Physiotherapy And ACL Reconstruction Rehabilitation
Physiotherapy is a crucial part of successful ACL surgery rehabilitation with much of the success depending on the patients dedication to their therapy and their progressive home exercise programme.
Every orthopaedic surgeon typically has their own specific protocol for how they wish their patients post surgical rehabilitation to be carried out, physiotherapy frequently begins within the first 10 days and follows the patient through till pre injury activity levels have been achieved around 9-12 months later.
Physiotherapy For ACL Surgery Rehabilitation In The Early Stages
Initial post surgical treatment in the first couple of weeks is focused around reducing swelling, gait re-education, appropriate muscle activation and improving range of movement (ROM).
As the rehabilitation stages progress the focus moves from being swelling and ROM focused towards being more concerned about regaining balance, postural control, strength, endurance and correct neuromuscular control. All of this must be restored prior to any return to sport.
Remembering it’s estimated 70 percent of ACL injuries occur through non-contact mechanisms, whilst only 30 percent result from direct contact with another player or object. Hence just because you may not be returning to a contact sport this does not necessarily mean you can return to sport any sooner as the mechanism of injury is often associated with deceleration coupled with cutting, pivoting or sidestepping maneuvers, awkward landings more so than any actual contact with someone or something else. If you do not have the strength, balance, postural control, neuromuscular control or endurance to maintain ideal biomechanics and motion throughout your exercise period you are putting yourself at a higher risk of re-rupture.
Accelerated Rehabilitation Programs
New surgical techniques and stronger graft fixation may have enabled an accelerated rehabilitation program to exist and a quicker return to pre injury activity levels but again if you haven’t done the hard work you are putting your self at a higher risk of re-rupture.
Simply waiting for your 9-12 months post surgical time frame to be up so you can return to sport is not sufficient, time alone will not properly rehabilitate your knee and give you your best chance of avoiding re-rupture.
Research Proven Rehabilitation Programs
A lot of work and research has gone into structuring rehabilitation programs over the years in an attempt to improve the process and reduce re-injury rates. Two such programs have been shown to significantly reduce re-injury rate when returning to side stepping sports these programs are the http://smsmf.org/smsf-programs/pep-program and the http://f-marc.com/11plus/exercises/
It is recommended the FIFA 11+ program should be performed from the 6 month mark, however only when given the OK to do so from your surgeon. At which stage it is carried out for a period of a three months coinciding with that ideal goal of return to sport 9 months post surgery.
Interestingly only 31% of ACL surgery reconstruction patients actually return to pre-injury level of sport at the 12 month mark. Psychological factors are predictors of return to sport, the patients view of their ability to return to playing is a strong predictor of them returning to pre injury level within the typical rehabilitation time frames. I would argue that adhering to either of these above programs would set you both physically and psychologically in good stead to return to pre-injury level at the 12 month mark, certainly more so than those patients not committing to either of these or similar comprehensive rehabilitation programs.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance on ACL Surgery should consult his or her orthopaedic surgeon, general practitioner or physiotherapist.