A blog by Riley Owen

Have you had an ACL reconstruction or are currently awaiting surgery? Here are our top 5 tips to help speed up your recovery and achieve an optimal outcome.

Start rehabilitation BEFORE surgery
It is completely understandable that you may want to get your ACL repaired as soon as possible after your injury. However, it is in your best interests to give your knee time to settle and complete some rehab surgery.

Recent research has proven that just 5 weeks of rehabilitation prior to surgery improved knee strength and function and led to higher return to sport rates 2 years after surgery. This involved a range of strength and neuromuscular control exercises once the initial pain and swelling had settled.

Importantly, delaying your ACL surgery has not been shown to increase your risk of developing osteoarthritis later in life.

The most important goals of the pre-operative stage of rehab are:

  • Eliminate swelling
  • Restore range of motion
  • Regain similar levels of strength to the uninjured side

Be prepared for heavy strength training
After you have had your ACL repaired it is time to commence strength training. While bodyweight exercises such as squats will be sufficient in the early stages of rehab, you will need to progress to gym-based strength exercises to properly prepare your knee for sport.

Heavy strength training is completely safe for your knee when prescribed appropriately and will be tailored to your current abilities. Your physiotherapist will provide you with a comprehensive gym program to strengthen your knee in preparation for running, jumping and change of direction.

Use testing before progressing to the next stage of rehab
It is vital to use testing criteria to determine progression through each stage of rehab, NOT the amount of time passed since surgery. Everyone recovers on a slightly different timeline, so it’s important not to compare your progress to others.

A common mistake is people being told to start running after 3 months, regardless of the strength levels of their knee. If your knee is not strong enough to cope with the demands of running, it will lead to excessive swelling and significantly delay your recovery.

Another mistake we see is when people return to sport without passing a range of screening tests designed to reduce the risk of re-rupture. ACL’s have a significant re-injury rate so it is critical to do everything you can to minimise this risk.

Requirements for return to play:

  • 90% symmetry of leg strength
  • Development of muscular power required for acceleration and jumping
  • Symmetry of hopping and landing tests
  • Development of chronic training loads relevant to the returning sport
  • Successful completion of a sport specific training block

This journey may take more than 12 months!
Yes, you’ve probably seen high-profile athletes return as quickly as nine months after their ACL injury. However, it’s important to acknowledge that they are elite athletes who are able to dedicate their entire life around their rehabilitation.

It can take as long as 2 years to complete your rehabilitation and return to sport. While this can be frustrating, it is important to stay the course otherwise you run the risk of re-rupture and having to endure the entire process again.

Unfortunately, not everyone returns to their pre-injury level of sport. Surgery does not guarantee a good outcome, so it’s important to commit to a long-term rehabilitation plan.

Rehab doesn’t end once you return to sport
It is vital to maintain high levels of strength (particularly quadriceps and hamstrings) to reduce your risk of re-injury after you have returned to sport. Therefore, you will be required to continue some of your strength exercises for the remainder of your playing career.

Additionally, you should complete a structured warm up before training and games to adequately prepare your knee for sport. Structured warm up programs such as the FIFA 11+ have been shown to reduce the risk of injuries by up to 58%.

Key components of a structured warm up:

  • Activation and mobility drills
  • Running drills
  • Cutting & change of direction drills
  • Strength, balance & plyometric exercise

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