If you're reading this, you may be one of the estimated 100,000 people getting an ACL reconstruction each year. The recovery from the surgery can be lengthy - current research suggests that a patient should not return to previous sporting activities until at least 9 months post-surgery. This research is based off of a significant reduction in re-tear rates after the 9-month mark. However, this is likely an oversimplified view of the problem. By delaying return to activity, you'll have more time for strength and power training, which will decrease your injury risk in the long run.
After an ACL surgery, patients typically begin walking with their knee immobilized in a fully extended position with 2 crutches. One of the first questions you'll likely ask your PT is, “When can I get off crutches after surgery?” or “When can I take my brace off?”. But here's the thing - it's not just a matter of time passing by.
The reason the knee is immobilized in a fully extended position is due to the decreased quad activation post-surgery. During walking, the quad is responsible for maintaining the knee position when someone has all of their weight on one leg. If the quad is not functioning well then a person could experience buckling of the knee causing a fall and potentially additional injury to the knee. With this in mind, a person should not be able to get out of their brace unless they display adequate quad strength. There are many ways quad strength can be tested at this stage of the process. My personal preference is by performing repetitive straight leg raises until fatigue. To perform this effectively, a you need to be able to actively lock your knee and fight gravity similar to walking. Once you can can perform 20 repetitions with good form pain-free, you can typically can stop wearing your brace.
After getting out of a brace, the next phase of rehab is to increase your overall function. Once you're walking well and doing basic daily functions with ease, the next question typically asked is, “When can I return to running?”. Again, it is common that people are given a very arbitrary time point of 3 months prior to running. The full criteria to return to run is beyond the scope of this blog and will be covered in a future blog in detail. However, similar to walking, running requires your body to produce and absorb forces. During running, these forces are greater than the body weight of the athlete. To do this successfully, and decrease risk of immediate or future injury, you should have a certain level of physical characteristics that allow you to run successfully. Not testing physical characteristics prior to allowing a return to running can cause compensatory patterns that lead to increased risk of joint related injuries as well as second ACL injuries. Physical testing is a more accurate way to determine if you're ready to return to running than just following arbitrary time points.
While physical testing alone does not completely reduce the risk of second injury, it definitely is more predictive than arbitrary time points. If you are currently rehabbing from an ACL injury, and are trying to achieve one of these goals without concrete objective criteria, you are likely missing something in your rehab. With any goal in life, you have to measure some objective criteria to determine success. Do not let your ACL rehab be any different!
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