The anterior cruciate ligament (ACL) is a ligament that connects your knee's femur and tibia bones. Positioned diagonally between the two bones, the ACL provides support and rotational flexibility to your knee. The American Academy of Orthopaedic Surgeons estimates that 100,000 people a year require ACL reconstruction surgery due to tears and other injuries often acquired during sports activities. After surgery, proper physical therapy is essential to healing. Most people require 4-6 months of physical therapy before they regain full leg functioning.
Phase 1 Recovery
Immediately after ACL surgery your postoperative rehabilitation process will begin. At first you will visit a physical therapist three times a week or more. Over the next six to eight weeks, your visits to the physical therapist may decrease to around once or twice a week. During Phase 1 recovery, your physical therapist will give you a variety of strengthening exercise that aim to reduce your knee's swelling and build up the strength of the surrounding muscles. Even on days that you don't visit your physical therapist, you will have a regimen of exercises to do for 30-60 minutes each day.
Another set of rehab guidelines, published by the Journal of Sports Medicine, breaks the Phase 1 recovery period into more detailed phases (Phase I for preoperative recovery, Phase II for the first two weeks after surgery and Phase III for the four- to six-week postsurgical period). During the first two weeks, ice your knee several times a day and keep the knee elevated to reduce swelling. Phase 1 (or Phase I and II by the Journal of Sports Medicine guidelines) exercises include knee extensions (with your leg extended in front of you, holding your heel on an object for 10 minutes at a time so that your calf is not on the ground), quad sets (knee extensions that require you to flex your quad for 10 seconds at a time) and straight leg raises (a slow raising and lowering of your leg as you keep your quad flexed).
Phase 2 Recovery
After your knee has healed a bit (roughly two months postsurgery), your physical therapist will move you on to more intense strength exercises to restore your knee's full range of motion. During Phase 2 you will begin to use weights and engage in more intensive cardiovascular exercise (such as on a bike or treadmill). In addition, your physical therapist will give you new exercises and stretches designed to restore your sense of balance and stability. The Mayo Clinic notes that since many people have insurance limitations on how many physical therapy sessions their plan allows, you may have to complete your Phase 2 recovery at a gym or sports club rather than in a medical physical therapy facility.
Typical Phase 2 recovery exercises include closed-chain kinetic exercises that require your foot to remain stable on the ground. Squats (either with a free weight or on a squat deck machine) are common closed-chain kinetic exercises. While your Phase 2 therapy may sometimes include open-chain kinetic exercises (like curls) during which your foot leaves the ground, most therapists do not recommend open-chain exercises during the healing process since they may aggravate the ACL. Talk to your doctor or physical therapist about the appropriate amount of weight you should use during strength exercises and how many repetitions you should do during each session.
Phase 3 Recovery
Your final two months of recovery will entail strength, balance and stability exercises that begin to test your new knee's full range of motion and functioning. One Phase 3 agility exercise used often is called the box jump. To perform the box jump, stand next to a small wooden box and jump sideways onto the box. Once you land, jump off the box to the other side. Pay careful attention to ensure that you land with both feet together. As you progress in your rehab process, you will eventually jump over the entire box sideways and land on the other side.
Phase 3 recovery will not begin until your knee's swelling has subsided, your motion is nearly full and your muscle mass is back to normal. Physical therapy during the final months helps to ensure your knee stays strong and helps to prevent further injuries. You may still feel some knee pain even after you have reached Phase 3, but your exercises will help to reduce pain and ease you back into your regular routine.
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