If you have been following my blogs you will know that last week I started a two part series on ACL tears. In the first post I explained exactly what it is and how to recognize when it has happened to you – so true to form in this post I will be talking about how physical therapists can help.
How Can a Physical Therapist Help?
As you may or may not know surgery is a common requirement when you suffer an ACL tear, although some people can recover without. So it’s probably not a surprise that once an ACL tear has been diagnosed you will work with a surgeon and a physical therapist to determine if you need surgery or if you can recover without.
If you do not need to have surgery your physical therapist will work with you to restore your muscle strength, endurance, and coordination so that with time you are able to resume regular activities. It is important to remember that sometimes your physical therapist will teach you different ways to modify your physical activity so that there is less stress on your knee.
Physical Therapy Treatment Without Surgery
If it is determined that you do not need surgery the great – you’ve been very lucky. There is actually a specific group of patients (called “copers”) who have the potential for success without surgery, so this would me you. The difference with copers is that they have injury only to the ACL and have not experiene episodes of “giving way” since the initial injury.
In order to determine if you fit into this group there are specific functional tests that will help your physical therapist will perform. If it is determined that you fall into this category your physical therapist will design a specific treatment program for you. Chances are that it will most likely including electrical stimulation to the quadriceps muscle, cardiovascular strengthening, traditional muscle strengthening, and balance training – but progams always vary slightly from patient to patient.
Physical Therapy Treatment Before Surgery
In some cases orthopedic surgeons will refer their patients to a physical therapist for a short course of rehabilitation before they perform surgery. If that happens with you then your therapist will help you decrease swelling, increase the range of movement of your knee, and strengthen your thigh muscles (quadriceps). They might also have you perform a “quadriceps lag”, which is when you try to raise your leg straight in the air, but you can’t control the knee, and your leg bends slightly. In addition he/she may also use electrical stimulation to help you straighten your leg.
It is important to take a surgeon’s advice – and seeing a physical therapist – in this case because research shows that improving your condition before surgery will lead to a better outcome after your surgery.
Physical Therapy Treatment After Surgery
Your orthopedic surgeon will provide post surgery instructions to you. However, physical therapists have developed and published guidelines on knee stability and movement problems, which recommend the following actions.
Bearing weight. Immediately after surgery you will need to use crutches to walk. The amount of weight that you are allowed to put on your leg – as well as how long you use the crutches – will depend on the type of reconstructive surgery you’ve had. Don’t worry though, it is your physical therapist’s job to guide you through this part of your rehabilitation.
Icing and compression. Immediately after your surgery your physical therapist will control the amount of swelling by applying cold to the area – such as an ice sleeve that will fit around your knee and compresses it.
Bracing. Almost all surgeons will give you a brace to limit your knee movement (range of motion) after they have completed your surgery – and some will give you a brace for sports, which will be used a little further into your recovery. Your physical therapist’s job in this case is to fit you with the brace and make sure you know how to use it safely.
Exercises to increase your ability to move. What most people are surprised to hear is that they will begin some exercises almost immediately following surgery. Within the first week your physical therapist will help you with range of motion, and show you exercises that you can do at home. These exercises will focus on regaining full movement of your knee, and if you are like most people it will take some time – so be patient. Your physical therapist will do also take you through both non-weight-bearing exercises and weight-bearing exercises, which could possibly be limited to a specific range of motion to protect your newly healing ACL graft. In some cases your therapist might also have to use electrical stimulation to help restore your quadriceps (thigh) muscle strength as well as those last few degrees so you can fully straightening your knee.
Exercises to increase your strength. In the first 4 weeks after surgery your physical therapist will help you put weight back on your knee. For this he/she will also be using a combination of weight-bearing and non-weight-bearing exercises. The exercises will focus on your quadriceps and hamstrings and could possibly be limited to a specific range of motion in order to protect the new ACL. Again there is a chance that electrical stimulation could be required in order to restore your quadriceps strength.
During weeks 5 through 12 you should begin walking without crutches and start regain a normal walking pattern. Your therapist will increase the intensity of your exercises and add balance exercises to your program at this point. After 3-4 months your thigh muscles should ideally have 75% of the strength of the muscles on your uninjured side – yay.
You should be able to return to sport when…
-You do not have any pain or swelling
-You do not feeling unstable during sport-specific activities
-Your quadricep strength is 90% compared to your uninjured side
-Your performance of the 1-legged hop test is at 90% of that on the uninjured side
Remember, each surgeon might have a specific plan for you; these are only broad guidelines describing what you might expect for your recovery.
So – now that you know all about ACL tears you are just that much smarter. I am sure that in this case especially you can see how important it is to visit a physical therapist. The bottom line is that this is a serious injury that – if not treated correctly – could severely hinder your ability to participate in sport and perform day-to-day activities. If you’ve recently suffered an ACL tear and do not currently have a physical therapist we urge you to give us a call. Our well trained and super friendly staff would love to help you get back to 100%.
If you don’t currently have a physical therapist and are looking for one please give us a call – one of our talented and friendly therapists would be more than happy to help. Do not hesitate to give us a call (201-585-7300), or fill out our contact us form online.