I just got out of ACL surgery. Now what?

Those first couple of days after ACL surgery can be terrifying if you are not prepared for what to expect. You most likely will be in much more pain than you were expecting, cannot contract your quadriceps muscle, and probably are having trouble pooping due to the pain meds. Don't worry, all of these things are normal and expected.

Depending on which ACL graft you received, whether or not the meniscus was also involved, and how well you did prehab before surgery (yes, that is also important), your experience the first few weeks can certainly vary person to person. For example, if it was only an ACL surgery, you are most likely allowed to put some weight onto your leg as you walk with crutches. If your meniscus was also repaired in the surgery, you are most likely going to be non weight bearing for a period of time (depending on surgeon preferences). With that being said, what you need to focus on those first few weeks largely remains the same. Here is what you need to know:

1. Get into Physical Therapy ASAP.

   
   

   Hopefully you have already been going to prehab with a physical therapist prior to surgery and have established a relationship with a good physical therapist. If not, make sure you get started with a physical therapist within those first 3 days ideally. If your therapist is not experienced in dealing with the nuances of ACL rehab, find yourself a new PT. Having someone skilled and experienced that can help you navigate the tricky ups and downs is a non-negotiable for this journey. Poor rehab is a leading contributor to why ACLers are being sent back to sport unprepared with re-tears occurring at ~30%.

   
   

2. Restore knee extension like your life depends on it

   
   

   You should be spending several hours every day (starting immediately after surgery) with your leg fully straight. This means that you need to have a pillow or something underneath your ankle to get the back of your knee floating in the air where gravity is pulling your knee straight. Resist the temptation to put a pillow or support under your knee (yes, I know that it feels good). Most people have at least a few degrees of hyperextension. The key here is to compare sided to side and make sure your surgery side is just as straight as your non-affected side (including that hyperextension - 0 degrees is not good enough!).

   
   

3. Reduce the pain/swelling

   
   

   Swelling is not your friend in ACL rehab. Swelling leads to increased pain, quadriceps inhibition, and decreased range of motion. Finding ways to decrease swelling plays a pivotal role in optimizing your rehab early on and keeping you on track. Your plan should include lots of elevation, icing multiple times a day, using your crutches appropriately, calculating your steps and decreasing if needed, and maybe even wearing a compression sleeve.

   
   

4. Get that quad firing

   
   

   It is normal and expected that your quadriceps will feel very difficult to contract after surgery. It is very important that you get started with quadriceps exercises early and often immediately after surgery. Make sure you have a Physical Therapist who is experienced in dealing with ACL rehab to help you progress your quadriceps strengthening. Knee extensions need to be a staple in your plan early and often. Other methods that your therapist may use early on include NMES and BFR training.

ACL rehab is long and difficult. Having a support system of friends, family, teammates who have also gone through ACL rehab is very important. Don't let poor rehab make this process any harder than it already is. If you are struggling with one or more of these, you are not alone and get the support that you need to get on the right track. Take the guesswork out and team up with an ACL specialist who will give you expert guidance every step of the way.