a “super strengthen” phase. We also begin focusing on plyometrics and rapid movements for our athletes.

What are plyometrics?

Plyometrics are jumping and moving quickly!

We work on jumping mechanics. Two foot jumps, 1 foot jumps. We are going airborne!

In the same breath, the agility ladder comes out. We want to make sure that you can move your feet quickly while keeping your knee in a good position.

What is good knee positioning?

Well, at this point, we work to get the body used to handling weight while you are moving around quickly. Mastering this is imperative so you don’t get reinjured, as many ACL tears occur when people simply cannot control their knee while moving fast.

In this phase, you can expect to be at physio 1x per week or 1x every two weeks depending on your goals and activity level.

Months six - twelve - Post acl surgery

This last phase of rehab lasts the longest and is truly unique and specific to each athlete.

We know that it takes 12 calendar months for an ACL to fully heal after surgery. During this last 6 month block, you will be instructed to gradually return to your sport (with a plan, of course!) until you are 100% ready to fully return.

Athletes and individuals who have lower impact activity needs (such as joggers, golfers, hikers, and riders) typically exit physio around the 8 month mark. By this time, their knee is moving extremely well and they have all the strength and control that they need to meet the demands of their lifestyles (although we do recommend that they continue to strengthen their knee independently until the 12 month mark).

Other athletes who have higher impact activity needs (such as soccer players, football players, downhill skiers, and baseball players) will need to wait out the entire 12 month process before they return to competition.

Determining when you return to full sport will be a conversation that you have with your physio based on your needs and sport. Some athletes return to sports with braces (for extra protection and to prevent a re-injury) while others do not.

This phase of rehab is uber unique to each athlete but will focus on progressive strength development, increased movement confidence, and a return to pre accident level of activity.

Once you pass the 12 month mark (from surgery), your ACL is fully healed and you are back to 100%.

WHOA - that was a lot of information.

And yes - we get that comment a lot when unpacking an ACL recovery pathway.

Saying that, the process to recovering from an ACL surgery is a journey that has a successful outcome. You simply need to know that in order to recover from you ACL surgery, you need a physiotherapist who is giving you:

Hands on therapy 
Progressive exercises 
And a physiotherapy plan that is frequent and intense enough to allow you to meet your goals

So, what’s next?

If you’re looking to get back to feeling your best, consider trying physiotherapy!

If you are dealing with an ACL or knee injury - whether it requires surgery or not - give us a call at MOMENTUM Physical Therapy in Okotoks. We would be happy to get your rehab going and get you back to whatever activity you are missing out on. Give us a call at 403-982-5600.

At MOMENTUM Physical Therapy, in Okotoks, we treat all kinds of pain. Our talented team of physical therapists and massage therapists have helped thousands of people with a wide range of pain and injuries. Reach out to us today at 403-982-5600 or online to book your appointment today!

So, here's your call to action: connect with a MOMENTUM physiotherapist today to get those hips feeling better! You'll be on the path to recovery in no time. Book online here!

Our award-winning team here at MOMENTUM Physical Therapy- in Okotoks, is ready to help! Give us a call today at 403-982-5600 to get booked in with one of our awesome physiotherapists, massage therapists, or trainers. Or feel free to book online HERE!

We’re here for you!

Frequently Asked Questions

How painful is physiotherapy after an ACL surgery?

You can expect to have some soreness in the knee after your ACL surgery. You will be sore from the swelling caused by the ACL surgery as well as at the site where the new ACL graft was harvested from. Saying that, physiotherapy is effective at reducing muscle tightness, reducing knee swelling, and improving knee movement which will all reduce the soreness you feel.

How long is ACL surgery recovery?

Regardless of the type of ACL graft that you have or your own level of fitness, complete ACL recovery takes 12 months. Some athletes can return to sports of lower impact before 12 months (such as bike riding, running, and golf), but contact sports and high impact sports usually require 12 months of rehabilitation.

Will my knee be the same after ACL surgery?

After you have your ACL surgery, your degree of recovery will be dependent on how diligent you are with your physiotherapy program. Individuals who seek treatment and progressively build knee strength, balance, and endurance can expect to have the best outcomes. Most people return to near 100% normal function.

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Momentum Physical Therapy, located in Okotoks, Alberta, is ‘Here for YOU’.

If you are experiencing neck pain, have recurring headaches, or you just want to learn more about how massage therapy and physiotherapy can help heal your pain, don’t delay and call MOMENTUM Physical Therapy today. You can reach registered physiotherapists and massage therapists at MOMENTUM, located in Okotoks, by calling 403-982-5600. We look forward to helping you feel you best again.

Physiotherapy for ACL Surgery